In Praise of National Review and Yuval Levin’s Serious and Insightful Article on GOP Health Care Policy and Strategy

A Rare Event – A Serious Discussion Without Vitriol

Conservatism like other legitimate ideologies has a role to play in American political discourse.  Too often it abdicates this role and replaces it with pure ideological dribble, but recently Yuval Levin writing in the National Review has published a very well written, very comprehensive and thought provoking article on the state of the Republican plan to repeal and replace ACA.  It should be read by everyone with interest in health care, that is, every person in the nation.

One lesser benefit of the piece is that it exposes Trump’s statements on ‘his plan’ as the pure fiction that they are. Trump in mid January indicated that he had a plan ready to go and all that was needed was a few finishing touches and confirmation of Tom Price as HHS Secretary.  Levin confirms what everyone concluded about this statement.

”After Trump’s Washington Post interview this past Sunday, the conservative health-care universe, including some people on Trump’s own team, quickly concluded that the separate administration plan he described was entirely a figment of Trump’s imagination.”

The Levin article has a tremendous amount of information and discussion of legislative strategy, far too much to be even summarized here.  But there is one thought that bears attention.  In describing alternatives Levin says this

“Some of these would allow the states to auto-enroll uninsured people in plans with premiums equal to the federal tax credit for which they are eligible; these could amount to a kind of “universal catastrophic coverage” policy, nearly zeroing out the uninsured and then enabling a competitive market for more comprehensive coverage above that. (This is the form that would seem best aligned with Donald Trump’s rhetoric about the uninsured.) “

Ok, aside from the fact that such a plan is totally unworkable notice the deviation from conservative thinking.  Under this provision states would select an insurance plan for an individual, enroll them in the plan and the feds would then pay the premium, no individual action involved.  If such a proposal came from Democrats the outrage would be deafening. 

One of the great benefits of Levin’s writing is that it clarifies what the Republicans are thinking of in terms of universal coverage and health insurance for all.  Their thinking is in terms of catastrophic coverage, where individuals would pay out of pocket all the lower costs and insurance would be for any major catastrophic costs like cancer treatment, major surgery etc.  This debate on what insurance should be is something the nation should have, but Mr. Levin and the conservatives should not be surprised if the nation rejects their vision of health insurance where individuals have insurance but still pay thousands, maybe more than ten thousand dollars a year out of their own pocket.

So kudos to National Review and Mr. Levin, hopefully everyone will read it but more likely no one, particularly the current President, is likely to do so.