Only 6 people managed to enroll in an insurance plan on Day 1 of Healthcare.gov

So much of the public debate regarding these issues is terribly confusing and misleading simply due to the wanton disregard for the difference between "health insurance" and "health care". I realize that some of the erroneous usage is just sloppiness, but these two things really aren't interchangeable from a public policy standpoint.

Prime example: the "Affordable Care Act" isn't about health care, it is about health insurance.

Ross Douthat has a pretty good summary of at least the egghead Republican health care policy preference and its pros and cons. The whole thing is worth reading.

http://douthat.blogs.nytimes.com/2013/10/22/why-not-medicaid...

Short version: Subsidized catastrophic care for real "insurance", and tax-advantaged HSA's for your more predictable medical costs. The former probably still requires something like the existing individual mandate, so it's unfortunate that Republicans seized on that as one of their primary objections to PPACA (an objection that Candidate Obama shared in 2008!)

More practically, a Republican alternative would certainly not have made these catastrophic plans currently being cancelled illegal.

This stuff is not fiddling around the margins: PPACA will only work if it substantially shifts costs from the old and sick (who need comprehensive plans) to the young and healthy (who would typically be fine with catastrophic ones). I don't know why you would expect the GOP to be happy about a wealth transfer like that, particularly when they couldn't expect to extract any leverage from their participation with a Democratic super-majority able to pass whatever it could agree on. All for a bill whose popular support never seriously cracked 50%? I wish Democrats had engaged with President Bush in '05 when he came out of the reelect gate for Social Security reform, rather then declare the whole thing DOA. But I certainly am not shocked they behaved like an opposition.

If that article really is a pretty good summary of Republican thinking in this sphere, then I'd say it completely backs up what I've been saying. There's not much substance in that article. It very briefly mentions the subsidized catastrophic insurance you mention, but it doesn't go into much detail at all. Worse, it completely handwaves away the major problem with that model, namely, what happens to people with chronic conditions, by basically saying "oh well, too bad, so sad."

In any case, I don't see how that approach is ultimately very different. Sure, it means people cover a bit more stuff out of pocket, and places a higher burden on sick poor people, but overall it's pretty much the same.

The ultimate question that has to be answered is this: do we, as a society, find it acceptable to allow people to die of treatable illnesses when they can't afford to pay for the treatment? This question has been solidly answered as "no" in the US for some decades now, ever since hospitals were barred from turning away patients in the emergency room. The question now is simply how you accomplish it.

So, back to these subsidized catastrophic plans. You'll have to have a mandate on them! Without a mandate, people who aren't sick won't buy them unless you hold some other threat over their head, such as denying them the ability to obtain insurance if they're already sick.

Unless we're going to let people die, the wealth transfer you describe has to happen in some way. Pre-Obamacare, it works using a de-facto hidden employment tax whereby better-off people pay, in a really convoluted fashion, for the unpaid bills of poor people. With Obamacare, it works by forcing people to get insurance even if they don't want it. The Republican idea discussed in your link is some combination of the two, and exactly what the combination is depends on the exact details.

Obamacare is just about the most free-market solution for universal health coverage you can come up with. It's more free-market than the pre-Obamacare regime, it was proposed by Republicans, and it was passed by Republicans in Massachusetts just a few years prior to becoming law at the national level. And lest we think that those Massachusetts Republicans were some fringe group, they nominated the governor for President! Why should I expect Republicans to object to it for any reason other than being the political party of Crazy?

Shock and awe, anyone?

On the one hand it's around 5% of the population, and unless you need subsidies, you can get policies directly from the insurers, and there are private comparison shopping sites.

On the other hand, most will have to pay more money, often a LOT more, often for worse coverage in ways they most care about, and this small fraction of the population includes some of the most influential. Maybe ... the rules of that seem to be changing, this could in fact be a good test of the recent Angelo Codevilla et. al. modern US ruling and country classes thesis.

YES! Romney called himself "severely conservative" at CPAC ... a phrase you'll only find non-conservatives using in that context (e.g. https://www.google.com/search?q=%22severely+conservative%22&... )

You're confounding the current eGOP, as in Establishment GOP, which controls the nominating process, with many of its "completely nuts" elected officials and its base, who've many times in the last few decades declined to (re)elect RINOs, i.e. G. H. W. Bush in 1992, Bob "Tax Collector for the Welfare State" Dole in 1996, McCain, who had a hereditary vicious tempter which he turned on the base after not getting the 2000 nomination.

And Romney, the sort of NE liberal/progressive Republican (granted, an old wing of the party, see e.g. Rockefeller vs. Goldwater in 1964, or Teddy Roosevelt after the previous turn of the century) who could win in overwhelmingly liberal and Democratic Massachusetts. It was the only state in the entire freaking nation to vote for McGovern in 1972 (along with D.C.) after all, "acid, amnesty and abortion", baby!

(Amnesty for Vietnam era draft dodgers, delivered by Carter.)