Earlier quoted context omitted.
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…
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 chro…
Describing comprehensive health care coverage and catastrophic insurance as "pretty much the same" is factually inaccurate and misses the point of Douthat's piece.
Consumers right now have essentially no motivation to choose a $30,000 maternity bed over a $50,000 one. Third party payment disrupts price signals and encourages overspending. Sure, there are a variety of ways to try to contain costs through centralized oversight or "per capita" reimbursement schemes, but the GOP, at least, believes that nothing works like a competitive market. Laser eye surgery is perhaps the canonical example: It's not covered by most insurance, so providers have had to compete on cost, and the result has been a rapid increase in availability and affordability. That's a free market, and it's nothing like how the vast majority of health care will be paid for post-ACA.
No, you're not going to pick which emergency room is cheaper when you're having a heart attack. Catastrophes are different, that's why you insure against them. But someone who's getting frequent treatment for a chronic disease should absolutely be allowed to consider visiting a less expensive clinic over a research hospital and pocket some of the resulting savings.
Why should I expect Republicans to object to it for any reason other than being the political party of Crazy?
That you think a plan passed by a ridiculously Democratic legislature in Massachusetts and signed by a fairly moderate Republican governor represents the will of the national Republican party is maybe not capital-C "Crazy", but it does call into question how focused you are on the realities of U.S. politics. Did you not notice what a huge stone that was around Romney's neck during the primaries, to the point that he had to make one of his key campaign pledges repealing ACA on "Day 1"?
Remember when Bill Clinton got NAFTA passed and created the WTO? How could Democrats object to comparable free trade agreements after that without being the political party of Crazy, right? GWB saw how that turned out, and even Obama had trouble in his own party getting his USTR confirmed. It turns out that political parties represent shifting interests and diverse demographic and geographic coalitions, and what a GOP governor of Massachusetts thinks is the best political deal he can get for his (deep blue) state may not be reflective of what the party would like as a national policy, especially when that party is skeptical of all one-size-fits-all solutions, and generally prefers state-by-state experimentation.