Why Obamacare can't be 'fixed'


Article Highlights

  • Monica Wehby, the GOP Senate candidate in OR, has fallen prey to a common delusion: that Obamacare can be "fixed."

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  • Wehby, a surgeon, runs through a list of changes she wants made to the president's health-care overhaul.

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  • You can see why Wehby would find this mix of policies attractive.

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Monica Wehby, the Republican Senate candidate in Oregon, has fallen prey to a common delusion: that Obamacare can be "fixed."

On her campaign website, Wehby, a surgeon, runs through a list of changes she wants made to the president's health-care overhaul. She would, among other things, get rid of the individual mandate to buy health insurance, offer more catastrophic insurance options on the exchanges and make it easier for people to buy insurance across state lines.

But she also wants to keep several Affordable Care Act provisions, including the one that bans insurers from discriminating against people with pre-existing health conditions.

You can see why Wehby would find this mix of policies attractive: Polls find that people dislike Obamacare, but they like the idea of "fixing" it and they like the discrimination ban. (They like it less when pollsters mention the costs of that ban.) In the effort to take the popular side of every health-care question, though, Wehby has come up with a plan that doesn't hang together.

President Barack Obama, remember, campaigned against an individual mandate in 2008. He changed his mind because without a mandate, the ban on discrimination against sick people would destabilize insurance markets. The ban means that healthy people have less reason to buy insurance, because they can wait until they get sick. But if fewer healthy people buy insurance, prices have to go up -- which will drive other healthy people away. That's a formula for destroying the insurance market.

Obama tried to solve the problem he created by making people buy insurance. Wehby's plan would keep the problem but weaken the attempted solution.

The rest of her plan works at cross-purposes with itself. Let people buy catastrophic options, and healthier people will buy them. The more extensive plans that sick people want will have to get more expensive or go off the market.

And while Wehby might not want to call for a "repeal" of Obamacare, Democrats would attack this plan as exactly that if it ever came to a vote in the Senate. How many times have you heard Democrats say that congressional Republicans have voted more than 50 times to repeal Obamacare? Their list counts proposed changes to the law that are a lot less extensive than the ones Wehby wants.

Wehby could, however, follow in Obama's footsteps. If she got elected, she could suddenly discover that her proposals don't add up and decide to go a different route. In that case, I'd hope she would support replacing Obamacare with a health-care plan that uses other means to help people with pre-existing conditions. But I'd prefer if she didn't emulate Obama's example at all. And other Republican Senate candidates should avoid hers.

Update: Wehby's campaign manager, Charlie Pearce, objected to this post. In an e-mail, he wrote: "Did you even read Dr. Wehby's replacement plan Ramesh? It specifically states the establishment of high risks pools, which I also told you over the phone was needed to keep the pre-existing conditions ban." He also writes that "Wehby in fact does want to repeal Obamacare." He made these same points in a voicemail.

This response misses the point. Wehby seems to want to campaign with a rhetorical emphasis on "fixing" rather than "repealing" Obamacare. Her website's description of her proposals (linked above) describes them as "fixes" and omits the words "replace" or "repeal." No Republican does that by accident.

High-risk pools do nothing to insulate insurance markets from the destabilizing effects of the ban on discrimination. Which is why almost all advocates of high-risk pools understand them as a substitute for such a ban, not something to layer on top of one.

I read Wehby's plan more than once. No matter how many times I read it, though, I couldn't make it make sense. I think she should change it, and unlike Obama, change it before the election.

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