



Jon Chait notes today that to the extent conservatives have any kind of plan to replace Obamacare, their plans are generally far more disruptive to far more people. It wouldn’t just be one or two million people who have their plans canceled or suffer from rate shock, it would be tens of millions who would be forced to give up coverage they like. What’s more, contrary to a general preference for comprehensive coverage, Republicans almost universally prefer plans that dump huge amounts of risk on individuals:

The right’s dilemma grows more acute when you move from the general to the particular. Their argument is that Obama forces healthy people to pay higher premiums to pay for a bunch of crap they don’t want or need. Karl Rove argues in his Wall Street Journal column that Obamacare forces people to pay for “expensive and often unnecessary provisions.” And what provisions are these? Where is the medical equivalent of Bridge to Nowhere or scientific research on animals that Republicans love to mock? The problem turns out to be a requirement that “every policy offer a wide range of benefits including mental health and addiction treatment, and maternity care (even for single men or women past childbearing age), and cover 100% of the cost of an array of preventive services.” This is a morally bizarre conception of what health insurance means. Most of us don’t need mental-health or addiction treatment. Some of us do. Some of us who don’t currently need mental-health treatment might potentially need it one day. You could have a system in which only people who need mental-health treatment pay for mental-health insurance, but then it wouldn’t be insurance anymore. It would be a system in which you pay for a doctor out of pocket. I’ve identified the new “welfare mothers.” Are you ready? Mothers.

The whole point of insurance is to pool risk because you don’t know what kind of problems you might have in the future. Would it be better to allow people to choose from a menu of things they want individually, rather than simply covering everyone for everything and then spreading the cost around? That’s surely a matter of opinion, but most Americans don’t like the idea. They don’t like it substantively because it obviously promotes free riding, and they don’t like it emotionally because it just doesn’t smell right. When we sign up for employer coverage—by far the most popular kind of health coverage outside of Medicare—we all understand that we’re joining a risk pool. I’m paying for someone else’s maternity coverage. They’re paying for my blood pressure meds. We’re all paying for the possibility of some kind of catastrophic bout of cancer that we all dearly hope will be someone else’s problem. What’s more, we all understand that the benefits of employer health care are immensely unequal. A 50-year-old head of household receives benefits that are probably worth about $20,000 or so. A healthy 25-year-old single worker receives benefits worth about $4,000. Is that unfair? I wouldn’t say so, and Americans have voted with their feet for years in favor of this kind of system.

In any case, as Chait says, the most bizarre part of the current Republican screamfest is their objection to men being forced to pay for maternity coverage. Seriously? They think that the societal cost of carrying on the species should be borne solely by women aged 18-40? Young women should pay the full freight and the rest of us should give them a vote of thanks but otherwise tell them they’re on their own? That’s morally contemptuous, and I’m pretty sure that most of us understand that.