Ezra Klein, a columnist at The Washington Post, is puzzled (or at least says he is; I suspect he understands it perfectly) by Republican hypocrisy over health care. For many years the G.O.P. has advocated for things that are supposed to bring the magic of the marketplace and individual incentives to health care: higher deductibles to give people "skin in the game"; competition among private insurers via exchanges (competition that would include reducing costs by limiting networks); and, of course, for cuts in Medicare, the insurance program for older Americans.
Now the G.O.P. is complaining bitterly that some Affordable Health Care Act policies have high deductibles, that the law relies on the horror of insurance exchanges, that some networks are limited and that there will be cuts to Medicare.
In an online article published in December, Mr. Klein suggests that Republicans are really upset by other aspects of Obamacare, but are going after the easy targets, even though they're attacking their own ideas. In a sense he's right, but as I said, I suspect that he knows that the issue is both bigger and simpler than he says.
What underlies this phenomenon, which commentator Jonathan Chait calls the "Heritage uncertainty principle"? He described it thus in New York magazine:
"Conservative health-care-policy ideas reside in an uncertain state of quasi-existence. You can describe the policies in the abstract, sometimes even in detail, but any attempt to reproduce them in physical form will cause such proposals to disappear instantly. It's not so much an issue of 'hypocrisy,' as Klein frames it, as a deeper metaphysical question of whether conservative health-care policies actually exist. The question should be posed to better-trained philosophical minds than my own. I would posit that conservative health-care policies do not exist in any real form. Call it the 'Heritage Uncertainty Principle.'"
Well, actually it's pretty simple. The purpose of most health care reform is to help the unfortunate - people with pre-existing conditions, people who don't get insurance through their jobs, people who just don't earn enough to afford insurance.
Cost control is also part of the picture, but not the dominant part. And what we're seeing right now seems to confirm a point some of us have been making for a long time: controlling costs and expanding access are complementary targets, because politicians can't sell things like cost-saving measures and limits on deductibility of premiums unless they're part of a larger scheme to make the system fairer and more comprehensive.
And here's the thing: Republicans don't want to help the unfortunate. They'll propound health-care ideas that will, they claim, help those with pre-existing conditions and so on - but those aren't really proposals. They're diversionary tactics designed to stall real health reform. Hence the rage of the right.
Here they were, with a whole raft of ideas they could throw out like chaff to confuse enemy radar, to divert and confuse any attempt to actually provide insurance to the uninsured. And those dastardly Democrats have gone ahead and actually incorporated those ideas into real reform.