Democrats view health care in the following ways:
1. Health care is a right, not a privilege. For both moral and economic reasons, coverage should be universal.
2. The market in health care, due in part to its unusual flaws, will never provide coverage that is either cost-effective or universal. Part of this, of course, is due to the normal workings of the market, which doesn’t provide every poor person with a Lexus, either. However, the health care market is unique in that: it is frequently dominated by local monopolies, at least for hospitals; there is a profound imbalance of knowledge between producers and consumers; and consumers of health care services typically are in no condition to bargain on price.
3. Poor health is frequently the result of bad luck, not bad choices. Random events and genetics play a huge role here. Society has an obligation to step in to assist the unfortunate.
4. Political action is needed to overcome the flaws in the market and keep prices down. The best way to deal with market failure is to create consumer cartels. Where that isn’t possible, for political reasons, redistribute wealth through regulation (e.g., community rating), taxing, and spending in order to provide universal coverage, or something as close to it as possible.
The GOP responds as follows:
1. While we begrudgingly accept that some minimal level of health care is a right, mostly it is a consumer good just like any other. Logically, the GOP should support the abolition of Medicare and Medicaid and the elimination of the legal requirement that ERs provide care to those who can’t pay, but that is politically unpalatable, so they instead propose “premium support” in lieu of Medicare and a rollback of Medicaid.
2. The market is the best mechanism to hold down health care costs. If you compare the American system to any European country, or even Medicare to private insurance, you will find it difficult to accept this proposition. Experience makes it clear that, if Medicare is deprived of its monopoly, costs will escalate dramatically, and either the taxpayers or consumers (more likely the latter) will be left holding the bag.
3. Poor health is the usually the result of poor lifestyle choices. Why should I subsidize your bad choices? That makes sense, except that it ignores the role of random events, the genetic lottery, and age.
4. All redistributions of wealth are inefficient and immoral. This is the principal evil of Obamacare, and must be eliminated. To the extent that political reality has to be accommodated, they would do it in the least intrusive way possible: hence, equal tax credits for the rich and poor instead of subsidies, and the watering down of community rating, which is essentially a subsidy from the young and healthy to the old, poor, and unhealthy.
Comparing the House Republican plan to ACA, therefore, you wind up with a system that is friendlier to providers, the wealthy, and healthy young people who don’t want to buy insurance. The cost of insurance for older people and people with pre-existing conditions would skyrocket, and millions of poor people would lose their coverage altogether.