Rock and a hard place

For seven years the Republicans have been obsessed with repealing Obamacare. Now they control the House, the Senate, and, as of next Friday, the presidency, so now they're going to get rid of it, right?

Well, it's not so simple. Now five senators are asking for a delay, of a little more than a month. As Josh Marshall writes at that link:

Republicans, through numerous public statements, have already made a huge strategic concession: that no one should lose their coverage or be worse off once Obamacare is repealed. In other words, they now agree - or to put it more crisply, are unwilling to publicly disagree - with the proposition that the more than 20 million people who've gained health care coverage under Obamacare should continue to have affordable access to coverage.

The problem is, none of the proposals Republicans are considering come close to accomplishing that.

And the reason for that is that there's no way to do it.

Well, there are ways to do it. Some of them, like single-payer, have a reasonable chance of being less costly for society overall than either the ACA or the status quo ante.

The problem is, for all of the flaws in Obamacare, there's no alternative that covers as many people and involves less government intervention in the health-insurance market.

As I explained in this post, the key question in health insurance is whether actuarial fairness will be applied to us as individuals, or in groups. If you think it should be applied to individuals, then you have to accept that there will be significant numbers of "uninsurables." If you think it should be applied to groups and not to individuals, then you have to accept that government will play a large role in setting the rules of the game.

The reason for that is that markets will always move us toward applying actuarial fairness to individuals. If you're applying it to groups while I'm applying it to individuals, you're either going to charge too little and lose money, or you're going to charge a lot and lose the business of healthy, young people. And once that happens, your pool of clients falls apart, and you might as well be applying actuarial fairness to individuals.

It's that simple, and the logic is that relentless.

That's why, after six years of calls to "repeal and replace," there has been no concrete replacement plan. If it covers as many people as the ACA, it involves a role for the government that Republicans refuse to accept.

In that light, the possible delay I mentioned above is a rather pathetic exercise. These noble senators want to delay for roughly five weeks, so that there can be an actual replacement available when they vote to repeal.

It took Democrats a year to craft Obamacare, and that was starting from a place of understanding how insurance works.

The Republicans have had six years to make a replacement, and they've come up empty-handed - in part, because they refuse to understand how insurance works.

Now in five weeks they're supposed to do the impossible? I think they're gonna need a little more time than that.