A Note on Ezra Klein and Republican Health Care Hypocrisy

This past Thursday, Ezra Klein published an article in which he chastised Republicans for what he perceives to be hypocrisy when it comes to health policy. Klein pointed out that Republicans have been criticizing President Obama’s Affordable Care Act on the basis of its high-deductible health insurance plans and narrow provider networks, when these are mechanisms that Republicans themselves have supported for years.

Republicans have zeroed in on two things that people really will hate about insurance under Obamacare: The high deductibles and the limited networks.

What’s confusing about this line of attack is that high-deductible health-care plans — more commonly known as “health savings accounts” — were, before Obamacare, a core tenet of Republican health-care policy thinking.

First of all, and not to nitpick, but high-deductible health-care plans are one component of health savings accounts; they are not the same thing, and high-deductible plans are not “commonly known” as HSAs. Individuals who enroll in these high-deductible plans are eligible to open a health savings account, where their tax-free deposits can roll over from year to year and can be used to pay for out-of-pocket medical expenses not covered by the high-deductible plan. Although Klein certainly knows all of this, not all readers do, so it’s important to clarify it.

To get back to Klein’s argument, though, I’m not sure I’m totally on board with the idea that criticism of the ACA along these lines represents “hypocrisy.” Now, I’m sure there are a lot of right-wing pundits who push high-deductible plans when Republicans are and decry them when the Democrats push them, but these sorts of analyses honestly speak for themselves. I do think, though, that there’s a principled free-market case to be made against the high-deductible plans of the Affordable Care Act alone.

Back in September, for starters, supporters of the ACA were very vocal about the fact that predictions for next year’s premiums were in many areas lower than critics of the ACA had claimed they would be. A lot of this cheerleading, however, overlooked the fact that an obvious mechanism for lowering premiums is raising deductibles. Since it isn’t clear that a low premium/high deductible arrangement is preferable for or will save money for every consumer, I think critics–even those who support high-deductible plans as a means of lowering health care costs overall–were within bounds in pointing this out.

Klein, for his part, sort of acknowledges this, and moves on immediately from there, so I think he probably does realize that it’s a fair enough point.

I asked some of the GOP’s most influential health-care voices about the tension between the criticisms Republicans are launching against Obamacare and their longstanding commitment to these ideas.

One common response I got was that it’s fair to criticize President Obama’s broken promises even if the underlying policies are desirable.

Now, there’s no doubt that many critics of the ACA, Republican or otherwise, have harped on the fact that the president misrepresented the health plan over the course of several years and dozens of speeches. This obsession, however, hasn’t really done much for me; whether or not the president simply didn’t understand the specifics of the economics at work here or whether he willfully misled people, it’s common knowledge that politicians make poor economists and can have less-than-reliable moral compasses. What’s more, it doesn’t really matter from an economic perspective if misunderstanding or dishonesty is behind it; the outcome is the same in either scenario. So, to summarize what I’ve tried to convey thus far, I think it’s fair to paint criticism of the ACA’s high-deductible plans as a call for clarification, even when the president’s equivocations are not of interest.

The larger point that I’d make in response to Klein, however, would be that there is a vast difference between pointing out the benefits of high-deductible plans to health care costs on the one hand and orchestrating an artificial and distortionary intervention into a sixth of the economy that directly results in such plans being more or less forced on consumers who were content enough with the policies they held previously on the other. (I suppose this isn’t a direct response to Klein, since mine is a criticism that applies broadly to both the Republicans and the Democrats). Ron Paul captured this idea much more succinctly, when he told Jay Leno that he’s “for seat belts, but against seat belt laws.”

In summary, Klein is probably right that many Republicans are hypocrites for their ACA high-deductible plan criticisms, but certainly not all Republicans are. What’s more, not all critics of the ACA are Republicans, either. It’s consistent to criticize the ACA crowd’s focus on low premiums but silence on high deductibles, while also liking high deductibles as potential health care expense-saving measures. Finally, all high-deductible plans aren’t created equal, and there is a world of difference to some of us between high-deductible plans that originate in a free market versus those that are the result of state fiat.

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