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When R's Talk Alternatives, It Means D's Are Winning

A quartet of Republican lawmakers* on Wednesday introduced an alternative vision for health care reform, which they're calling the "Patient's Choice Act." Ezra Klein and Igor Volsky have done due diligence breaking down the proposal. I'd recommend reading both if you want a sense of what's really in the bill.

But the broader takeaway--as Ezra suggests--is the remarkable conceptual overlap between what they're proposing to do and what Obama and his allies are proposing to do. In particular, unlike so many other conservatives, it recognizes the difficulty all but the healthiest people face buying insurane when they're not part of a large group.

What's more, the Republicans propose to deal with this problem by re-organizing the individual and small group markets and setting up cooperatives, through which insurers would sell regulated plans to all comers (although not necessarily at the same rate). There'd even be risk-adjustment. That is, the government would force insurers attracting unusually healthy groups of patients to subsidize those attracting unusually sicker patients--a scheme that, when done properly, sharply deters insurers from trying to cherry-pick the cheapest-to-insure beneficiaires.

Does all of this sound familiar? Broadly speaking, it's the same concept behind almost every major Democratic reform initiative of the last 30 years, including the ones on the table now.

The particulars of the proposal, naturally, are a bit less impressive. The details are pretty unappealing, except where there are none; and the whole thing is presented as the antithesis of big government when, in fact, it too would require at least some government intervention. ("The federal government would run a health care system--or a public plan option--with the compassion of the IRS, the efficiency of the post office, and the incompetence of Katrina," the Republican proposal says, adding a contemporary--if ironic--twist to this health reform cliche.)

The Republicans also say they can finance their plan with no new taxes, just offsets elsewhere in the budget. Good luck with that.

Politically, the bill is going nowhere, in part because not even the Republican leadership seems to be behind it. And don't forget that it would hardly be beyond Republicans to trash their own bill once political circumstances change. It happened all the time back in the 1993-94 debate, once Republicans realized they could kill the Clinton health plan rather than merely cut it down to size.

Still, the appearance of this plan is just one more indicator of where the debate is right now, less than three months before the target date for each house to pass legislation. And, for those of us who favor comprehensive reform, that place is a good place: Passage of a bill seems ever more likely, to the point where potential opponents feel they must offer alternatives that embrace some of the same concepts.

*For the record, the four are Senators Tom Coburn of Oklahoma and Richard Burr of North Crolina, plus Representatives Paul Ryan of Wisconsin and Devin Nunes of California.

--Jonathan Cohn