“Repeal Obamacare, and people will die.” How many times have you heard some variant of that claim during the last few years? My friend and colleague Michael Strain wrote an op-ed for the Washington Post against its use as an argument-ender. Jonathan Chait criticized Strain, but I don’t think he has really understood Strain’s point.
Strain wants Republicans to work to replace Obamacare with a plan similar to the one proposed by Senators Burr, Hatch, and Coburn last year, a plan that would enable roughly as many people to have health coverage as Obamacare does. He does not think that there is any reason to believe that replacing Obamacare with this plan would increase mortality rates. But even if it did, he argues, that would not be the end of the story. It would depend on the size of the effect and the other pros and cons of the policy.
When Strain writes that it “clearly would not be immoral” to repeal Obamacare, it seems to me in context obvious that he is not saying that repealing Obamacare would be morally okay whatever the replacement. (He’s not saying it would be alright to replace it with a system where it was illegal for poor people to buy health insurance.) He’s saying that the argument that repeal would kill people should not dissuade advocates of repeal, both because that effect is unlikely and because mortality rates aren’t the only criterion for evaluating a health system, although they are of course a very important one.
And while Chait stacks the deck a bit in his discussion of replacement — Republican plans to replace Obamacare are in about as developed a state two years before the next presidency as Obamacare was in 2007 — it’s not much of a criticism of Strain, since he writes that Republicans should have done, and should be doing, more to refine such plans. On all of these points, I think Strain is correct.