Karl Rove Shouldn’t Pretend He Understands Health Policy

Paul Krugman, NYT

Aaron Carroll points me to Karl Rove claiming that Republicans do too have health care ideas. Not surprisingly, what Rove actually does is demonstrate his party’s intellectual bankruptcy.

It’s always helpful here to keep your eye on the problem of Americans with preexisting conditions. That’s the best starting point for understanding why Obamacare has to look the way it does; it’s also often the best way to see what’s wrong with alleged Republican solutions.

So, ask the following question: how is it that many Americans with preexisting conditions have health insurance now? The immediate answer is, they get it from their employers. But why do employers do that? Well, employment-based health insurance is tax-advantaged: it’s a benefit employers can provide that isn’t counted as taxable income, which makes it better, in some cases, than offering higher wages instead.

But for company health plans to receive this tax-advantaged status, they have to obey ERISA rules, which essentially require that the same benefits be made available to all full-time employees — no discrimination based on health history, and you can’t provide benefits only to your highest-paid workers. So employer-based insurance is, when you come down to it, a lot like Obamacare, with enforced non-discrimination and a fair bit of subsidization of less-well-paid workers.

(More here.)