A San Diego Union-Tribune editorial, reprinted by the Press Herald on May 26, argues that the Republican House replacement for Obamacare is “cold-hearted” because the Congressional Budget Office concludes that it would reduce the number of insured individuals by 23 million.

The editorial is a reflection of an iron law of public policy, which is that it is impossible to give the American public a benefit, no matter how ill-judged or costly, and then expect to take back any part of it without cries of anguish and forecasts of chaos and misery.

The extension of Medicaid to working-age individuals with incomes above the poverty line and the provision of generous premium subsidies to families well within the middle class have increased the number of those with insurance, but also set such a high bar for benefits that any less generous but more responsible policy would seem parsimonious.

A health care policy whose primary goal is to insure as many people as possible may be appealing, but without much attention to costs and adverse incentives it is likely to be very expensive, dysfunctional and unsustainable, as Obamacare is proving to be.

Obamacare focuses almost exclusively on the cost of insurance instead of on the more important cost of care. The House bill’s provision for block grants to the states would exert some restraint on the spiraling cost of Medicaid, which would otherwise remain out of control, and the provision for expanded health savings accounts would give consumers more incentive to seek value and providers more incentive to create it. Obamacare is imploding, and fixing its worst flaws isn’t being cruel. The House bill isn’t perfect, but it is an improvement.

Martin Jones

Freeport