Let me start off with a full disclosure. I enjoy Philip Klein’s writing immensely. While I disagree with him often, I’ve found him to be fair and reasonable. So when he offered me the chance to read his new book, “Overcoming Obamacare“, I was excited to do so. What follows should not be considered a full review, but my high level thoughts of his work. I wrote most of these as I read the book.
This is a quick, easy read. That’s a compliment, not a complaint. Here are things I liked:
- I think he does a great job of quickly summing up the conservative thought behind dislike for Obamacare. Anyone who supports the law will not agree with what he’s written, but it’s a good summary of what I think many people believe.
- He and I are in agreement that it’s silly to continue to make it an employer’s responsibility to give health insurance to employees. It’s a quirk of history, and a tax-expenditure inducement that continues that practice. We’d all be better off decoupling insurance from employment.
- Klein does a good job citing research, as well as explaining its limitations. Kudos for that.
- His chapter on The Reform School was excellent. There, I think he did an extremely fair job in summarizing what conservatives might do, and what might happen if they did. He sums up Avik Roy’s plan very well.
- He acknowledges that one of the issues that conservatives have is that they keep comparing their budgets to a pre-ACA baseline. I have no problem with them comparing things to a real-world ACA baseline, but that’s likely because I’m not representative of conservative thought.
- I was surprised, but fascinated, by the apparent bitter divide between tax credit and deduction schools of thought.
- The Replace School chapter had far more specifics than I expected. I’d love to see some of the numbers corroborated by other sources, but – again – nicely done.
Here are some things I wish were different:
- Many of the arguments Klein makes are not new (again, not a complaint – he acknowledges this up front). But because of that, they have been rebutted many times, too. There are answers to “why can’t we have insurance sold across state lines” or “why can’t we let all the young people get cheap insurance if they want it“. Those answers aren’t liked by many conservatives, but they are there. He doesn’t present the answers to these questions enough for my taste. Maybe he has rebuttals to my rebuttals. If so, I’d love to read them. Not mentioning them can do the reader a disservice.
- I can’t let it go that he cited the results of the OHIE without at least mentioning the many issues with it.
- I wish that in addition to talking to many conservative wonks, advocates, and politicians, he had also talked to some less conservative ones. I get that this isn’t the book he was trying to write, but it often left me talking to the book instead of listening to it, because I have already answered many of the people he’s writing about.
- I wasn’t as fond of the Restart School chapter. I think he was far to fair to Jindal, who offered a lot of platitudes, but nowhere near the specifics of those in the Replace School. Of all the people cited in the book, Jindal was the only one who felt like a politician giving sound bites in an effort to run for office. And that is an enormous compliment to the rest of the book.
Klein wanted to write a book that sums up competing schools of thought from conservatives as to what to do about Obamacare, and he succeeds. I can recommend it without reservation. But in doing so, I think he shows the relative seriousness of those schools of thought. In the Reform School, we see incredibly detailed plans (like those of Roy) where numbers have been run and tradeoffs calculated. There are things that conservatives want, and things they’re willing to concede. The Replace School is better considered than I had previously thought, but a little less detailed (and, perhaps, a little less realistic). The Repeal School, however, left me feeling like it was just a political ploy, with hand-waving to old studies (which barely applied) and old ideas like “HSAs can fix everything”. I’m curious to see if others agree.
Bottom line, Klein is a talented journalist and writer who gave me some insights into what conservatives are thinking. Well worth my time. Likely worth your time, too.
