As I watched Rand Paul deliver his speech yesterday announcing his candidacy for the presidency, one thought kept occurring to me: this guy’s got some ideas. Granted, many of the ideas were fairly old and well within the safe confines of Republican dogma, which runs counter to Rand’s “different kind of Republican” routine. And some of his ideas were gimmicky (the “Read the Bills Act” forcing legislators to read every word of every bill), while others were irresponsible and destructive (a constitutional amendment forcing Congress to balance the federal budget every year, an idea so bad that it unites conservatives and liberals in loud opposition). But hey, at least they’re ideas, right?
And Rand covered a lot of ground, given how brief a speech it was. He talked about debt, infrastructure, taxes, Iran, domestic surveillance, “economic freedom zones,” the Cold War, his grandmother – lots of stuff! But for all those ideas and all the issue areas he covered, Rand Paul’s speech contained not a single word about one of the biggest policy questions a Republican president will have to face: healthcare.
Seriously, not one measly word. Rand burned 84 words talking about his legislation to make legislators read legislation, but couldn’t spare a syllable for the country’s healthcare system. He didn’t even promise to repeal Obamacare, which most Republican legislators do in their sleep at this point. Ted Cruz worked in a pledge to kill the Affordable Care Act into his announcement speech – it’s a lay-up applause line that your supporters expect to hear, but Rand left his people hanging. And Rand Paul is an actual, real-life doctor – a fact he mentioned several times in his speech. For the Doctor Candidate to not mention healthcare at all is kinda weird.
That raises the obvious next question: what would Doctor-President Rand Paul do about healthcare? Well, even though he declined to say so yesterday morning, Rand is right in line with the rock-solid Republican consensus that the Affordable Care Act is no good and must be eliminated entirely. Beyond that, though, it’s not all that clear what Rand Paul has in mind for a post-Obamacare landscape.
National Journal’s Caitlin Owens and Dylan Scott broke down the healthcare positions of all the top 2016 GOP contenders along three lines: tax treatment of insurance, subsidized coverage options for the poor and people in need of substantial medical care, and coverage for employees of small businesses. When it came to Rand Paul, they had a difficult time nailing down what he intends to do when it comes to taxes and coverage options for small businesses. The only thing they knew with any certainty is that Rand supports block-granting Medicaid, which would effectively create barriers to accessing the program and likely result in many low-income people losing coverage.
But they put all that together before Rand actually declared as a presidential candidate. Yesterday he launched a brand new campaign website with a whole section devoted to “Issues,” including healthcare. So what does it say? In a word: nothing.
After slogging through the rote denunciations of Obamacare, we’re treated to this vision for the future (emphases in original):
As your President, I will ensure that real free-market principles are applied to the American health care system so that it is responsive to patients, families, and doctors, rather than government bureaucracy.
There is a video, however, which does provide a couple of clues as to what Rand has in mind.
So he has three broad ideas: making medical expenses tax deductible, making it easier to sell health insurance across state lines, and expanding the use of health savings accounts. Absent any specifics, it’s impossible to break down in any precise way what the impact of these ideas would be, but some broad generalizations can be drawn.
Facilitating the sale of insurance across state lines is a standard-issue GOP policy idea endorsed by nearly every Republican politician. Some, like Ted Cruz, tend to view it as a cure-all policy that will leverage the power of the free market to bring healthcare costs down and give people the coverage options they want. People with a less fanciful view of how health insurance markets work worry that such a policy would set up a race to the bottom, as insurance companies flock to lightly regulated states and start selling cheap, bare-bones policies to people who don’t really need too much healthcare, leaving the old and the sick priced out of the market.
Again, absent any specifics, it’s tough to say one way or another what Rand Paul is talking about, and there will be lots of time for his campaign to flesh out his ideas on healthcare reform. But all indications seem to be that Paul’s vision for healthcare reform tracks with the general Republican goal of eliminating the ACA and replacing it with something less generous that doesn’t cover nearly as many people.