Jeb Bush has some ideas about healthcare. He spent most of last week trying to explain, re-explain and then explain again his stance on the Iraq War, but in between explanations he managed to weigh in on healthcare policy. His remarks on the topic were drowned out somewhat by his headline-grabbing Iraq War shambles, but they were noteworthy for how they captured the bankruptcy of the GOP's approach to healthcare.
As reported by Bloomberg News, Jeb was holding an event at a brewery in Arizona and he launched into a standard-issue exhortation to repeal the Affordable Care Act. In the middle of his spiel, Bush started talking about his Apple Watch and how wearable technology holds the potential to shake up how we access health information.
“On this device, in five years, will be applications that will allow me to manage my healthcare in ways that five years ago were not even possible,” Jeb imagined. “I’ll have the ability – someone will look at my blood sugar, there’ll be a wireless – someone will send me a signal, it’ll come here, I’ll get a double beep saying ‘you just ate a butterscotch sundae,’ or something like that. You went way over the top, you’re a diabetic, you can’t do that, whatever.”
It’s an amazing vision of the future! And I have no doubt that someone like Jeb Bush, who is very wealthy and can afford to purchase fancy Wi-Fi-enabled watches that sync up to a system that remotely monitors his blood levels and whatnot, will happily take full advantage of this incredible service. But the question is: How do the rest of us get there? What does Jeb have in mind healthcare policy-wise that makes this revolutionary (and likely very expensive) system broadly accessible?
After all, as Vox’s Sarah Kliff points out, these amazing healthcare services aren’t going to materialize out of thin air. “There is not some army of benevolent people out there monitoring blood sugar.” The “someone” Jeb imagines who will keep an eye on his sugar consumption is going to want to be paid for doing so, very likely through insurance. So what does Jeb propose?
Well, he wants to get rid of Obamacare and replace it with … something. In his Apple Watch remarks, Jeb called for replacing Obamacare with “a consumer-directed model where people are engaged in making healthcare decisions for themselves, and where they’re given the tools to do so.” That’s meaningless boilerplate that pretty much every Republican candidate endorses when talking about healthcare – more choice, more freedom, more flexibility, etc.
Speaking in Iowa a couple of months ago, Jeb laid out a longer and slightly more specific description of what he wants to see in healthcare policy. He wants government-subsidized catastrophic coverage as part of …
a model that is consumer directed, where consumers, where patients, have more choices, where they have more of a direct relationship; where the subsidies, if there were to be subsidies, are state administered; and if there are to be exchanges, they aren’t coercive exchanges; where there’s no employer mandate, employee mandate or requirements of services provided that are extraordinary; where people have more customized types of insurance based on their needs; and it’s more consumer-directed so that they’re more engaged in the decision-making, and they have more choices than what they have today.
What he’s talking about is a system that covers fewer people and guarantees less complete coverage than Obamacare. Without individual mandates or subsidies or coverage requirements for insurers, people will do what they did before the ACA: flock to barebones plans that have low monthly premiums but provide little in the way of health coverage or security. (Of course, that assumes you can get insurance and aren’t priced out of the market owing to a preexisting condition.) "His idea of how Apple Watches will improve health care specifically relies on people having insurance," Kliff notes. "And repealing Obamacare would mean reducing the number of Americans with coverage." It’s difficult to know precisely what he has in mind to replace the ACA since he never talks in specifics, but right now Jeb’s concept is of a healthcare system that covers everyone, costs nothing, regulates no one, and puts you and your Apple Watch in control of your own health.
This is the essence of Republican policymaking when it comes to healthcare. They promise an incredible future in which the federal government has no role and healthcare costs are driven down and all your health issues are affordably tracked and monitored by consumer electronics. How do we get there? “Consumer choice free market something something.” It’s a fantasy, and it’s one of the big reasons why, five years after the Affordable Care Act passed, Republicans still can’t get their act together on their own healthcare legislation.