Brian Beutler notes that Sen. John Cornyn is now saying RyanCare is “exactly like Obamacare.” Cornyn is, of course, on record favoring that ObamaCare be repealed and declared unconstitutional. So though I think there’s some truth to what Cornyn is saying — RyanCare uses exchanges that are very similar to the exchanges the Affordable Care Act — I think it’s mostly proof that a fair number of leading Republicans haven’t thought very hard about health-care reform and have no interest in doing so.
That said, the implications of Cornyn’s comments are interesting. As I’ve written previously, if the exchanges in RyanCare can hold health-care costs down to the rate of inflation, then the Affordable Care Act is going to work far better than anyone currently believes. They serve a population that requires less emergency care, that is more able to make decisions, and its using subsidies that are better set up for cost control.
Unfortunately, neither the exchanges in RyanCare nor in the Affordable Care Act can hold health-care costs to the rate of inflation, or even very close to it. Perhaps the best analogy for RyanCare isn’t ObamaCare, which, unlike RyanCare, includes a raft of efforts to reform how medicine is paid for and delivered in an effort to hold down its costs, but RomneyCare, which had the exchanges but no delivery-system reforms. And RomneyCare hasn’t been able to control costs, which is why Massachusetts is now trying to kick off a big effort at delivery-system reform.