Republicans boast that the CBO says their plan would reduce insurance premiums. This is true. The CBO predicted this would happen because the GOP plan would reduce premiums for healthy people, bringing more of them into the insurance pool, and raise premiums for sicker people, driving more of them out.
Why would Republicans favor a result like this? The better question might be, why wouldn't they? The modern Republican domestic agenda is, above all, an attack on redistribution, a crusade to free society's winners from shouldering the burdens of its losers.
Left to their own devices, millions of Americans could not afford to buy health insurance, because their expected medical costs are too high--they're the losers of the medical lottery--or their incomes are too low. Obviously, many Americans are left to their own devices, with horrifying results. But many more are not, because they're lucky enough to get insurance through their job. In an office insurance pool, everybody pays the same rate, meaning the healthy subsidize the sick.
The Democrats' health care plan aims to create pools for people outside of the employer market, joining healthier individuals together with the sick, so that the former effectively subsidize the latter. The common element of all the Republican plans is to do the opposite-to separate the healthy from the sick.
Republicans have long championed Health Savings Accounts, which give individuals who buy insurance a tax deduction for money they set aside for a high-deductible plan. Since tax deductions are worth more to people in higher tax brackets, and since high-deductible plans appeal more to those with lower medical expenses, the plans attract the rich and healthy, leaving the poor and sick behind.
The core of this philosophical divide was on display in last week's health care summit. Senator Tom Harkin, a traditional liberal, denounced policies that "allow segregation in America on the basis of your health." Harkin's point was that the only way to protect the sick is to pool them with the healthy. Conservatives seized upon Harkin's remark. "Having people pay their own way," mocked an incredulous Jeffrey Anderson, a former health care speechwriter in the Bush administration, "is apparently an injustice akin to segregating them by race or creed."
"Pay their own way"--that gets to the heart of the party's new vision of health as a consequence of personal morality. "I think a national health care act substitutes for a lack of personal responsibility," complained Republican Representative Steve King last August. Newt Gingrich gloats that Americans have moved "away from the idea of government-run health care and toward more personal responsibility."