Conservatives can rationally disagree with Obamacare, Mr. President

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One of President Obama’s cherished conceits is disagreement with him cannot be rational. That was the theme of his recent speech in defense of his health-care law.

Only “ideology” and “politics” are keeping Republicans from helping to expand Obamacare’s reach, he said. He himself is, in his self-portraits, willing to accept Republicans’ ideas if only they would operate in good faith.

The core problem with his speech was that he wouldn’t acknowledge conservatives have reasonable disagreements about his health-care policy.

Obama believes only comprehensive insurance policies are real insurance. Conservatives generally believe people should be free to buy cheaper policies protecting them only from financial catastrophes arising from health needs.

It’s a difference that leads to others. Obama says people who have trouble buying insurance on Obamacare’s exchanges should get more generous subsidies. He finds the conservative alternative – relax regulations that make the insurance unaffordable – unacceptable because it would be a retreat from comprehensiveness.

All of the president’s shows of open-mindedness include similar caveats. He noted Obamacare allowed state experimentation. But that is allowed only if the experiments promise to end with at least as many people having coverage that is at least as comprehensive as what Obamacare delivers.

Obama claims Republicans offered no alternatives to the health-care law. They have in fact outlined their plans. But they have not offered alternatives to get as many people covered as comprehensively as Obamacare does.

If you start with Obama’s assumptions about what the goals of health policy should be, it is true there is no reasonable basis for rejecting his policies. But those assumptions are not self-evidently correct.

Many conservatives want a less regulation-heavy system, where everyone has access to fairly cheap catastrophic policies. Obama’s speech offered no reasons for them to stop wanting that or doing what they can to move health policy in that direction.

This doesn’t mean Republicans should make no changes to health policy that fall short of replacing Obamacare – and they haven’t done so.

They have advanced legislation to fix what they see as specific problems with the law. But conservatives are not going to agree to changes that move the health-care system further away from what we want.

Obama resorted to a number of ill-considered analogies in his speech. One likened Obamacare to a “starter home:” “It’s a lot better than not having a home, but you hope that over time you make some improvements.”

Sometimes, though, you decide that you want a different kind of home altogether, and work until you can move there.

Bloomberg columnist Ramesh Ponnuru is a senior editor for National Review.