In a column about the Supreme Court’s health care decision today, David Brooks offers up a series of recommendations about how to improve the nation’s health care system that he’s positive are not already in the Affordable Care Act (ACA). It’s worth quoting at length because it’s so revealing:

“Crucially, we haven’t addressed the structural perversities that are driving the health care system to bankruptcy. Obamacare or no Obamacare, American health care is still distorted by the fee-for-service system that rewards quantity over quality and creates a gigantic incentive for inefficiency and waste. Obamacare or no Obamacare, the system is still distorted by the tax exclusion for employer-provided plans that prevents transparency, hides the relationship between cost and value and encourages overspending. … Republicans tend to believe that the perverse incentives can only be corrected if we repeal Obamacare and move to a defined-benefit plan — if we get rid of the employer tax credit and give people subsidies to select their own plans within regulated markets.”

Let’s take these in turn:

“Obamacare or no Obamacare, American health care is still distorted by the fee-for-service system that rewards quantity over quality … inefficiency and waste”

Actually, no. The ACA has introduced pretty sweeping reforms to payment delivery; see the Independent Payments Advisory Board (IPAB), created precisely to engage the issues Brooks raises.

“Obamacare or no Obamacare, the system is still distorted by the tax exclusion for employer-provided plans that prevents transparency…”

Again, no. The ACA does indeed limit the value of this tax exclusion over time.

“Republicans tend to believe that the perverse incentives can only be corrected if we repeal Obamacare and move to a defined-benefit plan — if we get rid of the employer tax credit and give people subsidies to select their own plans within regulated markets”

Actually, no, no and no.

‘Move to defined-benefit plans?’ What this bit of buzz-speak means in practice is simply exposing a higher share of peoples’ incomes to health insurance premiums over time. Like when exchange subsidies don’t keep up with projected health care costs (unless these costs slow). Just like in the ACA (which could actually even shift a higher share of premium costs onto exchange enrollees).

‘Get rid of the employer tax credit?’ I think he means the tax exclusion referenced above, but, if not, there is an employer tax credit in the ACA … that the ACA “gets rid of” in two years when the exchanges are up and running. And, if he does mean the tax exclusion, see above.

‘Give people subsidies to select their own plans within regulated markets?’ Seriously? Subsidies? Yup, in the ACA (do I really need to link to anything here?). ‘Regulated markets?’ Yup, also known as “exchanges.”

Health care is complicated and all, but this is amazing stuff. I know conservative commentators think it’s just a talking point, but the ACA really, really does reflect deep compromise relative to what many liberals think that health reform should look like; and it really does incorporate many ideas put forward by conservative health reformers over the years.

And to be clear, I’m not a huge fan of many of these compromises or conservative reform ideas—but they’re in the bill, and one should not be allowed to pretend otherwise.