Repealing Reform

| Tue Dec. 29, 2009 1:43 PM EST

Apparently the conservative base is demanding that all good Republicans campaign next year on repeal of healthcare reform. This is probably a good strategy since it (a) makes for good rabble rousing but (b) will never have to be followed up on.  Republicans will never get either the 60 votes they'd need for repeal or the two-thirds they'd need to override an Obama veto, so why not promise the moon?

But since there's not a lot to blog about this week, I guess I'm curious about how exactly they're going to do this. The problem, as other people have also pointed out, is that the current bill has basically been stripped down to the bare minimum you can have once you start from the point that everyone agrees about: reforming the insurance industry. Crudely speaking, the moving parts go together like this:

  • Insurance companies are required to take all comers, regardless of preexisting conditions.
  • This requires regulation of pricing, since taking all comers is meaningless if they're priced out of the market.
  • Regulation of pricing would destroy the private insurance market, since sick people would all buy cheap insurance and bankrupt the companies. So you have to ensure that everyone buys insurance, even the young and healthy. Thus, an individual mandate.
  • But if you're going to have an individual mandate, then you have to include subsidies so that poor people can afford it.
  • And that's the ball game.

Now, there's more to healthcare reform than just this. There's Medicaid expansion for example, which I suppose Republicans could fight against. But Medicaid is cheaper than subsidies, so costs would go up if they did that. There are also all the cost cutting measures and pilot projects in the bill, and some of them are unpopular. But again, they'd basically be surrendering completely on even the idea of reining in healthcare costs if they attacked that.

So what do they have left to campaign against? Maybe the specific funding sources, but that would be a pretty raw bit of pandering to the rich. The fact is that at any level of real detail, Republicans just don't have much of an argument.

I suppose this doesn't matter, though. It sort of reminds me of the too-clever liberal response whenever conservatives start railing about cutting the deficit without raising taxes. It goes something like this: "OK, fine. But two-thirds of the federal budget is taken up by Social Security, Medicare, national defense, and interest on the debt. You don't want to cut that stuff, so to eliminate the deficit you'd have to slash about half of the remaining stuff. So what are you going to cut?"

Liberals always ask that question, conservatives never answer it since they know perfectly well it would piss off practically every registered voter in the country, and it makes no difference. They just keep saying it anyway, and lots of voters buy it. Probably it would be the same with healthcare reform. They'd refuse to say just exactly what they'd cut, and it wouldn't really make any difference. It's the thought that counts, after all.

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