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Can The GOP Repeal Reform?

In National Review, Ramesh Ponnuru and Yuval Levin wax Churchillian, or perhaps Belushian ("Nothing's over until we decide it is!") over the fate of health care reform:

Passage of health legislation is probable, though not nearly as certain as the Washington consensus would have it. But the extensive debate over the legislation has revealed more opportunities for conservatives than anyone imagined possible a year ago. Moreover, that debate will not end if the Democrats’ bill passes — and in fact, the opportunities may increase....

We stand at the end of the beginning of the health-care fight, not the beginning of the end. And more than ever, it’s a fight the Right can win.

Okay, so Republicans can still defeat health care reform even after it's signed into law. How will that work?

They wanted the Congressional Budget Office to report that their plan would spend less than $1 trillion over the next ten years, so they rigged the bill to generate such a report. They achieved that goal in part by making tax increases and Medicare cuts go into effect several years before the bill’s benefits do. This sequence is likely to create years of political vulnerability for the new scheme. Voters will see mostly pain, not gain, from the legislation in its first four years — and four years is a very long time in politics. Conservative politicians will not have to threaten existing benefits in order to press for repeal, and they will be able to point to the bill as an example of the Democrats’ misplaced priorities while championing their own version of health-care reform. ...

Such an argument, which can serve as a means of opposing Obamacare now and of calling for its replacement with actual health-care reform if it passes, is the obvious path for Republicans in 2010, since it will connect public unease with Obamacare to the case for economic growth through fiscal restraint.

In the first paragraph, Ponnuru and Levin have a point. Democrats -- or, at least, the handful of moderate Democrats who hold the balance of power -- decided to hold down the top-line cost of reform by delaying implementation for several years. That does nothing to make the bill, which reduces the budget deficit, any more fiscally responsible. And it does open a window of vulnerability.

The strongest asset the Republicans have right now is fear of the unknown. While the public favors the health care bill when its contents are described to them, most people have little or no idea what's in the bill, and the economy-induced cynicism of Washington makes them believe the worst. As long as the law remains an abstraction, Republican scaremongering about rationing and massive tax hikes will take hold. Once the bill is in place, people will see that they're not paying massive new taxes, and Grandma is not having her care rationed by a death panel. But until then, Republicans will have chance to score political points.

What I don't understand is how Republicans can actually repeal reform. First of all, if you want to craft a repeal law, you suddenly have to draw up a law of your own. Republicans have resisted doing so all year, for a good reason: any plan they could concoct would fall apart upon scrutiny. And once you're designing a law, then the public is focused on you, and you become the subject of public cynicism about Washington. You have to explain why we should change the law to remove insurance subsidies from thirty million Americans, or allow insurance companies to refuse to cover preexisting conditions.

Ponnuru and Levin make no attempt to explain how that debate would work. Nor do they explain how the Republicans are going to acquire a veto-proof majority to pass that vote in 2010, or control of both chambers plus 60 Senate votes in 2012. And remember, the more senators the Republicans add, the deeper they'll have to reach into blue states where running on a platform of repealing universal health care may not be popular.

Unsurprisingly, GOP leaders Eric Cantor and Kevin McCarthy said last night, per Mike Allen, "They WILL NOT campaign for full health care repeal, but will demand partial repeal, including mandates for health coverage." Even that limited step is probably bravado. Keeping in place the highly-popular community rating provisions, which prevent insurance companies from discriminating on the basis of preexisting condition, requires a mandate -- otherwise, people will just stay out of the system until they get sick, causing costs to spiral, and more people to drop out, until the whole thing falls apart. Not only that, but the first ones to go down would be the insurance companies, and you can believe the Republicans won't put them out of business.

The reality is that the current system is totally dysfunctional, and the reform that will pass is a sensible centrist compromise that happens to lack any Republican support because the GOP has been overrun with wild right-wing partisanship. Republicans may extract some political benefit over the next couple years from opposing health care reform. Can they repeal it? Not a chance in hell.