Those who favor repeal of health care reform frequently note that a precedent for repeal exists. That is true. But that doesn't mean it will happen this time. I explain why in my latest column for Kaiser Health News, which is online at TNR.COM today:

In 1988, President Ronald Reagan and the Democratic Congress passed the Medicare Catastrophic Coverage Act. The bill promised to fill in some key gaps in Medicare coverage, chief among them an overall limit on benefits and a lack of prescription drug coverage. But the bill proved unpopular. Only a tiny fraction of seniors ever experienced catastrophic expenses that surpassed the Medicare limits; the drug benefit, although helpful, didn’t start right away. To pay for the benefit, the act raised taxes on wealthy seniors. Conservatives attacked that future mercilessly, implying (wrongly) that many more seniors would end up paying the tax. The public turned sharply against the act and, within a year, Congress had repealed it by an overwhelming margin.
Democrats complacent about their victory this week should remember that example and remember it well. But they should also take comfort in the fact that the situation is different in several key respects. Although most of health care reform’s benefits won’t begin until many years from now, the architects of the bill understood what happened with Medicare Catastrophic. That is why they front-loaded the bill with a handful of tangible benefits. Seniors will get additional assistance buying drugs, young adults under 26 will get to stay on their parents’ policies, the government will prohibit annual and lifetime limits on benefits and insurers will be prohibited from rescinding policies without good cause--all within the first year.
The politics have changed too. Precisely because Medicare Catastrophic was a bipartisan act, passed by a Democratic Congress and signed by a Republican president, neither party really took political ownership of it. Neither Reagan nor congressional Democrats had made it a defining issue of their previous campaigns and after enactment, neither was going to expend huge political resources defending it.
The situation today could not be more different. President Barack Obama and his allies made health care reform a centerpiece of the 2008 campaign. And over the last year, they’ve made it the signature cause of Obama’s first term. Their political survival depended on its passage and, now, their political survival depends on its implementation. In short, they are going to keep fighting for it.

The rest of the article addresses one of the main philosophical arguments for repeal: That it represents some huge lurch towards government control of the economy. As you can imagine, I don't quite see it that way.

*Obscure historical reference for students of health care policy

Update: Suzy Khimm, now writing for Mother Jones, details the emerging Republican split on repeal.