Pass repeated bills for full repeal of Obamacare. These bills probably won’t pass the Senate, and if they do Obama will veto them. That doesn’t matter. Pass them anyway and keep doing it. This process will pressure vulnerable Democratic Senators who are up for reelection in 2012 to justify their support of the unpopular new law. Some of them, perhaps enough to get a bill through the Senate, might eventually vote for repeal. That would help them and hurt Obama and the far-left Democratic leadership. Passing repeated bills, even if only in the House, forces Obama to continue justifying his program. Assuming that he continues to oppose repeal, his actions become a significant political liability in 2012 when his healthcare scheme will probably be even more unpopular than it is today. Having to respond to sequential repeal bills would also force him to expend a lot of whatever political capital he has left in the defense of an old policy rather than in making new mischief.
What Congressional Republicans should NOT do is what Mitch McConnell is suggesting they will do: make a perfunctory attempt at repeal, and when that fails negotiate marginal changes that strip out some of the most irritating features but leave the core of the socialized-medicine monstrosity in place. That is what the Democrats want. The want the public to dislike the program less, and they would be delighted if Republicans got involved in the process and, by helping the Democrats to smooth over some of the rougher edges, came to own part of the program themselves. Then the Republicans can be blamed if (when) things go sour in the future. Republicans should not fall into this trap. The new health law is essentially bad. To allow any part of this bureaucratic weed to survive is to insure its permanence. Republicans should make every possible effort to eradicate it. They might succeed, and if they don’t they will at least escape most of the blame once Americans start to feel the full destructive weight of the new system.
I agree. One of our local radio talkers was going on about “the Republicans can’t afford to get caught up in a time consuming fight over repeal when it it hopeless”. This confused the circus that around the passing of the bill, where it was necessary to some how come up with every piece of the 2000+page monstronsity, with a simple – “the PPACA is repealed” bill that can be written on a post card. The house at least, has no need to spend any resources on this at all. The Senate might see a filibuster if enough Democrats flip, but that’s the D’s choice. To some extent this is grandstanding, but the politics are simple – this bill is so bad that the only reasonable option is repeal and start over.
The real question is whether the House has the skill and nerve to try and de-fund the program. That will be a lot more complicated.
These bills should be timed, as well as they can be, to correspond with the financial jolts that are coming our way.
“We can’t afford this kind of stuff right now!” type sentiment (cover) might get repeal past the Senate and force a veto or two.
“We the People” vs. an “Imperial President” has always resonated in this country.
We have to face it – big business wanted health care reform to get them out from under competitive pressure on benefits. That’s why they funded Obama and the democrats in the 2008 election. They just didn’t count on the ability of progressives to fubar the project so thoroughly. And chose to ignore the likelihood of progressives including business unfriendly behaviour while accepting all the money.
Big business still wants reform, just not what they got. One way to shape this is to attach reform bills (ie tort reform, health care over state lines, etc) to each iteration of the repeal bills. This should be the first month or so. While the repeal bills are wending their way through the process, the defunding of the most expensive parts of the bill should be in process – one at at time, as simple as possible and heavily hyped. The bill as passed was 6 years of care for 10 years of taxes – it won;t take much to tip it over.
The health care bill was a skeleton in which 22,000 new bureaucrats were to be hired to write the regulations that are to be Obamacare. There are titles in the bill that are statements of intent but there is very little detail on how this (quality of care, cost control) is to be accomplished. The people who write the bill, Nancy Pelosi staffers, are the most left wing people in Washington. Don Berwick is well known in medical quality improvement circles but he is another command economy idealist.
To me, the most important role in stopping the implementation is to defund all the commissions and staff members. Second, the general thrust of the bill is toward first dollar coverage plus rationing. This is basically the Canadian approach which is failing. The Canadian system was designed to be political. Voters are mostly made up of healthy people who need little attention by the health care system and “worried well.” The latter are the people who fill GP waiting rooms. They were the people who filled up sick call in the military and were referred to as the “sick, the lame and the lazy.” The Canadian system makes it very easy to see GPs and so primary care is busy. Doctors’ waiting rooms are full. However, the really sick are a small percentage of the population and they see increasingly significant barriers to care as they seek more expensive, specialized care. That is the plan for Obamacare, as well. It was the theory behind the RBRVS. They would pay less for specialized care and there would be less incentive for doctors to provide it. Before I retired, the Medicare payment for a saphenous vein bypass in the lower extremity, which might take five hours to do, had been cut in half. I believe it has been further reduced.
What is needed is to start to replace Obamacare while the implementation is being obstructed. High deductible insurance is to be banned by Obamacare. Legislation should be passed to implement it again and to expand HSAs. The extensive mandates that will make the mandatory coverage so expensive should be cut severely. The basic coverage for a young person should be a catastrophic plan that pays only for serious illness and injury. That would be inexpensive. Prepaid primary care and “preventive medicine” are expensive and of little benefit. Medicare should allow balance billing with rules for posting of fees. That would begin to introduce a market mechanism and a cash option.
In other words, start to put the alternative in place at the same time the unworkable program is dismantled.
For those who may not know the details about the RBRVS, my link didn’t work. Here it is again.
I’ll not hold my breath. The GOP is skilled at snatching defeat from the jaws of victory. McConnell is a creature of Washington; why in the name of God would the victors want to assume a conciliatory position? I suspect it is because the establishment GOP figures secretly like the expansion of government influence and don’t have the stomach nor inclination to turn back the Leviathan state. We could throw them all out and start over and do no worse. McConnell, Graham, McCain, and the girls from Maine are not conservatives—they have more in common with their “good friends” Reid and Schumer….
I should have added this link to a NEJM article that explains how to dismantle Obamacare. Of course, they favor it and are warning how it can be repealed but it is a nice roadmap.
ACA opponents could deliver on another pledge: to cut off funding for implementation. Here is how such a process could work.
Customarily, substantive legislation “authorizes” spending, but the funds to be spent must be separately “appropriated.” The ACA
contains 64 specific authorizations to spend up to $105.6 billion and 51 general authorizations to spend “such sums as are necessary”
over the period between 2010 and 2019. None of these funds will flow, however, unless Congress enacts specific appropriation
bills. In addition, section 1005 of the ACA appropriated $1 billion to support the cost of implementation in the Department of Health
and Human Services (DHHS). This sum is a small fraction of the $5 billion to $10 billion that the Congressional Budget Office estimates
the federal government will require between 2010 and 2019 to implement the ACA.4 The ACA appropriated nothing for the Internal
Revenue Service, which must collect the information needed to compute subsidies and pay them. The ACA also provides unlimited funding
for grants to states to support the creation of health insurance exchanges (section 1311). But states will also incur substantially increased
administrative costs to enroll millions of newly eligible Medicaid beneficiaries. Without large additional appropriations, implementation will be
crippled. If ACA opponents gain a majority in either house of Congress, they could not only withhold needed appropriations but also bar the
use of whatever funds are appropriated for ACA implementation, including the implementation of the provisions requiring individual people to buy
insurance or businesses to offer it. They could bar the use of staff time for designing rules for implementation or for paying subsidies to support the purchase of insurance. They could even bar the DHHS from writing or issuing regulations or engaging in any other federal activity related to the
creation of health insurance exchanges, even though the ACA provides funds for the DHHS to make grants to the states to set up those exchanges.
That would set the stage for a high-stakes game of political “chicken.” The president could veto an appropriation bill containing such language.
Congress could refuse to pass appropriation bills without such language. Failure to appropriate funds would lead to a partial government shutdown.
There it is folks. The road map to stopping Obamacare is right there, provided by its supporters. The key is that the bill passed is NOT a health plan. It is a wish list and a skeleton that needs to be completed. In their hubris, they never dreamed that they would be turned out of office with the plan unfinished.
They should repeal the laws that outlaw light bulbs. The time fast approaches when it will be a felony to own or use a light bulb.