• James Capretta’s roadmap to repeal

    At National Review Online, James Capretta spells out how a Republican controlled government could repeal health reform, even without 60 votes in the Senate. It relies on the budget reconciliation process, which he explains (so I won’t). The key part of the piece is relatively brief,

    Senator Conrad’s contention that Obamacare shouldn’t be repealed in reconciliation because Obamacare reduces, not increases, the budget deficit doesn’t stand up to scrutiny. […]

    All the House and Senate would have to do is couple repeal with some strategic cuts in spending (including, perhaps, retention of some cuts that were enacted in Obamacare itself). The total package would then be estimated to cut the deficit and therefore fall well within the normal boundaries of a reconciliation bill.

    I am not enough of an expert on the rules of the Senate to independently verify the soundness of Capretta’s proposed strategy. [Later — Turns out, there is an incorrect implication in it.] I’m willing to believe it would hold up with the parliamentarian. If so, there is a lot of health care and health care reform riding on the 2012 election.

    What I do know is that repeal will be a campaign issue well before it is a legislative possibility. As such, you will likely hear that both implementing and repealing the law will be budget busting moves.

    My bet: in hindsight, either side will be able to claim they were right. If health reform is fully implemented, health care spending will still rise more quickly than inflation, the economy, or wages. That won’t necessarily be due to the law–it was expected to rise at least that rapidly anyway–but that won’t stop people from claiming it is.

    And, if health reform is repealed, health care spending will just as surely rise at a rate faster than inflation, the economy, or wages. We won’t know for sure whether it would have really risen more slowly with reform, but that won’t stop people from claiming that it would have.

    My other prediction is that if reform is repealed by reconciliation and replaced with something else, we’ll see that something else repealed by reconciliation too. In other words, there’s no reason to expect one round of repeal and replace. Once we start down that road, there’s no end to it.

    The US has been at health reform for a century. Another is not unthinkable.

    UPDATE: Important follow-ups here and, more importantly, here. If you’ve read this much, you might as well check them out.

    • Austin,

      As always, astute, but I would take exception with one important conclusion.

      While to-and -fro (reconciliation) shenanigans may arise and persist, once there is system decentralization the genie is not going back in the bottle.

      What do I mean?

      If the the fed-state compact for Medicaid is torn (block grants), or the platform on which Medicare currently stands is corrupted (guaranteed premium, not benefit), errant or not, reconciliation becomes less a potent partisan weapon, and more a diminished retaliatory gesture.

      I hope that is not the future, but next iterations may lack policy heft, but can still radically alter the trajectory of the system. Reconciliation wont bring that back, nor will legislation, once the pilot light goes on.

      Of course, this all if politics will allow; I dont know if the electorate would tolerate serial reconciliation maneuvers either.



    • I respectfully disagree.

      Players in the healthcare system, which range from providers to insurance companies to governors to patient advocates, would never tolerate that kind of uncertainty.

      The Tea Party will fade (has faded?), and so will the burst of energy from the left that brought us reform. The quiet, tempered support (read, money) of corporate interests will guarantee stability in the long term.

      One of the most intelligent things Obama did was gaining the support of the various players in the system. It resulted in a more moderate bill than many on the left wanted, but it bought a ton of insurance against repeal.

      For example, will the insurance industry really tolerate the repeal of an individual mandate without a replacement? If it is repealed, you can bet a lot of insurance and hospital money will go toward putting something in its place.

      • Both bulldog and BradF are suggesting that there are other forces that will prevent constant tinkering via reconciliation. It’s an argument I usually make and, had I remembered that, I’d have put it in the post. However, what the post actually says, among other things, is that if reform is repealed by reconciliation, that will not be the end of its use for reshaping the health system. I think that’s a reasonable prediction, which means it need not be iron-clad. What the commenters are really suggesting is that repeal by reconciliation won’t even happen in the first place. That’s also a reasonable prediction and not one I explicitly deny in the post.

        Since repeal by reconciliation appears possible, if unlikely, we all should take the election and that possibility very seriously. That’s really my larger point.

    • Good analysis.