Is Repealing Health Care Reform the Next Big Debate?

It sounds like it. But there are a couple reasons why it's meaningless to discuss repeal as anything more than a campaign promise to burnish conservative credentials.

First, the vote. It's still highly unlikely that Republicans take the Senate and set the agenda to repeal the most significant legislation from the president's first two years.

Second, the veto. Even if Republicans take the Senate, the president can and will veto anything that cripples the health care reform bill.

Third, the logistics. Before you know it, minor surgery on health care reform turns into a full body transplant. Wanna repeal the individual mandate? There goes the linchpin for the insurance regulations. The uninsured could wait until they got sick and sign up for insurance companies who couldn't reject them. As a result, insurance co's would protect against the chance they get slammed with lots of free-riders by raising prices for everybody.

If Republicans try to defund the Medicaid expansion or subsidies, they'll take away health care from millions of Americans. If they try to reverse the Medicare cuts, they'll take away the mechanism that "pays for" (in terms of deficit-neutral accounting) millions of Americans' health care. What's left: Death to the independent Medicare council Death Panel?

Some smart conservatives have said, and will say again, that we should wipe the whole thing off the record and start over with health savings accounts and catastrophic coverage protection. It's the "family vacation" solution to health care: the kids pay for the little stuff and mom and dad handle the expensive purchases.

I still think health care reform as it exists can be nudged in that direction in the 2020s when the exchanges are set up to catch the families that fall off their employers' health care. Families buy their own high-deductible insurance with prevention incentives with generous and smart coverage on top of that. Anyway, that's a debate for another year. For now, let's abide the promises to kill Obamacare. Conservatives can listen, but they shouldn't get their hopes up.

____

Update: Ten minutes after I pressed Publish, the New America Foundation emails: Will Health Reform Be Repealed?

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Derek Thompson is a senior editor at The Atlantic, where he writes about economics, labor markets, and the entertainment business.

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