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The Morning After: Waking up with a Coyote Ugly Healthcare Bill

Tuesday, March 23, 2010

Let’s look ahead to what could and should be done to reverse the damage and make real progress: A six-part strategy.

The reality is sinking in that the House finally approved the (temporarily) last version of healthcare overhaul legislation late Sunday night. It has been signed by the president, and is well on its way into law. But before the Senate takes up another round of changes in the budget reconciliation bill later this week, it’s time to revise Gerald Ford’s words upon replacing Richard Nixon as president in August 1974: “Our long national nightmare is far from over.”

As President Obama and his Capitol Hill allies assemble to take their victory laps, a different majority of likely voters and working Americans are looking for a better alternative than chewing off their own legs to escape the jaws of a dangerous fiscal trap ahead.

Admittedly, many taxpayers would rather review what remains of their Final Four basketball brackets than contemplate filling out their future tax brackets. However, last week’s Capitol Hill maneuvers probably reminded them of a different sport as ObamaCare strategists engaged in contortions, leaps (of faith), and balancing acts worthy of Olympic gymnastics. For sheer degree of difficulty as a program, they averaged a “9.” On the other hand, the execution on the floor registered much lower numbers (although the East German judges in the media gallery appeared to score it much higher!).

Rather than recycle the well-worn criticisms of fundamentally flawed legislation that threatens to undermine future healthcare choices and competition while further destabilizing both our economy and politics, let’s look ahead to what could and should be done to reverse the damage and make real progress.

A six-part strategy ahead would include:

(1) Stop the reconciliation bill coming up in the Senate this week. Several successful “Byrd rule” procedural challenges could strip key provisions out of the bill—although an initial ruling by the Senate parliamentarian late Monday night on the deal to delay the effects of a “Cadillac” tax on very high-cost insurance plans suggests the process remains wired for the majority. The Senate Republicans still hope to sink the rest of the bill by removing portions of its net budget savings and other House-favored changes. A host of Republican amendments also could stretch out this latest war of attrition and (if we want to be optimistic) result later in a House-Senate stalemate in a conference committee before the promise of a quick fix is abandoned.

(2) Challenge and slow down early stages of the final law’s implementation at various chokepoints. The health legislation remains fundamentally unworkable. Forcing it to run a multi-year gauntlet of critical comments and questions in the rulemaking process, rigorous administrative procedure requirements, and a tsunami of legal challenges to its statutory provisions should start the hemorrhaging.

(3) Mobilize the tens of millions of irate voters who were dissed and dismissed by leaders of the current (but not future) majority on Capitol Hill. The November 2010 congressional elections will provide the only place to administer the sort of pain that matters to those who pursued their own ideological and partisan agendas rather than the wishes and interests of their constituents.

(4) “Repeal” is not enough. Candidates opposing this year’s toxic brew of “health reform” in name only need to construct a more accessible, credible, and understandable short package of "this is what we have to change and do differently" instead of just yelling “repeal” in crowded town hall meetings. The rationale for overturning most of this law is to provide something better, not just a return to the unsatisfactory past. To provide a better gloss and purpose to the coming electoral fury, some starting points might include more serious funding for high-risk pools, interstate competition in health insurance that moves beyond slogans, stronger transparency measures for healthcare costs and value, honest talk about the limits of public funding resources, and transitions to defined-contribution financing of healthcare choices—without reversing minor (but popular) new benefits already put in place within the next year. The most perniciously destructive stuff does not kick in until 2014.

(5) Before the 2012 election, the only way to overcome a firm presidential veto barrier to significant changes in health policy is to hook narrowly appealing ones to must-pass legislation. The strongest candidates for such legislative brinksmanship involve future continuing resolutions for year-end appropriations, debt limit extensions, and unpopular emergency fixes. However, these tactics all face strong odds against changing permanent law and are more likely at best to score political points and reframe the 2012 national debate.

(6) Ultimately, it takes a new majority to elect a president who listens to all Americans, instead of just a selective sample who send supportive letters and personal stories. Yes, it’s hard to reverse deceptive and destructive promises cynically embedded into the modern welfare state, and the going just got tougher. But we have dug out of deeper holes before, and the hunger across the country for change that we really can believe is indeed shovel-ready.

Thomas Miller is a resident fellow at the American Enterprise Institute.

FURTHER READING: Miller’s previous articles on healthcare for THE AMERICAN include “Should We Fight Today’s War on Obesity Like the Last War on Tobacco?,” “Healthcare Dreams, Healthcare Realities,” and “What You Don’t Know Can Hurt You.” Scott Gottlieb writes, “Obamacare Is Going to the President’s Desk—What Next?” and Michael Barone explains why the “Health Plan Means Bigger Deficits and Higher Taxes.”

Image by Darren Wamboldt/Bergman Group.

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