JONATHAN COHN JANUARY 20, 2011
Austin Frakt is calling bulls**t on the Republicans. And I think he's right.
Republicans who want to repeal the Affordable Care Act say a primary reason for their opposition is the fiscal disaster the law is sure to create. The parts of the bill that call for spending money will cost more than the official estimates suggest, they say. And the parts of the bill that call for saving money or raising taxes won't generate enough revenue to offset that cost. As a result, we'll end up with higher deficits and higher health spending, neither of which we can afford.
I disagree with that analysis, for reasons discussed previously, but let's assume they are right and I am wrong. Then why, Frakt wonders, are Republicans calling for full repeal? Why aren't they calling to repeal only the spending portions? Why wouldn't they keep the parts that reduce spending on government programs and raise new revenues?
My hunch is that if you could peer into the heart and soul of somebody like Douglas Holtz-Eakin, whose fiscal conservatism I've always believed to be sincere, you'd discover he favors such a strategy. He'd probably reject the higher payroll taxes on the wealthiest Americans, but he'd probably keep the reductions in Medicare spending, the tax on generous private insurance policies, and the myriad delivery reforms (electronic medical records, encouraging collaborative medicine, and so on) designed to curb over-treatment and administrative waste.
After all, Holtz-Eakin endorsed the Medicare cuts and the benefits tax back when he was John McCain's campaign economist. And just the other night, during our Intelligence Squared debate, he admitted that the law's delivery reforms represented a bipartisan consensus on how to reduce health care spending. (His main complaint, with which I agree, was that the delivery reforms should be even bolder.)
But most of the Republican Party wouldn't touch a plan like this. (And if Holtz-Eakin believes in it, he sure isn't saying so publicly.) Remember, Republicans have repeatedly excoriated the Democrats for daring to cut Medicare spending. They've rejected new taxes. And there's no mystery why: These measures, on their own, are extremely unpopular.
When the President Obama and his allies sat down to write health care reform, they made a good faith effort to produce a bill that would pay for itself and, over time, reduce health care spending--and to do so in a way that a neutral arbiter, the Congressional Budget Office, would certify as real. And the only way to accomplish this, they reasoned, was to package unpopular ideas (like cuts to Medicare) with popular ones (like prescription drug assistance for seniors).
If Republicans think that strategy was a mistake, they're entitled to make that case. But they should make their case honestly and offer an alternative consistent with their rhetoric about the importance of reducing health care spending. That's not what they're doing.
Note: None of this is to say the Republicans have no ideas at all. They have a few. More on those soon...