One of the many ironies of the current situation is that, on the right, there is a mismatch between the stridency of rhetoric and the radicalism of policy proposal. The more established conservative media figures often have an unusual relationship to policy. Their policy bark is more radical than their bite. In Liberty and Tyranny, Mark Levin is highly critical of Social Security and Medicare as bankrupting statist projects designed to tie down the people. His main policy proposal is to fight against nationalized health care. In Arguing with Idiots, Glenn Beck took a similar path. He bashed the NHS, Michael Moore and pointed out how Medicare's actual costs have far outstripped the initial cost projections. As a positive program, he mentioned some information technology and productivity enhancing developments but there was little on policy.
Neither guy came out for the actual repeal of Medicare (though Levin seemed to make an implicit argument for allowing younger people to somehow opt-out of Medicare.) The focus is less on undoing the resented past, than to prevent the next state intrusion into medicine. Medicare isn't going away, but we can learn from the problems of Medicare to stop nationalized health care. The result is a combination of rhetorical maximalism and policy stand patism. The result is also a ratchet effect in which conservatives resentfully acquiesce to the last expansion of state power over health care and do battle against the next one, and then, when that fight is lost, throw up new defenses against the next statist proposal. The result seems to be the super slow motion government takeover of health care.
I'm not singling out Levin and Beck. This strikes me as having been the general position of most conservatives since at least the mid-90s. I'm irritated at hearing liberals argue that Obamcare's (at least it's current iteration) combination of individual mandates, coverage mandates, and subsidies was the conservative position on health care reform because similar proposals had been floated by some guy at Heritage, Orrin Hatch and Mitt Romney. Just because a position was taken up by some think tank guy I never heard of, an FOTK (Friend of Ted Kennedy) Senator I didn't care about, and a politician I never trusted didn't make it the conservative position. I knew what I thought, what the other conservatives I talked to thought, what I read, and what I heard and saw in the broadcast media. The conservative position was that government involvement had gone too far already and , minus some tweaks like tort reform and (later) interstate purchasing, the government should leave the private health care system alone.
This defensive mentality creates a situation in which whenever liberals move policy closer to government-run health care, they win and when they fail, they don't lose - because policy doesn't go backwards. This has implications for the future of Obamacare. There are structural reasons to think that Obamacare won't be repealed anytime soon (though Republicans should try.) The danger is that, five or seven years from now, conservatives will have come to a resentful acquiescence of Obamacare and thrown up a new set of defenses that will be worn down over time as the current iteration of Obamacare makes existing problems of medical inflation worse. Based on the experience of Massachusetts, it is reasonable to expect that Obamacare will lead to an even faster increase in insurance premiums. This will, over time, lead liberals to advocate for some combination of price controls and a government-run insurance option that will crowd out private health insurance. Conservatives will point to the problems caused by Obamacare as a reason not to go further in the direction of government-run health care. They will be right, but a merely defensive policy position will be overrun. The premium increases really will be unsustainable and liberals will only have to win the policy battle once. A mere repeal of Obamacare strategy will also be problematic because with premiums much higher than at present, people will be terrified of losing guaranteed issue and government subsidies in the hope of declining insurance prices that might never happen.
If conservatives really want to stop a government takeover of health care, they (and I don't just mean some think tank nerds and Paul Ryan) are going to have to go on the policy offensive and popularize the arguments for a more free-market driven health care system and a series of policies that will help people of low income and preexisting conditions participate in such a system. It means more than just undoing Obamacare, it means creating a more free market health care policy than we had before Obamacare. This strategy will have to be specific. It will have to offer real world benefits and be constructed in such a way that it can be implemented a little at a time with victories here and there that increase the number of health care consumers that act like health care customers and are better off for doing so. We should move to a strategy on health care in which winning means more than temporarily not losing.