I can't find the post, but I remember Reihan Salam writing that repealing and replacing Obamacare might be the work of decades. I hope not. I can hope that, in 24 months, Congress will be well on the way to passing a repeal bill that will be signed by a Republican President. There is an element of chance as to whether the election of 2012 will return results that make Obamacare's repeal possible in the short-run. If James Capretta and Yuval Levin are right that "If the health care debate is lost, then the fight for limited government is lost as well" and Salam is right that the chances for are near-term repeal of Obamacare are questionable, then conservatives will need a health care reform approach that maximizes their odds of prevailing both next year and years down the line.
Conservatives shouldn't waste any opportunity to undo Obamacare, but let's be honest: it's not entirely in our control when that opportunity will come. Some elections are between evenly matched parties, but sometimes circumstance tilts the playing field strongly in favor of one side. The Democrats were smart to nominate candidates like Jim Webb and Jon Tester in 2006 but most of their political advantages in that year came from the Bush administration's mishandling of the Iraq War - absent Bush's epic unpopularity, George Allen probably still wins the Virginia Senate race. Webb also turned out to be the marginal vote for passing Obamacare past the 60 vote hurdle for cloture. Obama didn't earn the financial panic of 2008 (though by not seeming either panicky or overtly demagogic he maximized the political benefits.) In 2010 the Republicans surely benefited from the high unemployment rate and the Democrats' insistence on passing the most liberal bill that could unify their Senate caucus after the maximum application of presidential influence. Opportunity will come when it comes.
But opportunity won't be enough. A public desire to throw out the Democrats might result in a Republican victory, but if the Republicans aren't ready with good policy, who cares? I see no reason to repeat the Schwarzenegger experience of Republican administration of liberal governance. But opportunity and a plan aren't good enough either when the issue is health care. Health care policy is an intensely personal issue that almost everyone has a stake in. The Democrats and their allies and well wishers in the media and other institutions will expend every resource to prevent a repeal of Obamacare and a center-right reform of health care. If conservatives are to retain enough public support to enact their policies, they will need sufficient support from the public. It probably won't have to be an absolute majority but a 40% to 60% split in favor of Democratic policies on such a high salience issue will probably be fatal in the long-term. This is going to be a debate and Capretta and Levin's words should be remembered, "If the health care debate is lost, then the fight for limited government is lost as well" I think that this argues for a multi-track approach to repealing and replacing Obamacare. Some suggestions about what that might look like:
1. Continue to argue for a full near-term repeal. Continue to explain what is wrong with Obamacare and explain strategies for incremental right-leaning reform at the federal level (including block granting Medicaid.) It could work. The Republicans could retain their House majority while a Republican Senate majority and a Republican President are elected. You would almost certainly still have at least forty one Senate Democrats who will filibuster any attempt to repeal Obamacare. You would need at least fifty Republican Senators ready to vote to kill the filibuster in order to pass a repeal. I think it would be worth the trade, but I'm not sure Susan Collins agrees. Anyway, a Republican President could use their discretionary authority to move health care policy in a more market-oriented direction and lay the groundwork for the next stage of right-leaning health care reform.
I don't think it is a good idea to put all of our eggs in this basket. We should do all we can to bring this result about, but for all of our efforts, opportunity might not come just when we wish. The labor market could improve sufficiently to give the President a political boost. A large fraction of the population is already behind him and he does not need many more reinforcements to be well on the way to victory.
2. Focus on state-level health care reforms. Right now. I can't overestate the importance of expanding the social basis of market-oriented health care reform. The best arguments for conservative health care policies won't be found in think tank papers. They will be found in the experiences of people who have benefited from those policies. Republican governors and state legislators should do everything they can to get as many people as possible on HSA/catastrophic coverage plans (especially state and municipal employees.) It would save the government money while increasing the take home pay of the workers. It would make the full implementation of Obamacare harder. Let the Secretary of HHS tell millions and millions of Americans that a health insurance policy they like will now become illegal and that they should now pay more in order to get no better care. Make our day. If the Obama administration blinks, we win and there is an expanded social basis for market-oriented reform down the line. If they don't, then it is an issue for 2014 and 2016. In the meantime, much of the public is now better informed about the benefits of right-leaning reform. It is a win-win-win.
3. Expand public knowledge of the principles and benefits of market-oriented health care reform. This is an enormous challenge. Public awareness (much less public understanding) of right-leaning health care reform policies is abysmally low. I doubt that enough Republican politicians or the populist right-leaning media can reasonably be expected to bear the burden of expanding public understanding in the early stages of a public education effort. It would be worthwhile for some conservative foundation or right-leaning 527 to expend much of its money not in a particular election campaign, but in a campaign to increase understanding of some key issues. Perhaps money spent on the 407th, 408th and 409th 30 second ad for a candidate just before an election might be better spent on a 90 second ad that explains how right-leaning health care reform could save the government money, increase people's take home pay, and maintain people's health care security. This would be about shaping opinion between elections to make it easier for conservative candidates to talk about alternatives to Obamacare and make it harder for liberals to demagogue conservative policies. The ads shouldn't just be on during election seasons and should be on the Rush Limbaugh Show, The O'Reilly Factor, The Daily Show and Sabado Gigante (though the content might vary somewhat depending on the audience.)