Strengthening Constitutional Self-Government

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Health Care Links

1.  Howard Kurtz is right that Republicans should hit IPAB as centralized rationing really hard.  The biggest weakness of Obama's demagogic speech last week wasn't its tone, but his suggestion of using IPAB to cut over a trillion from Medicare.  This is just a down payment on trillions more IPAB-directed Medicare cuts if Obama is reelected.  They should also follow Kurtz's advice in arguing that Obamacare puts all Americans on the road to IPAB rationed health care and higher middle-class taxes.  I would stay away from the socialist stuff.  The policies are bad enough without bogging down into abstruse arguments about what is and isn't socialism.  The correct tack is that they are terrible policies no matter what you call them.

2.  Josh Barro's City Journal article is something that should be read by every Republican presidential candidate whose primary interest is something other than promoting a reality television show.  Conservative need to come to terms with constructive criticism of Ryan's Path To Prosperity and come up with better policy proposals that can withstand scrutiny.  Unlike Barro, I'm for getting rid of IPAB and replacing it with a purely research-oriented body that is attached to the HHS bureaucracy - then again I'm for a different Medicare reform than Ryan's.  Republicans are going to need a proposal that includes realistic funding levels for Medicaid and especially Medicare and adjust their tax proposals accordingly.  If Republicans include proposals that don't add up (and especially if they seem to shortchange Medicare), they are going to pay the price and the price will almost certainly be another Obama term and the kind of socialism that Kurtz outlines.  Now you might think that Republicans will be able to get by with Medicare proposals with major weaknesses.  After all, Obama got away with promising just about everything to everybody + a tax cut for most + a net budget cut and got away with it (politically.)  There are several reasons I don't think a similar strategy will work out for Republicans in 2012:

a.  Obama is a far more competent candidate than McCain, and will run a ruthless and obscenely well funded campaign.  If a right-leaning wonk like Barro thinks that the Republican plan is too optimistic in its Medicare cuts and will lead to near-term care reductions, then so will every last (formerly) persuadable voter.

b.  The media that persuadable voters consume will cover these issues extensively and without mercy (though not always with malice.)  That doesn't mean that Republicans can't win the argument, but they need well thought out, and well articulated answers that stand up to scrutiny.  Evasive or misleading answers on an issue as personal as health care will be fatal unless...

c.  The Obama administration could be so discredited that none of this matters as long as the Republican plan has the barest shred of credibility and the Republican candidate doesn't show a Joe Miller-type desire to simply undo the federal welfare state.  I doubt this kind of circumstance will attain in 2012.  In Fall of 2008, Bush's Real Clear Politics job approval average varied from 32% to 25%.  The only circumstances where Obama's job approval falls to that level by November 2012 is if the living envy the dead.  Even when the unemployment rate was around ten percent and Obama was losing the debate over the enactment of Obamacare, his RCP job approval average bottomed at 44%.  I guess it is possible that a commodity shock will send the economy into another recession within the next year but I doubt it.  At best, Republicans will be facing economically ambiguous circumstances in which the persuadable populations of the public might be disappointed in Obama, but still listening to what he says, and know that major changes are needed, and are leery of any big changes proposed by the Republicans.

3.  It isn't online (outside of a firewall) so I can't link to it, but you should read Ramesh Ponnuru's article in the April 18, 2011 issue of National Review on replacing Obamacare.  It points to a politic and incremental strategy for moving towards a more sustainable and market-oriented health care system.  It is much more prudent than the more radical health care reform strategy that McCain put up on his campaign website and then ignored. 

4.  The crux of the argument over health care policy will be over whether market-oriented changes can bring down the cost of health care while maintaining access to high quality care or whether bureaucrat-directed rationing is the best we can hope for.  The less theoretical this argument this is, the better.  I won't shut up about this.  It would do Republicans a world of good if their 2012 presidential nominee has a record of saving the government money on health care, maintaining access to high quality care, and even increasing the disposable income of some health insurance clients.     

5.  Run Mitch Run.  

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