GOP Still All-Or-Nothing on Health Care.

You may recall that longtime conservative advocate and former Bush II speechwriter David Frum was excommunicated from the conservative movement after he suggested that implacably opposing the Affordable Care Act was strategically misguided (he argued that the GOP would have been better served by negotiating to make the bill more conservative). Frum landed on his feet, and now has some more advice for his fellow conservatives on health care. Once their silly theatrical presentation on repealing the ACA is done, Frum writes, they ought to try doing some things to improve the law:

If Republicans cannot repeal the healthcare law, and they cannot, they should fight at least to make that law’s costs as visible as possible. How about a health care VAT? Every time you go to the store, you'd pay the full cost of health care subsidies, right up front, where nobody can miss them. Suddenly that abstract talking point in the president's speeches — the one about spending 17 percent of national income on health when most other industrial nations spend between 10 percent and 13 percent — will become a whole lot less abstract.

A second focus for Republicans should be this: 2011 is the year in which health-insurance companies begin to get penalized if they spend "too much" on administration or retain "too much" profit. Why is this bad?

It's kind of cute, Frum's effort to encourage Republicans to think about policy and legislating. But here's what's actually going to happen from here. They'll have their repeal vote. Then they'll hold some hearings in the House, if they can come up with a way to do it without discussing anything the bill actually does ("Our first witness, small-business owner Joe Wurzelbacher, will be telling us why socialism is a total buzzkill"). Then they'll wait around for the lawsuits to work their way up through the courts, hoping that Anthony Kennedy comes through by joining the four conservatives in inventing an entirely new understanding of the Commerce Clause, according to the principle, "things that conservatives don't like are unconstitutional."

What they won't be doing is engaging in serious efforts to craft legislation that will alter health-care reform. They'll try to undermine and sabotage it, but they're not asking themselves, "How can we alter the law so it works better?" They just aren't. Health care is still an all-or-nothing proposition for them. They'd like to destroy the ACA, but they're not going to be trying to improve it.

-- Paul Waldman

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