Please repeal responsibly
Austin Frakt examines what a repeal effort focused on deficit reduction would look like:
The ACA has provisions that are clearly in the spending category (Medicaid expansion, exchange subsidies), provisions that are clearly in the savings category (Medicare cuts), provisions that are clearly in the revenue category (taxes), and provisions that are in the experimental category (ACOs).
Thus, if I were to make a budget-based argument for repeal, I’d advocate a partial one. Kill the spending, keep the savings, keep the revenue, and probably keep the experimental. The experiments could have costs, but it is hard to argue that we don’t need to try new Medicare/Medicaid financing approaches. Maybe not all of the savings will materialize, but should we not try to save something in an otherwise fiscally unsustainable patchwork of federal/state health systems?
Two things to say here. First, the distance between what Frakt is proposing and what the Republicans are proposing is further evidence that the GOP's erratic and unreliable concern over the deficit just isn't on the level. It's there when convenient, gone when inconvenient.
Second, this goes to something important in the bill: It's a bargain. Deficit hawks got liberals to support all sorts of Medicare reforms and cost-control experiments and taxes that they'd have never accepted in normal times. You can easily imagine an independent board empowered to cut costs in Medicare being exactly the sort of thing that liberals fight with every fiber in their bodies. But lured by the promise of universal coverage, the liberals struck the deal. Without universal coverage, there is no deal. Republicans don't want the cost controls -- they've repeatedly singled them out for attack, and made a very conscious decision to attempt a fiscally irresponsible repeal bill -- and liberals don't want them without the coverage expansion. People who talk about these cuts and taxes and projects as "low-hanging fruit" that can be easily plucked by future deficit hawks are sadly misguided. Without coverage hawks (health hawks? life hawks?) in the coalition, you don't have enough votes.
| January 19, 2011; 2:21 PM ET
Categories: Health Reform
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