How Republicans Might Game Obama’s Proposed Bipartisan Health Care Meeting

Congressional Republican's clearly don't want this health care reform bill to pass. They made the political calculation that allowing Obama to achieve victory on this bill will only help Democrats in 2010. So, with this televised, bipartisan meeting scheduled for February 25th, the question is how will the Republicans play the meeting to get the upper hand.

I see two potentially workable strategies for Republicans. They can either use the meeting to systematically tear down the current bill by pointing out all its flaws, or they can make themselves appear sensible with an alternative that would require completely starting over and wasting months more on the subject.

Tearing Down the Bill

Republicans don't have many good ideas left for health care reform. Almost every non-crazy idea put forward by Republicans has been integrated in some fashion into this current, right-of-center bill. Trying to explain why Republicans are not voting for the bill because it simply lacks tort reform and a less-regulated way of selling insurance across state lines will probably not play well, especially after Obama explains what selling insurance across state lines really means for consumers. But just because Republicans might not have many popular ideas to add does not mean there aren’t many unpopular provisions in the bill ripe for attack.

Republicans can use this meeting to go piece-by-piece through the health bill to make the case for why it is unacceptable. There is not just the “Cornhusker kickback,” there is the deal with PhRMA, there is a special provision for Blue Cross Blue Shield of Michigan, several deals to help different hospitals, and many different carve-outs. If Republicans take the time to shine a spotlight on each of these deals, it could be damaging to the bill’s prospects, and to the Democrats.

Republicans could then make a rather sensible-sounding set of demands on which they know Democrats won't be able to deliver. It would start with a demand that all special deals are scrubbed from the bill. Then Republicans could request provisions Democrats can't or won't be able to include. For example, the GOP could push for adding drug re-importation, which blows up the PhRMA deal. Other ideas are extreme tort reform, eliminating the individual mandate, scaling back minimum benefit requirements, and a much smaller price tag.

The secret for Republicans here is to make the demands big enough that they know Democrats won't be able to meet them, but small enough that they sound possible. There is always the danger that Democrats are so desperate for Republican cover, that they would give in to every demand—resulting in a tough Choice: Republicans either vote for the revised bill or be exposed as hypocrites that are simply, basely against everything.

A Sensible-Sounding Alternative

Republican leaders are demanding Democrats scrap the current bill and start over. To properly sell this message at the meeting, Republicans are going to need an alternative purpose that at least sounds sensible, something they have not yet offered. I personally can picture two possible Republican alternatives: one idea is a system of health savings accounts for the uninsured, combined with an extreme catastrophic insurance plan, like Singapore's health care system.

The second is simply $400 billion in voluntary block grants to states to expand coverage how ever the state wants, combined with some mild health care reforms. This solution is cheaper, extremely simple to explain, “states’ rights” based—and it lets the Republicans avoid getting their hands dirty with any messy details. It is almost impossible to attack block grants because there are basically no details. It could be anything, including state exchanges like the one in Massachusetts, high risk pools, an expansion of Medicaid, new public/private programs like Washington State's Basic Health Plan, etc. (This idea is so easy to sell, I don't know why Democrats did not think of it.)

The most important thing for Republicans is that their alternative just sounds sensible. It does not need to be great, be workable, or hold together very well under scrutiny as long as it looks reasonable during the meeting. If Republicans look like they are trying to offer a starting point for a new compromise bill, it could turn into a real political win for Republicans. Democrats would, of course, be fools to try to take Republicans up on this new bill idea. Republicans could then just slow-walk the “negotiations” until the election, effectively killing reform.

A Possible Win for Republicans?

Obama did very well in his question-and-answer session with Republicans, but this next meeting might not be a repeat of that moment. It is possible the GOP could turn this bipartisan meeting into a real political win. Their success will depend on making the current bill look as bad as possible, while also appearing like they are promoting reasonable solutions that Democrats are refusing to consider.

For the meeting to be a political success for Democrats, they must show how inflexible Republicans have been in their obstructionism, and draw attention to politically toxic Republican health care ideas, like privatizing all of Medicare. If Democrats make it clear Republicans simply have essentially no good ideas on health care--or that GOP ideas would make our health care system worse--it could make it easier to perceive a Democratic bill as the only pathway to finishing health care reform.

The idea that one televised meeting at this point would lead to real bipartisan reform is laughable. There is no victory here if that is really Obama's goal.

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