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Who’s Credible on Health Care?



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Yesterday, White House Chief of Staff Rahm Emanuel said on This Week that Republicans have become the party of “no,” “never,” and “no new ideas.” And he challenged GOP leaders in Congress to come to the table with proposals and be constructive in negotiations.

Emanuel seems to be under the impression that the Obama administration has met the credibility test by offering serious plans of their own, full of new ideas and fresh thinking.

They haven’t — at least not in health care. 

The president has stated repeatedly that both health-care and entitlement reform are dependent on finding ways to “bend the curve” and slow the rapid escalation of health-care costs.

In fact, the White House has already held two full-day summits, filled with talk, to demonstrate how serious they are about the issue of rising costs. 

But they have offered no plan to actually do anything about it, and there is no prospect of one emerging in Congress either.

When the topic is raised, administration officials, including Emanuel, always fall back on their efforts to promote more health-information technology and so-called “comparative-effectiveness research.” 

First, these aren’t new ideas. Second, they won’t come close to “bending the cost curve.” But that doesn’t stop the New York Times from dutifully reporting on the “president’s plans to make health care affordable” for more Americans.

What is clear is that the Congress and the president would like to stand up an expensive new health-care entitlement program. Credible estimates put the cost at $150 billion per year. How will the president pay for it? After a lot of bobbing and weaving, Mr. Emanuel’s answer yesterday was, essentially, “We’ll work with Congress on that.” Not exactly “The buck stops here.” It will be interesting to see if Democrats in Congress are willing to take on tax increases and spending cuts that the president himself was unwilling to embrace in his budget. Don’t bet on it.

Meanwhile, today in Politico, several Republican strategists worry that party leaders are late in coalescing around a plan for countering whatever plan emerges in Congress. 

There is certainly reason to be concerned. Democrats have long enjoyed a substantial advantage with voters on the issue. Republicans cannot close the gap without a more coherent message that they are willing to repeat as often as necessary.

But Republicans should not despair. The gap can be narrowed — with a lot of effort.

Fundamentally, the health-care debate is about how to allocate resources in the health sector. And there are only two choices: It’s either the government, or consumers and suppliers of services in a marketplace. 

The Democrats want the federal government in charge (although they won’t admit so this year). Always and everywhere, that leads to government-driven rationing of care, which the public rightly fears. To compete more effectively on this issue, Republicans must first hammer the message home to voters that the Democratic plan would give the government too much power over who gets care, and when.

When enough people become concerned about a government takeover, there will be a short window of opportunity to present an alternative vision. Republicans will need to be ready with a compelling vision of their own.

It won’t be easy building a consensus position, though. Many voters are skeptical about the virtues of a health-care marketplace. A GOP plan will need to include effective government oversight to give the public confidence that they will have good options to choose from in a reformed marketplace. But it can be done. And it’s not too late to pull such a plan together — not yet anyway.



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