A primer on the principles that conservatives need to defend in offering an ObamaCare alternative

Avik Roy has written one of the best short primers on the principles that conservatives need to defend in offering an alternative to the straight party line passed health care reform bill in 2010, in the National Review.  He has also offered a dose of realism on what it will take to repeal or unravel the worst features of that law.

In short,  the House can vote to pass a repeal in the next week, but the effort is purely symbolic. To repeal the legislation would require a Republican president elected in 2012 , a GOP controlled House after the 2012 elections, and a filibuster proof majority of 60 GOP Senators in that year (the same number the Democrats needed to overcome a GOP filibuster and pass the original  Senate version of the legislation in 2009).  That will not happen in 2012, even with Democrats defending 23 of the 33 Senate seats that are up in 2012.

Short of repeal, the GOP can use the budget reconciliation process to repeal much of the bill.   That requires 51 Senators, if they stick together.  The Republicans will need to pick up a net of 4 seats in 2012 to accomplish that. That is doable, though not a lay-down by any means.  If they just miss, the will rue the blown Senate seats in Delaware, Colorado and Nevada that were winnable but lost in 2010, as weak candidates were picked in party primaries.

Even if the GOP gets to 51, the budget reconciliation process, which was used  by the Senate to adopt the House of Representatives' adjustments  to the Senate version of ObamaCare, can only impact items that have fiscal cost, and must in total, reduce deficits, not increase them.  Since the CBO scored the package as a deficit reduction totaling $132 billion over ten years, the GOP could not just pass a simple two page bill repealing the legislation.  Rather the House and Senate have to leave some things in, or add items that reduce the deficit that may not be health care related, as occurred with the original bill, when student loan funding changes were jammed in to get more "savings."

Roy calls for three core principles to focus a substitute health care reform effort: freedom,  safety, and innovation:

"First, the conservative vision must, out of both principle and pragmatism, hold that the best health-care system is one that trusts individuals to make the choices that are best for them and their families. The liberal view of health care is the opposite: that individuals are neither knowledgeable enough nor wise enough to make health-care decisions for themselves; instead, these decisions are best left to unelected government experts.

"Second, conservatives must stand firmly behind the principle of a safety net for those who are genuinely down on their luck, and also for the principle that those who pay for insurance and play by the rules will get the care that they've earned, without losing out on technicalities. Liberals might agree rhetorically with these principles, but they use them as a pretext for expanding the entitlement state, with destructive effects: extension of government insurance to those who don't need it, at a cost the country can't afford, and strangulation of private insurers with onerous regulations that the market can't sustain.

"Third, conservatives must always keep in mind that the entire point of health care is to extend and enhance life. Thus their vision can include, but must be broader than, the hot-button issues of abortion and stem-cell research. A pro-life health-care policy involves accelerating the pace of medical innovation, by reducing the regulatory and financial burdens we place on the pharmaceutical and medical-device industries. That means strengthening the influence of market forces, as opposed to subsidies and price controls, on the development of drugs and devices. It also means streamlining the FDA so that innovative new therapies can reach the market more quickly and cheaply. It means minimizing, and if possible eliminating, the ability of federal bureaucrats to deny life-extending care.

"Liberals, on the other hand, tend to look askance at medical innovation. Most progressive health-care economists blame new medical technologies for rising health-care costs: costs that can, in their view, be lowered only by restricting patients' access to those technologies. In addition, new drugs and medical technologies are developed by private companies, for profit: a concept to which many on the Left are instinctively hostile."

As an example of Roy's third point,  in 2010 only 22 new drugs were approved by the FDA.  The process has become so burdensome and expensive, that only the biggest pharmaceutical companies are prepared to navigate the route.