Calls for Health Reform Repeal are Déjà Vu All Over Again

By guest blogger Robert Field:

Here's a quick quiz. In this summary of recent political events, guess which party is which.

Party A, which controlled the White House and both houses of Congress, pushed through a massive health care overhaul extending new coverage to tens of millions of Americans. The cost has been pegged at close to $1 trillion over the next 10 years.

The plan was extremely complex. It was filled with numerous provisions unrelated to its stated purpose, many of which were included to gain the support of special interests. The bill that contained the plan was hundreds of pages long, and it passed almost entirely along party lines.

Party A expected big political gains from the new program and was surprised when those gains failed to materialize. It actually lost public trust on health care after the bill passed.

Party B vehemently opposed the bill and complained of numerous backdoor deals leading to its passage. It promised that when it retook power, it would repeal the law or at least make dramatic changes.

Okay, you've probably guessed that this is a trick question, and it is. Party A is the Republicans, and the plan is the Medicare prescription drug benefit. It was enacted as part of the Medicare Modernization Act in 2003. Party B, the Democrats, retook power in Congress in 2006 with major revision of the plan at the top of its agenda.

What happened after control of Congress switched? Not much. A few changes were made in 2010 as part of health reform, but most of the law has remained intact. Too many interests had gained too large a stake in the program to let it unravel.

One lesson that can be drawn from this story is that talk of ideological differences between the parties on the government's role in health care is largely nonsense. They have taken turns over the years proposing and opposing similar kinds of reforms.

Another is that the future path of Obamacare will likely be complex and unpredictable. Once new entitlements are in place, they are difficult to repeal or modify. Major changes face opposition from beneficiaries and from businesses, like insurance companies, that have a financial stake in maintaining them.

Obamacare is a political lightning rod, just like George W. Bush's health reform. However, when the dust settles, its fate will likely depend not on ideology but on the market forces and economic interests that it supports.

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