Next week's vote in the Republican controlled House to repeal health care reform is, in the short-term, nothing more than symbolic -- it won't pass the Senate and in the unlikely event it did, would be vetoed by President Obama. But just because it's symbolic doesn't mean that Democrats and progressives shouldn't take it seriously.
Obamacare is a decidedly mixed bag of good and not so good reforms and the voting public is decidedly ambivalent about many of its provisions. In particular, the individual mandate -- which starting in 2014 requires the uninsured to buy private health insurance or pay a tax to the Federal government (with a partial subsidy up to a certain level of income) -- is likely to remain unpopular among voters and a potent weapon for Republicans to use against Democrats. Overall 53 percent of Americans oppose the Democrat's health care reform and only 43 percent support it, with many of the opponents likely much more intense in their opposition than the supporters are in their support. Moreover, as premiums continue to skyrocket due to the failure of Obamacare to adequately regulate costs (e.g. Blue Cross of California just announced a 57 percent premium increase on individual policies) voters are likely to blame Obama and Democrats for everything that's still wrong with the health care system.
Democrats can merely defend against Republican attacks on health care reform by attempting to point out the elements that are likely to be most popular with voters such as elimination of preexisting conditions for children immediately and for everyone in 20014, allowing young people to stay on their parents' policies until they are 26, providing tax credits to small business who offer health insurance, and reducing the "donut hole" for Medicare prescription drugs.
Or they can go on the offensive and seek to improve the law in ways that will be popular with voters and make it more effective. Going on the offensive is a far better strategy than just playing defense. In politics, as in sports, the only thing a Prevent Defense does is prevent you from winning.
Here are several things Democrats can try to achieve to go on the offensive while improving some of the flaws of Obamacare:
1. Lower Drug Prices. Two of Obama's broken campaign promises were to allow Americans to buy cheaper drugs from Canada and other advanced countries and to repeal Bush-era laws banning Medicare from using its market power to negotiate lower drug prices with pharmaceutical manufacturers. Obama famously (or infamously) made a deal with big PHaRma to give this up in exchange for their not opposing the health care bill. Voters saw the spectacle of liberal Democratic Senators voting against these provisions that would have lowered the drug prices for Americans in order to honor Obama's deal. But surely there's a "statute of limitations" on any such deal. Did Democrats really promise the big PHaRma lobby that they would never again readdress these issues? If Democrats want to convince more Americans that health care reform is in their interests, it's time to fulfill their 2008 campaign promises to let them buy cheaper drugs from abroad and negotiate lower prices for Medicare drugs.
2. Repeal Anti-Trust Exemption for Insurance Companies. In an odd historical quirk, the insurance industry is exempt from anti-trust laws. This makes it difficult for the government to do much about the anti-competitive health insurance oligopoly under which, in most states, the health insurance market is dominated by one or two large health insurance companies, allowing those companies to set prices, make sweet-heart deals with health care providers, and effectively close the market to competitors. Harry Reid proposed ending this exemption in the 2010 health care reform bill, but it didn't make it into the final legislation. It's time to change that.
3. Medicare Buy-In. Allow Americans ages 55-65 who do not have employer-sponsored health insurance to buy-in to Medicare at cost. This is the group which has the hardest time obtaining affordable private individual insurance policies. Even in 2014, when insurance companies will no-longer be able to deny adults coverage for preexisting conditions, under Obamacare, insurance companies will be allowed to charge older adults three times the amount as younger adults, which is likely to make mandated health insurance a huge financial burden on this group, who will punish Democrats for it when they go to the polls. Already, voters over 50 are the most likely to vote Republican. Allowing them to buy-in to Medicare would give them a huge benefit while likely increasing their support for health care reform and for Democrats.
Moreover, it could be a first step towards the only real solution to providing health care for all Americans at a reasonable cost which is Medicare For All. Every few years, the age at which Americans would be allowed to buy into Medicare could be dropped, progressively adding tiers from 45-55, 35-45, 25-35, etc. Eventually it would force a decision on whether it's better for individuals and employers to directly pay for health insurance out of their pocket, or whether it would be cheaper and more efficient to fund health care for all through taxes, as is done in most other democratic capitalist countries.
Fighting for these essential improvements to health care reform, rather than just reacting to Republican attacks, could put Democrats and progressives on the offensive, improve the lives of millions of Americans, and make it more likely that passing health care reform could become a net electoral plus and not the electoral albatross that it now is for many Democrats. Even if, in the short-run, House Republicans blocked these popular common sense reforms--forcing Republicans to take a stand against Americans buying cheaper drugs from Canada, Medicare negotiating for lower prices, or 55-65 years olds having a right to buy into Medicare--would take the initiative on health care back from the Republicans and put it back in the hands of Democrats and progressives.