Now that ObamaCare has passed, we can mostly put that year's worth of debate and rancor into the rear view mirror. Contrary to what the GOP seems to be telling itself, the 2010 elections will not be decided based on the potential repeal of the health care bill. It will be decided based on the array of issues that will be decided in 2011 and 2012, and based on how big a check the people want to put on the Obama administration.
First, with regard to health care:
- The bill can't be repealed while Obama is still president
- As I've written before (here, here and here), our exisiting health care system is deeply flawed and preposterously expensive (and getting worse), making it hard to defend the status quo
- Any bill that comprehensively deals with such a large and complicated system (and has the ability to pass Congress) will be flawed and imperfect
- Polls have consisently shown over decades that Americans care about this issue, that they are open to governent-run health care, that they are worried about costs, that they would like access to be universal (but not necessarily free), they favored the "public option" right up until the end
- The people in the middle of the electorate (i.e. the ones that really matter) will prefer to see this bill tweaked rather than have it junked and return to the status quo ante
- As we have seen with other entitlements, the principle of universal access is now established, and will not be taken away
- People (rightly) don't believe that the bill will reduce the deficit, and the real threat to long-term solvency of the US come from the $38 Trillion present value of the unfunded Medicare liability (see here, page 70), so health care is now THE deficit issue going forward
- The Medicare liability can't be reduced without reforming the way medicine is paid for. It will not be about raising taxes or tweaking benefits. It will either be about rationing by government edict (a less-sensational version of "death panels") or by using market forces to ration care. The moral element of health care makes market purity difficult, however.
- There will also be alot of experimentation around the edges: tort reform, punishing unhealthy eating, promotion of exercise, etc.
- Health care will be one of the dominant economic issues for a generation…we want to continue to invest in health care innovation, but we don't want it to engulf the entire economy
As for the 2010 election, barring some foreign crisis, the issue set is as follows:
- Financial reform (favors Democrats; the GOP will be crazy to block this and allow it to still be an issue in the 2011 election)
- Trade with China (mostly favors Democrats; it is time to stand up to their mercantilistic practice of building currency reserves to promote exports at our expense)
- The deficit (favors Republicans; divided government is best for fighting deficits; the issue will have more potency if interest rates rise and less if rates stay where they are)
- Expiration of the Bush tax cuts, estate tax (mostly favors Republicans; although a strict anti-tax position could backfire if they are unwilling to compromise on deficit and entitlement reform)
- Energy reform (mixed; people want compromise, like more domestic energy coupled with reasonable investments in efficiency and green energy)
- Health care reform (favors Republicans; as long as they focus on reformist ideas like tort reform and HSAs and don't blather on about lost liberty and creeping socialism)
- Entitlement reform (favors Republicans; divided government would force the compromises that are required, i.e. raising taxes and cutting benefits)
- Jobs (mixed; "jobs" is not an actual issue, it is a shortcut taken by lazy pundits; the "jobs" issue favored Obama in 2008 because he was most likely to support fiscal stimulus; the stimulus chamber is mostly empty now, so there is no actual "jobs" issue on the table outside of the economic issues outlined above or other small-bore initiatives that might get brought up as window-dressing)
- Social issues (mixed; the Democrats elected a good number of social conservatives in swing districts in the last two elections, and the Republicans weren't focused on these issues in NJ, VA and MA, either; it seems to be mostly about economics now)
- Foreign Policy (not an issue; the President runs foreign policy)
Good news for Republicans, the following issues are now off the table:
- Universal health care
Please don't shoot the messenger with this. I am trying my best to just give you my analysis, with as little personal bias as possible. In this day and age, with the hyperbole thrown around by both sides (Bush is a Nazi! Obama is a socialist!), we must remember that the actual US electorate is pragmatic and centrist and is just doing the best it can with the choices it has available.