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Republican Tide Could Topple Healthcare Reform, Leading to... a Government Takeover!

Listening to Rand Paul's victory speech -- which, stripped of its rhetoric, was standard Republican fodder about how capitalism has made America great and government doesn't create jobs -- I was reminded of that greater communicator, Ronald Reagan, who said that government was the problem.

Republicans still believe that, and therefore, do everything in their power to make sure that government doesn't work. They'll take that approach with healthcare reform (and much else) in the new era of Republican Congressional control. But ironically, our healthcare system is the proof that free enterprise doesn't always work, either, and that sometimes government needs to step in.

To most healthcare watchers, and certainly to many in the industry, it's abundantly clear that our current methods of delivering care and reimbursing providers can't last. Setting aside the vast increase in the number of uninsured in the past few years, Medicare actuaries project that, if current trends continue, healthcare spending will reach $4.5 trillion in 2019. There's no way this country can afford that, and there's no way the government will be able to finance the roughly 50 percent of that total that will go to Medicare and Medicaid.

Rand Paul and his ilk offer an easy solution: cut government programs. If, as a result, the old and the poor can't obtain healthcare, too bad for them. They should have worked harder or invented the iPod or had the good luck to come from a family that could afford to send them to medical school.

But those of us who live in fact-based reality struggle with more complex concepts like accountable care organizations, comparative effectiveness research, and population health management. These aren't sound bites like "death panels" or "take America back." They represent the long, hard work that must be done before we can get health costs under control. In the meantime, the individual insurance mandate that the Republicans hate so much will guarantee that the healthy subsidize the sick, thereby ensuring that most people receive the care they need before they end up in the ER or the hospital and cost the system even more.

Of course, the Republicans aren't interested in any of that; they simply want to destroy healthcare reform. Rep. Joe Barton (R-Tex.) has already said that, if he becomes chairman of the House Commerce and Energy Committee, he'll drag Health and Human Services Secretary Kathleen Sebelius and Medicare Administrator Donald Berwick up to Capitol Hill and grill them over the details of how the Affordable Care Act became law and how the Administration has promoted it in the media. Barton intends to accuse the government of covering up estimates of the cost of reform that are higher than the official estimates. And he will question Sebelius about why she threatened insurance executives who blamed reform for higher premium costs.

That's only the beginning. As noted in this space last week, the Republicans can defund parts of the law's implementation that are critical to its success, such as money to help the states establish the insurance exchanges. Only about $115 billion of the $1 trillion cost of the legislation requires separate Congressional appropriations, but defunding some key provisions could cripple the program.

The net gain in Republican governorships will also block the implementation of reform, especially in establishing the state exchanges and preparing state Medicaid programs for the big Medicaid expansion that's slated to occur in 2014. While the federal government is paying 100 percent of the cost of that expansion for the first several years, uncooperative state governments could bring it to a crashing halt.

All of this, naturally, will be done in the hope of dismantling and, ultimately, repealing what Republicans says is an unpopular program. Of course, if they succeed in turning the reform legislation into a zombie (to use Henry Aaron's phrase), it really will become unpopular. That will make it easier to repeal if the GOP retakes the White House in 2012.

Replacing the law, however, will be harder than repealing it. The half-baked reform ideas served up in the Republicans' "Promise to America" platform will only hasten the breakdown of the system. Then, perhaps, the Tea Party and their Republican confreres will get what they deserve -- a real government takeover of healthcare.

Image supplied courtesy of Wikimedia Commons.