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A health-care fight Democrats should welcome

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Tuesday, January 4, 2011

If the incoming Republican leadership in the House of Representatives is serious about trying to repeal health-care reform, there's only one appropriate Democratic response: "Make my day."

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Just to be clear, there's no earthly chance that a bill repealing the landmark health-care overhaul could make it through Congress and be signed into law. Even if Republicans managed to hold together their new majority in the House, they would face the inconvenient fact that Democrats still control the Senate. And even if a repeal measure somehow sneaked through the Senate, President Obama would veto the thing faster than you can say "preexisting conditions."

So this exercise in tilting at windmills can't even be described as quixotic, since that would imply some expectation of success, however delusional. The whole thing is purely theatrical - and woefully ill-advised.

Yet Republicans promise to stage a vote on repeal before Obama delivers his State of the Union address, expected late this month. "If we pass this bill with a sizable vote, and I think that we will, it will put enormous pressure on the Senate to do perhaps the same thing," Rep. Fred Upton, who will be chairman of the House Energy and Commerce Committee, said on "Fox News Sunday." "But then, after that, we're going to go after this bill piece by piece."

This sounds fine, until you actually look at the pieces. Already in effect are parts of the reform package that no self-interested politician is going to vote to take away.

No child can be denied insurance coverage because of a preexisting condition. Coverage can no longer be canceled when the policyholder gets sick. Insurance companies can no longer impose annual or lifetime limits on payments for care. Adult children can remain on their parents' policies until they turn 26. Policyholders cannot be charged extra for seeking urgent care at an emergency room that is not in the insurance company's approved network of providers.

Those measures took effect in September. Another set of provisions became law on Saturday: requirements that insurance companies spend a certain percentage of the premiums they collect on care; a discount on prescription drugs for some seniors covered by Medicare; a rule that gives seniors free screening for cancer and other diseases.

Republican leaders aren't dumb enough to explicitly propose taking all these benefits away. But Democrats can, and should, force them to have that debate.

The GOP strategy is to go after the less popular elements of the reform package. These include a requirement that businesses do a lot more paperwork for the IRS, a measure allowing federal money to pay for abortions in the case of rape or incest, and the mandate compelling individuals to buy health insurance. "We will look at these individual pieces to see if we can't have the thing crumble," Upton said.

But these are fights that Democrats should welcome.

The tax-reporting measure, which requires businesses to file a 1099 form with the IRS for every expenditure over $600, really has nothing to do with health care; many Democrats are as eager to get rid of it as Republicans. As for abortion, the provisions of the reform package are fully in keeping with existing law - and with public opinion.

It seems likely that the constitutionality of the individual mandate will ultimately be decided by the Supreme Court. It takes nothing more than simple arithmetic, however, to calculate that in order to make possible the other parts of the reform package - prohibiting denial of coverage because of preexisting conditions, keeping kids on their parents' policies, all those goodies - it's necessary to bring as many people as possible into the insurance pool. Otherwise, only sick people would buy coverage. Rates would inevitably skyrocket.

I suppose you could call it a "tax" or a "user fee" instead, but a debate about the unpopular mandate is really a debate over rescinding the popular, consumer-friendly measures that are already bringing peace of mind to millions of American families.

Maybe the new House leadership believes it needs to stage this fight to keep the Tea Party types from going rogue. Smart Republicans must know, however, that they won their public-relations advantage on health-care reform by framing it as a big, amorphous beastly thing labeled "Obama-care."

All along, what Democrats really wanted was for Americans to look closely at the details. Now it looks as if the GOP is ready to oblige.

Eugene Robinson will be online to chat with readers at 1 p.m. Eastern time Tuesday. Submit your questions or comments before or during the discussion.


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