Make no mistake, repeal by purse strings could create a mess. The law has many moving parts that act together to create a sensible, complete whole. And implementing a piece of legislation as complex as the ACA requires fully funding the agencies that oversee it. So, this strikes me as the most politically viable, serious attack on health reform.

I’ve thought as much for a while. Back in December 2009 I wrote,

To the extent we hear more about health reform it will be for one reason: the money. While the legislation may be internally balanced so it scores as deficit reducing, it will not be viewed as monolithic once it passes. It has both spending and savings. Could we keep the savings and gut the spending? Sure.

Who would do that, and why? Answers: Republicans, for tax cuts. While the former are out of power, that won’t last forever. And the latter are always popular. This reform will be attacked. Things may quiet down, but this is not the end of it. Money has a way of drawing attention and a crowd.

The combination of “savings” created by failing to fund implementation and tax cuts is likely to appeal to the Republican base. Keep in mind that the ACA does very little for the broad middle-class of voters who are covered in the large-group market. In these hard economic times, such voters may prefer some money in their pockets than additional spending on a program for which they expect little benefit. (Of course losing one’s job jeopardizes one’s insurance so the ACA really does add a meaningful layer of protection for all Americans.)

As I said before, I don’t think this is very likely.  It”s the popular things that cost money. Closing the donut hole. Subsidies. Decreased Medicare copays. The “bad” stuff like the mandate can’t be easily defunded. So when they actually go to starve things, it won’t be nearly as popular as they think.

Moreover, I think that think this is exactly the fight the White House wants. Up until now, Republicans could only make threats. To actually defund it, they would have to put something down on paper. They will be attacked ruthlessly for it. And it still likely won’t pass.

I bet they don’t do it.

There is a very insidious myth right now that there is a large group of progressive leaders who want to “kill” health care reform in its entirety. While there might be some progressive leaders out there who have advocated for this position, I have yet to hear from them. What I have heard from people like Howard Dean, Markos Moulitsas, Keith Olbermann, Jane Hamsher, etc… is that they simply want to kill the current version of the Senate bill. None of them, to my knowledge, have advocated ending all efforts to pass a health care reform bill. I believe each and every one of them have advocated for simply passing a different bill through different means. Do not heed those who are working to create a false dynamic where the only two options are passing this horrible Senate bill or passing nothing at all. The idea that there is a large group of progressive leaders trying to kill health care reform is a red herring.

The other great myth is that if this current Senate bill, thoroughly compromised to get 60 votes, does not become law it will be impossible for any health care reform to pass during this Congress. President Obama made sure to include instructions to pass health care reform using reconciliation in the budget for a reason. It is still completely possible to pass an arguably better bill with only a simple majority in the Senate using reconciliation. Progressive activists are demanding to “kill this particular Senate bill” because they know Democrats will not walk away from health care reform empty handed. If need be, they will use reconciliation. While Senator Harry Reid and Barack Obama for some reason think it is preferable to let Senators Joe Lieberman, Ben Nelson, and Blanche Lincoln gut health care reform; if they are forced to, they will use a special procedure that completely cuts these conservadems out of the debate.

That’s a legitimate plan, but darn risky.  If you want a full and thorough discussion of why that’s so, go read Nate Silver.  It’s long, but it’s thorough, and I’m not sure I could do it better.

If, however, you believe we can use reconciliation to pass a public option, or Medicare buy-in, or whatever, why can’t we just do that next year?  Or in 2011 after the midterm elections?  Of anytime before 2013 when the bills go into effect?

Why do those who support this plan believe we have to have that passed first?  Seems to me that using reconciliation might jeopardize the passage of the stuff in the bill now.  Things like the exchange, regulations on premium levels, no denials becuase of pre-existing conditions, subsidies for insurance, etc.  If you used reconciliation, I can pretty much guarrantee you aren’t going to get those things in a regular bill because you won’t get 60 votes in the Senate.  You will lose some votes.

So why not pass the bill instead of killing it, and then come back to reconciliation once those parts are safe?

Note – I’m not telling you to pass the bill.  I’m just curious why this wouldn’t be a better strategy for those who support reform efforts right now?