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The Senate health-care bill is not definitively dead, but it’s unmistakably ailing—and the prognosis is not promising.
Still, Republicans have to do something. Obamacare in its present form does bear down hard on Republican voters outside coal country. It does stress the country’s finances. It does offend their ideological instincts. What’s needed now is something practical: incremental reform in a conservative direction.
The ACA needs a replacement funding stream that yields more revenue and that taxes more broadly. This was the deal that Republicans should have demanded in 2009-2010. It will be harder to achieve today (because with ACA an accomplished fact Republicans now have less to trade), but it still should be their goal. One way to achieve that more difficult goal is to propose funding streams that are not only larger than the surtaxes on high incomes, but that Democrats and liberals will find even more attractive.
The future of health-care cost-cutting in America is top-down cost-cutting, not bottom-up. It’s the providers who will have to be squeezed, not the consumers. That’s a job that demands hard-nosed, green-eye-shade accountants of the David Stockman type: formerly a Republican specialty.