With the House of Representatives poised to vote on the repeal of the Patient Protection and Affordable Care Act, there has been a flurry of commentary regarding what is at stake. First and foremost, the law itself is not at risk this week. Regardless of the action in the lower chamber, no sane observer believes that a repeal vote will pass the Senate or ever be signed by President Barack Obama.
Despite this, defenders of the law have launched a massive disinformation initiative regarding the vote. So, in the interest of dispassionate evaluation, let us step back for one moment and review the situation.
First, this is not about denying coverage to those with pre-existing conditions. Yes, repeal would roll back the specific provision of the health law in this regard. But there is nobody on either side of the debate who favors the inability of those with costly, pre-existing medical ailments to obtain insurance. There are deep disagreements over the best way to reach this goal, but the basic objective is, and always has been, shared on both sides of the aisle.
Similarly, a repeal vote is not about defending insurance companies. Conservatives have no love of insurers and many of their proposed reforms would have forced insurers to compete much more vigorously for the business of Americans. For this reason, many (if not all) insurers are nervous about the notion of repeal as it puts at risk the easy access to customers engendered by the measure's individual mandate.
More generally, repeal is not about being happy with the status quo. It is easily forgotten that at the start of the health care reform debate in January 2009 there was a bipartisan agreement that health care reform was needed. And there was consensus that real reform would provide insurance for more Americans. So assertions like that of New York Times columnist Paul Krugman – who said of the Republican leadership: "They're against reform because it would cover the uninsured — and that's something they just don't want to do" – are just nonsense and shameful.
This brings us to what a repeal vote is about: real health care reform. In January 2009, all sides agreed that the central tenet of health care reform was to control the growth of health care spending. And it is now well understood that the health law fails this test, as witnessed by the findings of dispassionate experts ranging from the Congressional Budget Office to the Obama administration's actuary. So, with the overhaul's framework, the health care cost spiral will continue. Repeal is about moving to reforms that will control costs.
Worse, the law sets up two new open-ended entitlement programs that will feed at the trough of excess cost growth and fuel the already-explosive growth in federal spending, deficits and debt. Repeal is about caring enough for the next generations to not destroy the foundation of their prosperity and saddle them with our debts.
Finally, repeal is hopefully about a new era in politics. Many candidates ran for office promising to reverse this measure. They ran in an environment in which the top three issues where jobs, controlling federal spending and accountability. To not hold a vote for repeal would be to deny their accountability to the voters who put them in office. It would be to deny the importance of controlling federal spending. And it would be to deny the importance of pro-growth policies, especially in the one-sixth of the economy most riddled with inefficiency: the health care sector.
Real health care reform that delivers quality care at lower cost and controlling explosive federal spending and debt -- that is what the repeal vote is about.