Old and busted: Repeal; New hotness: 'Transition' away from ObamaCare

Avik Roy, one of the most prolific and insightful critics of ObamaCare on the scene today, has written an interesting if somewhat confusing piece for Forbes in which he seems on first glance to view the notion of repealing ObamaCare as delusional folly. But when you read it carefully, you see that what Roy is really talking about is the need to use the right language when speaking to the electorate - especially in 2016, because without a Republican in the White House, we're probably not getting rid of ObamaCare no matter what happens in congressional elections.

To Roy, the insistence on flat-out repeal is a non-starter - not because there's anything good about ObamaCare, but because it has already contorted the health care market to the degree that you can't just go back to the former status quo as if ObamaCare never happened. You have to deal with the changes it's wrought, whether you like that or not. Roy seems to believe that Capitol Hill Republicans get this better than grassroots conservatives, and he worries that when the political establishment tries to appeal to the center with more agreeable words like "transition," the base will go ballistic and see it as a sell-out. Is the right really going to come apart at the seams over language?

So, a repealer-and-replacer gets nominated by the GOP, much to the satisfaction of conservatives. That nominee runs against Hillary Clinton, whose only campaign ad of the year points out that for the 35 million people on ObamaCare-sponsored health coverage, you won't be able to keep your plan under the Republicans. If 70 percent of those 35 million people vote for Hillary, Republicans lose in a landslide.

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Republican politicians won't admit this out loud, but they are well aware of this problem. And they're trying, with baby steps, to explain that to the voting public. "[Repealing] ObamaCare...isn't the answer. The answer is repeal and replace. The challenge is that ObamaCare is the law of the land," said House Speaker John Boehner at an event in his Ohio district. "It is there and it has driven all types of changes in our health care delivery system. You can't recreate an insurance market overnight. Secondly, you've got the big hospital organizations buying up doctor's groups because hospitals get reimbursed two or three times [what] doctors [in private practice] do for the same procedure just because it's a hospital. Those kinds of changes can't be redone. "So the biggest challenge we are going to have is -- I do think at some point we'll get there -- is the transition of ObamaCare back to a system that empowers patients and doctors to make choices that are good for their own health as opposed to doing what the government is dictating they should do." Note that key word -- transition -- which, despite Boehner's ritual incantation of "repeal and replace," requires a much less disruptive approach to health reform than repeal and replace can offer.

On substance, I have no problem with the word "transition" either as a campaign position or as a policy position. Roy and Boehner are both right. You can't just repeal it and go back to the old system. The old system has been destroyed. This is the very thing that makes ObamaCare so problematic (well, it's one of many), but it's the fact as we stand here today. The right legislative approach dismantles ObamaCare and creates new structures to deal with the harm it has caused. Besides, the old status quo was rife with problems of its own. I wouldn't want to go back to it. Now, having said that, I do think Republicans could use the problems with ObamaCare to pave the way for a system much better than the one we had before. People have seen first-hand throughout this fiasco why it's really not in their best interests to be so reliant on a third party to pay for their medical needs. That puts Republicans in a strong position to argue for a system in which most of the economic relationship in health care is between patients and their doctors, and third parties only get involved when it's absolutely necessary. I don't think people saw that quite as clearly before as many of them see it now. But as to the political dynamic, I'm not sure Roy is giving the grassroots enough credit for understanding where we are. You can make your average Tea Party activist understand that transition to something entirely new - something that solves the problem of ObamaCare and lays the groundwork for something more sensible going forward - is preferable to flat-out repeal and nothing else. The problem, though, is that the grassroots have an understandable mistrust of Boehner and other Capitol Hill Republicans precisely because they have proven so inept at thwarting Obama's agenda. It's not so much that they won't accept "transition" as a way forward. It's that they suspect it's a weasel word designed to set the stage for another capitulation. If Beltway Republicans want the support of the base, the key is not in the words they use so much as in the seriousness of the effort. That's what's been lacking ever since 2011, when they gained power in the House and, we thought, would use it. Show us you're serious, and we'll be fine with whatever words you choose to use.