Don't just attack Obamacare, pass a better law

Recently, the Republican Party proved that it has the votes to repeal health care reform — but only in the House of Representatives. (Unfortunately for conservatives, the Senate and the White House also have a say in the matter.) The House vote last Wednesday may be remembered as a first step toward actual repeal, or as a futile exercise in fist-shaking. It all depends on whether Republicans can find a strategy for undoing the health care legislation that doesn't involve an immediate frontal assault.

One option is for congressional Republicans to hold hearings, stage more symbolic votes and hope that the 2012 election delivers them a Senate majority, a new occupant in the White House and a chance at full repeal. But of course there's no guarantee that Barack Obama will be defeated — and even if he is, by 2013 health care reform may be more entrenched, and the Democratic Party more united than ever in its determination to defend it. (The filibuster, lately a Republican weapon, could become the means by which supporters of Obamacare ensure that it endures.)

Another option would be to attack the law piecemeal by going after its least popular provisions — the new taxes, the Medicare cuts and the fine for Americans who don't buy insurance. This strategy might be good short-term politics but would do little to lay the groundwork for an actual conservative alternative. Worse, in the unlikely event that the piecemeal attacks succeeded, Obamacare would be transformed from a notionally deficit-neutral bill into a straightforward budget-buster. And heightening a program's contradictions in the hopes that it falls apart is an approach better suited to Marxists than conservatives.

What Republicans need is a different kind of incremental approach, one that uses the strongest conservative critiques of the health care bill as a framework for a reform of the reform. If Obama is defeated in 2012, this framework could easily be adapted into a full scale repeal-and-replace effort. But in the event that he's re-elected, it would offer a Republican Congress a blueprint for improving the law without doing away with it entirely.

Here are three such conservative critiques: first, that Obamacare entrenches the very model of health care financing that drove costs sky-high to begin with — a model in which every insurance plan has to be comprehensive, every significant payment is made by a third party and consumers have no idea what their treatments actually cost.

Second, the new subsidies for the uninsured are so expansive that they may encourage employers to stop offering insurance altogether, offloading their employees into the new health care exchanges and swiftly overwhelming the federal budget.