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Republicans need to articulate a health care vision if they want to replace Obamacare

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Beltway Confidential,Opinion,Philip Klein,Obamacare,Republican Party,Health Care,2014 Elections,Campaigns

More Americans have an unfavorable view of President Obama’s health care law than at any time since the law’s March 2010 passage, according to a Kaiser Family Foundation tracking poll.

The news that 53 percent of Americans now have an unfavorable view of Obamacare, compared with 37 percent who hold a favorable view, is welcome news to Republicans who have made opposition to the law a key part of their midterm election strategy.

It also cuts against the long hope of Democrats that as the law was implemented and Americans began to see its benefits, its popularity would soar.

Though this works in favor of the Republican position, another part of the poll found that just 35 percent of Americans wanted to repeal and replace the law — the stated position of Republicans — compared with 60 percent who supported working to improve the law.

Now to be sure, this result on repeal doesn’t necessarily undermine the 2014 strategy for Republicans, because it doesn’t say anything about the intensity behind each side’s position and it’s taken from a pool of adults living in the United States.

In other words, those who want to repeal and replace the law may be more likely to vote in a midterm election and more likely to vote based on their position on health care.

But while the short-term politics of Obamacare may favor Republicans, the more ultimate question for conservatives is not whether Republicans can win elections, but whether they can actually deliver on scrapping Oabmacare and replacing it with a market-oriented plan.

My guess is that because Republicans haven’t done a good job of articulating an alternative vision for health care, when Americans are asked whether they’d support “repeal and replace” they likely assume it means repeal and do nothing.

If Americans had a real sense of where Republicans ultimately wanted to take the U.S. health care system, they could probably have a better chance of moving some of the “work to improve the law” crowd into the “replace” category.

This isn’t to say that no Republicans have released health care proposals — many have. But those proposals aren’t really talked about outside of the policy wonk community. And they aren’t connected to a broader vision for health care.

Well before the actual details of Obamacare became known — or Obama was even involved in politics — the general vision of Democrats on health care was pretty clear. They have long wanted to exercise government spending and regulatory powers to expand access to health insurance with the ultimate goal of universal coverage.

Those familiar with free-market health care policy have known that their vision calls for policy changes that would give more power to American consumers over their own health care — a sector of the economy that’s currently dominated by government, hospitals, drug companies, doctors, employers and insurers alternately warring against or colluding with each other — and in the process bring down costs and improve access and choice. It’s a vision I outlined with a bit more detail here and a lot more detail here.

There is a big debate within the Republican universe as to whether it makes sense to put out a plan that has no chance of becoming law while Republicans are out of power. As the argument goes, such a plan could be used to attack the GOP, thus distracting attention from the flaws of Obamacare and making it harder for them to ever gain power and be in a position to revise health care policy.

But that view isn’t incompatible with the view that Republicans should be better about painting a broad vision of what they’re for when it comes to health care policy, rather than merely focusing on the problems with Obamacare.

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