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GOP's "Second Opinion" on Health Care Same as First

May 14, 2010

Back in March, Senate Minority Leader Mitch McConnell announced his party's fall campaign to undo health care reform, declaring, "I think the slogan will be 'repeal and replace', 'repeal and replace.'" But a funny thing happened on the way to November. Surveys from Kaiser and Deloitte showed Americans strongly supported individual provisions of the new law, while Republicans' own polling revealed independents hated "repeal and replace." This week, an NBC/Wall Street Journal poll showed Americans want to give the new law a chance by a 55% to 42% margin. So the GOP is rolling out a new slogan on health care: "Second Opinion." Unsurprisingly, it's the same as their first.
While there are only so many ways to say "no," the Republicans are committed to trying to find new ones. Roll Call described the effort:

A group of Republican Senators who played key roles in the yearlong fight over health care legislation met Thursday in Minority Leader Mitch McConnell's (Ky.) office to discuss the strategy. Under the slogan "second opinion," Republicans plan to communicate their message on multiple fronts, including on the Senate floor, in press conferences, via the Internet and through television and radio appearances.
A Republican Senate aide described the effort as intended "to draw attention to the consequences of the health care law that the White House hopes people miss."

This latest Republican effort takes many forms. Senators Coburn (R-OK) and Barrasso (R-WY) launched the "Senate Doctors Show" Facebook page to promote the "Second Opinion" campaign. (It's also just one of the many fronts in the GOP war to block the nomination of the highly respected Donald Berwick to head the Centers for Medicare and Medicaid Services.) Under the leadership of Tennessee's Lamar Alexander, the GOP Conference has also rolled out a "Second Opinion" web site to aggregate Republican talking points and favorable press coverage.
Wyoming's physician Senator John Barrasso is the front man for the campaign. (Barrasso was probably the best choice among the Republican doctors in Congress, given Charles Boustany's malpractice woes, Tom Coburn's C-Street shenanigans and fears of rampaging lesbians in Oklahoma's high schools, and Tom Price's disdain for Medicare.) As Roll Call detailed:

Sen. John Barrasso (R-Wyo.), an orthopedic surgeon and key player in the health care debate, has not halted his criticism of the new law in the weeks since it was enacted. Barrasso, who coined the "second opinion" slogan, participated in Thursday's strategy session in McConnell's office.
"I've gone to the floor every week for the last four weeks and given a doctor's second opinion of this health care law because at least every week something that I predicted would happen has actually happened," Barrasso said, citing a new Congressional Budget Office report estimating that the health care overhaul could cost an additional $115 billion.

The operative word here is "could." As Ezra Klein documented in the Washington Post:

That's true, at least in the first decade. But it's all about that "if." Aside from $10 or $20 billion of administrative costs, the estimate is based on items that are not currently funded and that may not ever be funded. It's up to the appropriations committees to make those decisions, and we don't know what decisions they'll make. Moreover, because discretionary spending is limited, new programs tend to compete with old programs (i.e., appropriators decide to spend $2 billion on a demonstration project in Medicare and take that money from somewhere else, which means net cost to the deficit is zero). So CBO doesn't count potential discretionary costs because they may or may not be real, just like it doesn't count savings that may or may not happen, because they can't be projected with any sort of certainty.

Klein offered a similar analysis when Republicans latched onto an April CMS assessment that national health care costs would increase under the Democratic plan signed into law by President Obama. As Klein noted, the Center for Medicare Services only forecast out to 2019, after which health care cost increases begin to decline:

CMS is looking only at the spending side. And here's what it finds: In 2019, implementation of the Affordable Care Act will reduce the ranks of the uninsured by 34 million people and increase nation health expenditures by 1 percent.
One percent.
And that 1 percent is actually 1 percent and falling: When the legislation is fully implemented in 2016, the spending increase will be 2 percent. But cost controls kick in over those years and bring it down to 1 percent. Assuming the trend holds, the second decade will see national health expenditures fall below what spending would've been if the bill hadn't passed. So that's the bottom line of the report: We're covering 34 million people and come 2019, spending is expected to be one percentage point -- and falling -- above what it would've been if we'd done nothing.

And nothing is exactly what Republicans wanted to do about health care. We don't need to hear their second opinion on the topic. It was the same as their first diagnosis. For Republicans, no means no.


Jon Perr
Jon Perr is a technology marketing consultant and product strategist who writes about American politics and public policy.

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