Netanyahu on Iran: Sounds Like Cheney on North Korea

I didn't really follow Netanyahu's speech to Congress, but since everyone else is talking about it, so I might as well throw in my two cent's worth.  His (predictable) point is that the US should not agree to the current deal under negotiations because it allows Iran to have some uranium enrichment capacity, even if it is quite limited and subject to arms control inspection, because allowing Iran any uranium enrichment capacity whatever is an existential threat to Israel.  This argument is not surprising, because it is the one hardliners have been making from the start.  

The obvious question is, compared to what.  Netanyahu apparently said that really, if we just hold out a little longer we can get a much better deal, in which Iran agrees to no nuclear enrichment whatever. Of course, there is no evidence whatever that if we just take a somewhat firmer line, Iran will give us everything we want.  Or, as this article says:

He defines “a much better deal” as a deal that doesn’t merely freeze and inspect Iran’s nuclear infrastructure but dismantles it—completely. Furthermore, the deal should be written so that, at the end of the 10-year period, the restrictions shouldn’t be lifted unless Iran stops all aggression against its neighbors, stops supporting terrorist groups, and stops its rhetorical threats to annihilate Israel—in short unless Iran changes its behavior or (here’s the real upshot) changes its regime.

Um, yeah, exactly.  Wishful thinking is not a realistic foreign policy.  Realistically, the options we have are (1) whatever deal (if any) we are able to negotiate with Iran, (2) war, or (3) allowing Iran to go ahead with its nuclear program.

Some people propose regime change as a fourth alternative, but there is no evidence that it is in the cards.  Wishing the overthrow of the government is a fringe view in Iran, without any significant support (either in terms of individuals or of firepower).  Even if someone did violently overthrow the Iranian government, there is no guarantee whatever that we would like them any better than what we have now.  In short, regime change fits in the category of wishful thinking.

So, if those are the three alternatives and you reject (1), it is incumbent upon you to choose between (2) and (3).  Thus far, no one is prepared to come right out and say that they favor war.  But Netanyahu has made clear that he prefers no deal, i.e., letting Iran continue unchecked, to any deal that allows Iran to keep any enrichment capacity.

I can only assume that to Netanyahu and to many US hardliners, given the choice between cutting a deal that allows Iran some enrichment capacity but prevents it from developing nuclear weapons and having no deal at all and Iran actually developing nuclear weapons, they would opt for the second because at least they would have the comfort of knowing that they took a maximalist stance against Iran and were not complicit in the bad outcome.

All of this feels familiar.  In fact, take out the name "Iran" and put in "North Korea" and it sounds very much like the debate we were having about a decade ago over any sort of deal with North Korea.  Bill Clinton had cut a deal with North Korea that we would give them various goodies in exchange for shutting down its plutonium reactor and inviting in weapons inspectors.  Hardliners of the same type denounced the deal as capitulation to blackmail.  When Bush came to power, he made one of his top priorities ending this deal.  Nor was he willing to negotiate a new one.  "We don't negotiate with evil.  We defeat it, " said Cheney.  And listening to blog discussions, there is no doubt to my mind that to many people, not submitting to blackmail and not paying protection money was a whole lot more important than actually keeping North Korea from getting a nuclear bomb.  And when North Korea did, in fact, set off a nuclear bomb, they weren't too happy about it (of course), but they
ultimately regarded the outcome as secondary.  An unyielding stance was a whole lot more important.

So, in the end, I can't do much better that cite and link to this column from the time.  Many paragraphs you can simply cross out North Korea and write in Iran and it will seem just as fresh today:

The Agreed Framework has been criticized on several counts. First, some people say that we allowed ourselves to be blackmailed by North Korea. This is true. However, given a choice between (a) shutting down North Korea's plutonium program in exchange for giving it some fuel and some nuclear plants that can't be used for nuclear weapons, and (b) letting it go forward with its plutonium program, I think that (a) is just obviously a better alternative. Paying blackmailers is never an ideal solution, but sometimes it's the best option you have.
. . . . . . .

To say that the fact that North Korea cheated on the agreement shows that the agreement was not worthwhile, you have to . . . think that the difference between a North Korea that works for years without being able to get enough uranium for one bomb and a North Korea that can extract enough plutonium for six bombs in twelve months doesn't matter.
. . . . . . . .

[T]he Cheney policy of not negotiating with evil is absolutely silent on the question: what alternative approach should we adopt? This would be fine if not negotiating with evil somehow caused its defeat: then we could simply wall ourselves off from all the evil countries in the world and wait for them to crumble under the crushing weight of our non-engagement. . . . The Cheney/Rumsfeld camp claims that they have a policy: regime change. . . . Well, I could declare that my policy will henceforth be to win the lottery, secure world peace, and cure cancer; but in the absence of any actual plan for achieving these goals, this wouldn't be a policy at all. It would just be a bunch of meaningless words. Similarly, like Cheney, Rumsfeld, and Bolton, I wish the regime in North Korea would change as soon as possible. It's vile, oppressive, and a danger to its own people and to the world. I wouldn't describe myself as having a policy of regime change, though, since I have no idea what I can do to bring regime change about. I don't see how that their commitment to regime change is any more a "policy" than mine.

Only one thing need be added.  Any time you tell a foreign government that you consider its existence unacceptable and that no deal is possible unless it ceases to exist, you can expect this maximalist policy on your part to be met with equal maximalism on theirs.

All things things need pointing out.

Gaming Out What the Supreme Court Will Do

All legal analyzes of King v. Burwell, the case that is challenging the Obamacare subsidies, rest heavily on the 1984 case of Chevron v. Natural Resources Defense Counsel, a case about whether the Clean Air Act authorized certain regulations being passed by the EPA.  The details are unimportant. Two things are important.

First:  This case developed the Chevron test for the validity of an agency regulation.  The court will look at the statute authorizing that agency to make the regulation to see if there is an ambiguity in it. If the statute is unambiguous, then the agency must follow the unambiguous will of Congress.  If there is an ambiguity, and if the agency's interpretation of the statute is plausible, then the court will defer to its interpretation.

Second:  This approach is widely seen as necessary for the whole regulatory state to exist.  If the courts claimed that their interpretation of a statute supersedes the agency interpretation, then agencies could be paralyzed, never knowing if their regulations will be overridden.

There are at least two rationales for this,  One is that the courts are generalists, interpreting all statutes, while regulatory agencies are specialists who interpret only one statute and therefore have greater expertise in their narrow area than courts.  The other is political.  In the case of Chevron, for instance, the EPA had changed its regulations (and, by implication, its statutory interpretation) when Reagan replaced Carter in the White House.  The theory is that regulatory policy changes with who was most recently elected President, and the courts should defer to the people's will, as embodied by presidential policies.

King v. Burwell turns on a phrase in the Affordable Care Act (ACA, the official name for Obamacare) that makes subsidies available to people buying health insurance on an "exchange established by the states."  There is no mention of the federal government.  However, the IRS (which administers the subsidies) passed a regulation allowing subsidies on federal exchanges as well.  So the question is whether the statute is ambiguous as to where it allows subsidies and, if so, is the IRS interpretation reasonable.  Going by that single phrase, the statute appears to unambiguously limit subsidies to purchases on state exchanges.  But things are not that simple.  Also taken into account is the context of the phrase in the complete statute, the purpose of the statute, and legislative history to determine legislative intent.  And if the phrase in isolation appears to limit subsidies to state exchanges, the broader statute, its general purpose, and legislative history all point in the opposite direction.

All of which means the Supreme Court has three main options:

1. It can say the statute is ambiguous and the IRS interpretation is plausible, so subsidies are allowed on federal exchanges.
2. It can say that the statute unambiguously limits subsidies to policies purchases on a state exchange.
3. It can strike down Chevron altogether and say that from now on, court interpretation of statutes trumps regulatory agency interpretation.  

Since many right winger/libertarians in this country (including some on the Supreme Court) see our whole regulatory state as constitutionally and morally illegitimate, this might look like a fine opportunity to destroy it altogether.  But the general consensus is that the regulatory state is too well entrenched to overthrow at a single stroke, so the Supreme Court would stop short of that, much as it might be tempted.

So I can make a pretty good guess what seven of the nine Supreme Court justices will say in King v. Burwell.

The liberal contingent (Ginsburg, Breyer, Sotomayor and Kagan) will hold that the statute is ambiguous and the IRS interpretation is plausible, so people buying insurance on federal exchanges can keep their subsidies.

Scalia and Thomas will call for overturning Chevron altogether and striking a death blow to the unconstitutional and immoral regulatory state.  Scalia will say this because he knows he is outvoted and there is no chance of his measure actually passing.  Thomas, by contrast will be completely serious.  Regulatory agencies were not part of the state at the time the Constitution has passed; the Constitution was never amended to allow such agencies; therefore they must go, consequences be damned.

Alito will uphold Chevron but say that the statute unambiguously limits subsidies to state exchanges. This is a longstanding game the Supreme Court conservatives have.  Roberts, Alito and usually Kennedy vote in favor of the conservative policy preference, but limit their opinion to the case at hand and avoid sweeping implications.  Scalia and Thomas like to issue opinions that reach the same conclusion on the issue at hand to Roberts and Alito but have sweeping policy implications.  Being sure you are outvoted can do that.

The judges I can't place are Roberts and Kennedy.  They may join with Alito.  Or they may rule that Congress unambiguously intended withhold subsidies from federal exchanges in order to coerce states into making exchanges, but the attempt was unconstitutional because Congress failed to give the states adequate notice.  That will be a brilliant way to square the circle and mask a substantive defeat as a procedural victory.  It will accept the Republican interpretation of the statute and declare part of Obamacare unconstitutional, but avoid the messy consequence of stripping millions of their subsidies and putting Congressional Republicans on the spot to do something about it.

But I am inclined to think that one or the other will join Alito.  There were, after all, four votes to hear King, which almost certainly means four votes against the subsidies.  The fifth vote (whether Kennedy or Roberts) is the real wild card.



Follow up question:  Suppose the Supreme Court upholds the IRS regulation.  What is to keep our next Republican President from issuing an IRS regulation limiting subsidies to state exchanges? Politics, basically.  The overall lessons of the last six years of gridlock are as follows:

1. People give the President credit or blame for just about everything that happens on his watch.
2. In case of gridlock and obstruction between the President and Congress, people blame the President.
3. If Congress tries to force something over and there is a showdown, people side with the President and blame Congress.
4. If problems obviously started under his predecessor, people will give the President a certain grace period to get it right.

Now if a new President comes to power and issues a new IRS regulation stripping millions of their health insurance, that decision will be unpopular.  And everyone will know who to blame.

Averting Catastrophe: How to Pass It

All, right, so substantively, I would favor restoring Obamacare subsidies permanently in exchange for (say) repeal of the employer mandate and medical equipment tax, or a temporary extension to give Republicans time to come up with something better.  But politically, how do you get it to pass?

Personally, I would recommend something like the following:  Representatives of Obama and the Republican leadership in the Senate and House meet in maximum secrecy and work out a deal. Republican leaders call a press conference to announce it.  Obama denounces it as an intolerable outrage and vows to fight it at all costs.  He rallies liberal activists (some in on the joke, most not) to lobby against it.  Tea Party leaders are definitely not in on the joke, but do figure out that any system that keeps the subsidies flowing will, in fact, keep Obamacare alive.  Most people, however, don't much care about the details so long as millions are kept from losing their health insurance.  Moderate Democrats and Republicans join ranks to pass the measure.  Seeing no alternative, Obama "capitulates" and signs the thing.  Liberal activists grumble, but eventually figure out that they got most of what they wanted.  Moderate Democrats are just relieved the whole thing is over.  Moderate Republicans rejoice over their procedural victory, but eventually figure out that it was a substantive defeat.  The Tea Party says, "I told you so."

If that calls for too many conspirators keeping quiet to be workable, we can always go with our old standby.  Republicans pass a purely symbolic, meaningless repeal in the House.  Maybe Democrats filibuster it in the Senate.  Maybe they let it pass so Obama can veto it and denounce it as an attempt to strip even more people of their health insurance.  Maybe Senate Republicans figure out that responding to eight million people losing their health insurance by passing legislation to take insurance from even more is really bad politics and let the thing drop.  Someone in the Senate comes up with a reasonable compromise that either temporarily extends the subsidies or permanently extends them in exchange for something else.  Ted Cruz denounces it as the end of all liberty and little short of a Communist dictatorship.  But Obamacare advocates keep parading stories of cancer patients having their health insurance yanked and Obama makes speeches about how this can be resolved with a one-line bill fixing a typo.  Enough Senate Republicans defect to pass the measure.

In the House, the Tea Parties vows that they will allow the measure to pass when you pry their cold, dead fingers from the trigger.  John Boehner says it would be political suicide to introduce the measure.  But the pressure is building.  Republicans are caught between demands to make no compromises with the devil and pleas to restore people's insurance.  Eventually, enough defect that Boehner can introduce the measure pass it with mostly Democratic votes.  This one really might cost him his speakership.

But in the end, the Republicans may learn the hard way that stripping millions of their health insurance is a very poor hill to die on.  And restoring it just might we worth the sacrifice.

Republicans' Real Problem with Health Care (and Education and Everything Else)

Here is the Republican Party's real problem.  It holds some views that, if put into actual practice, would be highly disruptive and cause, at a minimum, serious short-term suffering.  It has a substantial base of followers who adhere to its views as an abstract proposition.  But there are a whole lot fewer who are prepared to deal with the real world consequences.

This, I think, is what underlay the 1995 government shutdown.  The Republicans won the 1994 election by denouncing government as an evil monster, crushing liberty under its iron heel and draining our life blood while giving us nothing in return.  It proved a highly popular campaign.  So naturally Republicans assumed that if government was an evil monster, crushing liberty under its iron heel and draining our life blood while giving us nothing in return, shutting down this monstrosity would be popular.  And as for any inconveniences involved, well they would be a small price to pay for freedom.  Its supporters, by contrast, assumed that if government was an evil monster, crushing liberty under its iron heel and draining our life blood while giving nothing in return, shutting it down would not be accompanied by any serious inconvenience.

And such has been the Republican Party's dilemma ever since.  The share of the population that regards the government as an evil monstrosity that should be crushed to dust with a jackhammer is a good-sized voting bloc -- about 30% of the population.  The share of the population that is prepared to tolerate even a minor inconvenience in pursuit of this goal is a lot smaller.  And the share that is willing to suffer serious inconvenience like, say, the loss of Medicare is minuscule.

Or consider Governor Sam Brownback of Kansas.  He was elected on a promise to make deep cuts in taxes.  And he did.  Now everyone is shocked, shocked that the tax cuts have led to massive deficits and are forcing major cutbacks on education.  To which I can only say, well, duh!  Haven't you ever heard of Starve the Beast.  Republicans have two rationales for why taxes should always be cut.

1. Supply side economics.  Tax cuts will spur such growth that revenue will increase and on spending cuts will be necessary.
2. Starve the beast.  Tax cuts will choke off revenue, precipitate a fiscal crisis, and finally force spending cuts.

Granted, they can't both be true.  But they can be a game of heads I win, tails you lose.  Either way, tax cuts are justified.  It's just that when the beast starts getting really hungry, announcing that your plans to starve it tend to be unpopular.  Quite simply, Brownback has plenty of backers -- some libertarian, some Evangelical Christian -- who consider public schools illegitimate and want to starve them.  (Evangelicals so churches can run the schools and libertarians so anyone but government can run the schools).  But now that it is beginning, apparently no one has the courage to come right out and say so.

The parallels with Obamacare are obvious.  Republican wonks/think tanks/donors/activists have a large libertarian contingent who believe that government providing paying for anyone's health care (except possibly through county indigent funds) is absolute evil.  There is some disagreement whether the evil because it "enslaves" recipients by fostering dependency in them or because it "enslaves" taxpayers by forcing them to pay for healthcare (which is functionally no different from dragging them from their beds in the middle of the night and forcing them to empty bedpans at gunpoint).  But either way, government paying for anyone's healthcare is morally unacceptable and must be stopped.  Stripping millions of their health insurance is acceptable because in the long run, the free market will come up with something better.  And we are all dead in the long run and loss of health insurance means the long run will come sooner for some people -- well, either you are better off dead than enslaved by dependency, or whether you live or die is less important than not allowing you to enslave taxpayers.

But this is stronger medicine than most people, including much of the Republican base, are prepared to take.  Or to impose on others.  And the proof of this is in the behavior of Republican state governors.  Many Republican governors have refused the Medicaid expansion.  But invariably they have given some sort of excuse like fear that it will strain the state budget in the future.  None have come right out and said that they don't want anymore poor people to have health insurance, or that poor people are better off dead than dependent.  Likewise, governors who have refused to build exchanges have given a wide variety of excuses, but keeping people from getting insurance has never been one of them.  You don't hear the governor of Tennessee calling a press conference to boast that while Kentucky has seen its rate of uninsured fall by half, Tennessee has widely avoided that horror. Nor do you hear Sam Brownback boast that his modifications to Medicaid have actually increased Kansas' rate of uninsured.  Or when Texas was cutting off funding to Planned Parenthood, no one ever boasted that they were cutting off women's access to healthcare; rather the response was to deny it.

In short, the Republican Party lacks the courage of its convictions, or at least the courage to speak them out loud in public.  Instead, it prefers to deny even the most obvious consequences of its actions.  And there is one serious problem with ignoring reality.  Reality won't go away just because you pretend it isn't there.  If your most cherished initiative is an attempt to strip millions of their health insurance, don't be surprised that if it succeeds millions lose health insurance.  Or that you find yourself under immense pressure to do something about it.

Republican Alternatives to Obamacare

It would be false to say that the right wing leadership lacks a firm consensus on healthcare policy. Quite the contrary, the Republican Party, its donors and activists, libertarians, right wing think tanks, and the right wing press unanimously share the same view on healthcare policy.  They are opposed to it.

There is some disagreement on how far that opposition should go.  Should be simply end all government role in healthcare?  Does government have a legitimate role in the form of county indigent funds and limits on medical malpractice suits?  Should we recognize that such sudden measures are too painful and launch a gradual rollback of Medicare and Medicaid by turning them into something that looks a lot like Obamacare?  Should we see Medicare and Medicaid as morally and constitutionally illegitimate but irreversible and simply seek to keep the rot from spreading?  Or should be embrace government coverage for people over 65 and limit ourselves to keeping anyone under 65 away from the party?  All of these viewpoints would agree that Obamacare must go, no matter how many people lose coverage as a result.

The trouble is that while the right wing leadership may hold such views, the Republican followership is much more likely to see Obamacare as an evil monstrosity that has to go, so long as no sympathetic person actually loses insurance as a result.  In other words, now that people have insurance, simple repeal is out, as is repeal and replace.  Republicans' only hope is in replace and repeal.  And this means they have to have a healthcare policy, despite it being against their absolute principles.  And when people who are ideologically opposed to healthcare policy are forced by circumstances to come up with one, this can lead to disagreement on how far political reality can be accommodated without losing one's ideological bona fides.

It is much easier to be opposed to healthcare policy.  Since every heathcare policy has losers as well as winners, one simply takes the part of the losers.  But coming up with their own forces policy makers to pick winners and losers of their own.  And, as the Republicans know all to well, it is easier to rally potential losers against a policy than potential winners in favor of potential benefits.

To the extent that Republicans are forced to have a healthcare policy their most important principles are:

1. Expenditure must be minimized;
2. Government regulation must be kept to a minimum, or at least less than under Obamacare;
3. The best way to minimize expenditure is to cover as little as possible and make people pay for more of their own healthcare.

The question is whether such plans would be politically palatable.  This article contains more details.  Most plans provide financial assistance to fewer people, cut it off at a lower income level, reduce the package of benefits insurers are required to cover, give insurers greater leeway to increase fees for older customers, and replace Medicaid with subsidies to buy private insurance.

None of these measures are likely to be popular, and Republican constituencies in particular are apt to dislike many.  They also show how easy it is to be unprincipled as an opponent, and how difficult to stake out an actual position.

Consider:  

Republicans were great champions of high deductibles and narrow networks, until Obamacare started offering a lot of plans with high deductibles and narrow networks and these proved unpopular, at which point Republicans started denouncing them as an outrage.  

Republicans were champions of young people who saw their premiums increase while older customers saw them decline.  The unregulated workings of the free market provide great rates for healthy young men; clearly the rates charged healthy young men were the most important trait in any healthcare system.  But faced with the prospect of lower rates for younger customers and higher rates for older customers, Republicans are apt to remember which group makes up a larger share of their base.

One obvious way to save money is to set a lower income threshold for eligibility for subsidies.  Except that will mean people getting their subsidies being cut off and being unhappy.  Worse still, lower income groups are less likely to vote in general, and to vote Republican in particular than more middle income votes, which does not bode well for anyone proposing to lower the income threshold for subsidies.

Alternately, some Republicans propose to allow subsidies to buy policies on the exchanges, but allow states to opt out of the regulations, such as the mandatory package of benefits, the individual mandate, and the ban on discriminating against pre-existing conditions.  Well, I think we dismiss this last.  Getting up and fighting for the right of insurance companies to exclude people with pre-existing conditions is a good way to commit political suicide.  Allowing states to end the individual mandate simply means allowing states to induce a death spiral.  Inducing that death spiral is one of Republicans' favorite ways of killing Obamacare on the theory that so long as they avoid short-term catastrophes, they can shift the blame to Obama.  I think any Republican seeking to induce a death spiral should be confronted with some tape of policymakers or wonks describing the strategy and forced to explain exactly why they want people's premiums to spiral out of reach.  It could be entertaining watching them squirm.

Finally, although I could not find the link, many others are still digging up old proposals to end the tax subsidy for employer-based insurance.  Look, basically all wonks, liberal, conservative or libertarian, agree that basing health insurance on employment was a mistake and it would be better to somehow separate the two.  But the vast majority of the population are not wonks.  One of the Republicans' favorite schemes in opposing Obamacare was leading people to believe it would mean the end of their employment-based insurance.  And, indeed, many people were suitably alarmed. So if Republicans are preparing to do just that -- well, let's just say I look forward to them getting a taste of their own medicine.

The Political Disaster of the 18 Month Extension, Or Demagogues Wanted, Quantity Valued Over Quality You

So, one Republican proposal if the Supreme Court cuts off the subsidies is to extend them for another 18 months to give Congress time to come up with an alternative.  The Supreme Court is expected to come out with its decision in June.  That will make 18 months fall around the beginning of 2017. This has the advantage (from the Republican perspective) of kicking the can down the road until after the next election.  It has the distinct disadvantage of requiring action to be taken immediately after the 2016 election.  Which will, in turn, make "what next" a major election issue.  That is bound to be awkward.

As Democrats have learned the hard way, proposals to change the healthcare system tend to run into a lot of resistance.  People fear losing what they have and want to hold onto it.  And, this proposal would make Democrats, probably for the first time, champions of keeping what we have the Republicans the ones who threaten it.

But Obamacare remains unpopular, you may say.  Running in favor of it is a surefire loser.  It might start to look different, though, if ending Obamacare starts to mean in any concrete and realistic way stripping millions of their health insurance, as it will is the Supreme Court cuts off the subsidies.

If the Supreme Courts decides against the subsidies and Congress passes an 18-month extension, the question of what next will loom large in the election. Democratic candidates will simply say that they favor making the current extension of subsidies permanent so things can continue as they are, and then go on to paint in lurid detail all the things Republicans are threatening to disrupt if they win out. Republicans will have grave difficulty offering any sort of coherent answer.  And any Democrat with an ounce of sense should be able to dig up any number of quotes (or better recordings) of, if not candidates, then top Republican policy wonks or advisers talking about their eagerness to induce a death spiral and cause insurance rates to spiral out of everyone's price range and force the Republican into embarrassing disavowals.

Some article (which, alas, I can no longer find) says that, except in the unlikely circumstance of Democrats winning the triple crown in 2016, an 18-month extension will almost certainly end up leading to an endless serious of 18-month extensions, rather like extensions of the debt ceiling or of adjustments to Medicare reimbursement rates.  I am inclined to agree.

On the subject of Greece, I said that in case of the Grexit, Greece will need a first rate team of economic advisers to manage the devaluation and a top-notch demagogue to convince people to endure the ensuing hardship without an explosion.  As for US health insurance, I can only say to the Democrats that if the Republicans hand you this prize, any fourth-rate demagogue should be able to make hay out of it.  You just need to ensure that you have at least one in each election.

Why "Repeal and Replace" Just Doesn't Cut It

The Republican mantra on Obamacare has always been "repeal and replace."  That was never going to happen.  If Republicans had won the triple crown in 2012 they would simply have repealed with a vague promise to replace and some undefined time in the future.  The replacement would never have come about, the old system would have continued, and not much would have happened.  Republicans have never actually wanted to replace, and before the system came on line in 2014, there was no real pressure to do so.

Since the system came on line, Republicans are facing a whole new reality.  "Repeal and replace" is no longer viable.  Consider.  Suppose the Republicans win the triple crown in 2016.  Suppose their first action is to finally repeal the monstrosity that is Obamacare in its entirety.  That will mean stripping as many as 20 million people of their health insurance.  Suppose they then tell the people who have lost their insurance, "Don't worry, we will have a replacement for you soon.  It should come online in another two to three years."  My guess is that the next election would not go well for them!  Since Obamacare has come on line, "repeal and replace" has to be exchanged for "replace and repeal."  Getting a new system up an running takes time -- typically about two to three years. (Obamacare passed in 2010 and did not actually insure anyone until well into 2013).  Unless Republicans are willing to strip some 20 million people of their health insurance and face the electoral consequences, they will have to tolerate it until their substitute is up and running.

And at that point, they run into trouble yet again.  First of all, Republicans don't want to come up with an alternative to Obamacare.  They want to minimize the role of government in healthcare.  How many people lose their insurance or are otherwise harmed makes no moral or ideological difference. In fact, I am sure that many people in libertarian think tanks would be quite happy simply to destroy Obamacare (and, if they could, Medicaid and Medicare as well) and replace it with nothing. To all the people who lose their health insurance as a result, they would offer the comfort that in the long run the unregulated free market would come up with something better.  Of course, in the long run we're all dead, and for some people losing their health insurance is apt to make the long run come a lot faster that it otherwise would.  Which means that the people who lose their health insurance make a political difference that Republicans are just going to have to cope with.  And if the Supreme Court rules their way, Republicans will have to come up with a solution, and fast.  So what are the options?

This article suggests five:

1. Fix the glitch and continue the status quo;
2. Fix the glitch in exchange for some other concession;
3. Allow the system to crash;
4. Repeal and replace;
5. Build an off-ramp (which sounds a lot like replace and repeal). 

One is out of the question because Republicans are unwilling to simply save Obamacare without getting anything in return.  Three is extremely dubious.  The pressure to do something is going to be overwhelming.  Four, well, as I have said, repeal and replace is not going to cut it.  It will have to be replace and repeal.  So that leaves either two or five.  

I have no objections to the second option, i.e., a quid pro quo, so long as the deal does not threaten the survival of the whole system.  The Republicans do control both houses of Congress, after all.  The people voted Republicans a landslide just a few months ago.  These facts have to be taken into account.  A certain amount of horse trading is appropriate here.  I would favor exchanging fixing the glitch for repeal of the employer mandate and the medical devices tax.  

As for the  exit ramp a/k/a replace and repeal, the devil (as always) is in the details.  The article  quotes Republican wonk Ramesh Ponnuru as proposing to allow states to opt-out of most of the requirements of Obamacare, including the employer and individual mandates, the requirements that insurance companies provide a wide range of benefits, and the ban on rejecting customers for pre-existing conditions.  That last is going to be a surefire political loser.  As for the rest, I will discuss them in substance later.

A related proposal is to extend the subsidies for another 18 months to give Republicans time to come up with an alternative.  Obviously the substance of such a proposal would depend on what (if anything) Republicans come up with.  But the politics of it are disastrous, as I will discuss shortly.  

What I oppose (and most fear) is Republicans refusing to take anything less in exchange than repeal of the individual mandate.  This will mean exchanging rescuing Obamacare in the short run for sacrificing it in the long run.  It will also be popular, since the individual mandate has always been the least popular part of the statute.  It may be popular enough to peal off large numbers of Democrats.  And (I suspect) it will reverse the perceptions of hostage taking.  If Republicans refuse to restore the subsidies unless the whole law is scrapped, states are allowed to let insurance companies exclude patients with pre-existing conditions, or something else unpopular, they will once again look like they are taking hostages.  But if Obama announces that he will veto any extension unless it leaves the individual mandate in place, it will look as if he is taking hostages.  This is based on the assumption that the people do not automatically support the President in a showdown with Congress and see Congress as the ones taking hostages, but automatically see as hostage takers the side that is insisting on something substantively unpopular.  Refusing to extend subsidies is substantively unpopular, and tying it to an unpopular or even neutral deal will look like hostage taking.  But the individual mandate is also unpopular, and tying it to allowing the extension to go through will also look like hostage taking.

Republicans are not the only ones with good reason to pray for the Supreme Court to uphold the subsidies.