What can Republicans do in the next four years?

I see no reason why Obama's health care drive can't be stopped. The partisan makeup of Congress is very similar now to what it was in 1993, and we were able to stop Hillary's big push for it then. Obama will learn from Clinton's mistakes, but we have greatly refined our own alternatives, and have more conservative GOP caucuses in each house of Congress. Health care nationalization is an enormous and complicated undertaking with lots of thorny problems. Getting most of the congressional Democrats behind a single plan will be very difficult. No matter what they do they will have many members of their caucus upset that they are going too far or not far enough.

They will also have a huge problem figuring out how to pay for it. They haven't dared to push a sizable tax increase since 1993, and pushing one to pay for health care will make the program far less popular. And with deficits already skyrocketing and tons already being spent on the stimulus and various bailouts, just charging it up will also be difficult.

Plus there are a bunch of tricky ethical issues to address. For example, one of the key reasons Hillarycare failed was because the Dems had several dozen members refusing to vote for it if abortion was not included, and another few dozen refusing to vote for it if it was. They needed both groups to push the bill through but couldn't resolve the impasse.

Certainly stopping a major expansion of government control over health care will be difficult, but it is very possible. Stopping it should be a very high conservative priority.

 Jon, this is very, very good.  A couple thoughts in response:

1) Regarding the principles of freedom, free markets, and limited government, not only do Republicans have no viable strategy to act upon them as you point out, but there is a widespread perception that Republicans only give lip service to these principles and actually do violence to them.  The last 8 years has seen everything but limited government and the GOP has become identified with efforts to "supervise" our personal lives including (apparently) our relationship with God.

2) Inflation, mostly like sustained high inflation, is a likely consequence of present policies.  If so, this should create an opportunity for the GOP if it acquires the adequate intellectual capital and operational strategy to exploit the issue.  If inflation accelerates in the next few years, the problem won't be that it is overstated; rather, the government will understate it and lie about it as they did in the '70s.  The population will know better, thus creating a potential opportunity.

1. If you look at the record you see that Hillary Care's largest stumbling block was the requirement that any medical professional or hospital who accepted geovernment payments would be prohibited from providing private pay services.  The liberals saw this as a mechanism to prevent "one health care system for the poor and one for the rich."  The middle class saw it as a barrier to getting the health care they wanted when they wanted it.  If Clinton had been willing to yield on this one point, we would have had universal coverage in 1993.  Reid and Pelosi will probably stick with the class warfare argument; but, Obama and Emanuel are much more pragmatic and will go for the win.

2. We were coming out of a recession in 1993, not going into one.  People were a lot more confident about their own ability to cover health care costs and the stability of their employers' health care plans.

3. For a wide variety of reasons, health care costs have risen much faster than inflation.  In 1993 most people recognized that a major illness or injury could seriously dent thier savings and the extended nursing coverage usually required just prior to death could deplete their childrens' inheretence but the first event was seen as relatively rare and the second as a part of life.  Today, even a moderate illness or injury could wipe out years of savings already ddepleted by the economy and preventive care is only affordable if you are covered by a good insurance policy. (Yeah I know contributing to an HSA would allow a person to save a couple thousand a year if they can find it after paying all their other bills.  My preventative cardiac tests ran close to $14,000 in a matter of a week.  Make the HSA pitch to someone who has delt with real medical bills and they roll on the floor laughing.)

Nevertheless, Republicans can and should fight hard to maintain choice, accountability and responsibility through several mechanisms.

First, there must always be aprivate pay option available.  Take the heat on the class warfare nonsense and insist it is a fundamental right of a doctors, hospitals and patients to make whatever private arrangements fit them best.  The fact a doctor has 20 government patients should not prohibit taking on private patients as well.  Nor should the fact a patient has recieved government health care prevent them from supplementing it with private care.

Second, push hard for single payer/multiple provider where universal coverage is achieved through a refundable tax credit that allows individuals and families to purchase health insurance through the private sector.

Three inist that HSAs combined with high deductable health insurance is part of the mix.  It is not a pariticularly good deal but it should be an option for those who want it.

Four, fight hard against including the government as a direct provider of either health care or health insurance.  There is no need for a government plan with single payer/ multiple provider and we can make the argument it would only waste money and become the "health care for the poor" option the class warfare clowns rage against.

Five, oppose any and all requirements that health care providers and/or insurance companies cover procedures that violate their religious convictions (abortion).  Insist on the rights of religious groups to band together to operate hospitals and insurance companies.

We can win these points, if not in Congress than in the public's opinion.  Our choice is to be percieved as the know-nothing and do-nothing party or as the sane sensible alternative party.

I think the premise of your post has gotten the Republicans in the spot they find themselves.....universal healthcare or nothing at all. Why is that the case? Obama is already on record as not wanting to go as far as Hillary with mandates...why not reach out and try something different? Healthcare for kids up to age 12, or coverage up to age 15 or 16 (whatever age you can legally be employed).

One gets the sense that if the healthcare system was left as-is, and if it weren't for Democratic whining, Republicans could care less. What Republican considers health care reform his/her signature issue? This is where the "do-nothing" perception comes from in public opinion.

the south has always been in need of federal dollars... rural areas in general, and particularly Appalachia too.

Find some republicans somewhere else, or create a coalition that works there, and you can do conservative things.

I don't know about the GOP or TNR or Henke, but it wouldn't be that difficult to fight* any of those (if someone were so inclined). That would involve coming up with real questions designed to reveal the flaws in those proposals, and then going to public appearances and asking those who support the plans to answer them. If the questions are good enough, that will reveal the flaws in their proposals. And, the exchange can be uploaded to video sharing sites. For a tangible example, see this. That occurred pre-Youtube and involved someone few have heard; if it had been on video and had involved a national politician it would have had an impact on their ability to push that plan.

If people would start actually doing things, it would be tremendously effective in many ways: it would show that the promoters haven't thought things through, it would hold politicians accountable, and it would make the MSM look bad.

Yet, several bloggers who get a lot of traffic refused to back that plan, and in some cases it's been actively opposed.

Perhaps the real problem is that there's a leadership gap, or that some people don't want to attack their opponents in an effective way lest those same techniques be used against them.

If there's anyone here who can overcome that, try to engage Kirsten Gillibrand about what she now supports, and upload her response to Youtube. And, ask your leaders why they're engaging in defeatism rather than promoting plans that would work.

*UPDATE: "Fight" is meant in the "fight with all one's might expecting to win" sense rather than the McCain "I'll show up" sense.

Jon I think your points are well taken and for the most part correct. However I would challenge Republicans to actually think of what policies they would implement if they were given the majority and actually communicate this. Part of the problem during the SCHIP debate last year when Bush vetoed the bill is that we didn't have a coherent message as to why it should be defeated and we didn't offer real alternatives to deal with the problem. As a republican who has worked in healthcare I am often embarrased how we handle this issue and I think what we say resonates horribly with voters, especially women. One idea House and Senate Republicans could offer is that they would put forth legislation that would allow for interstate competition among health insurance. For example, a person in Massachusetts can buy a more affordable insurance in say, Minnesota, and therefore avoid having to pay for $400/month premiums that mandate coverage for accupuncture. I think Congressman Shadegg has a bill to this extent but it never gets passed or considered. Either way, we're losing the next few years so we might as well pull ourselves together.