If we only had a genuinely moderate-to-conservative Republican as President, we might have a rational approach to health care reform. This Republican President would approach health reform in the following way:

1. Tell the public that health reform was a fiscal/budget imperative; if we didn’t "bend the cost curve" the federal deficit would explode and their premiums would rise without limit.

2. Demand that any reform be "budget-neutral," and set an arbitrary limit on "costs," irrespective of what it did to the total national health expenditure per person; but do nothing to regulate premiums; extract the revenues by directly or indirectly reducing payments/benefits to current health care recipients.

3. Sympathize with the goal of providing everyone with insurance, and list it as a goal, but not consider any government-based framework that could actually achieve it.

4. Create a "market" mechanism to expand insurance to the uninsured, and funnel federal subsidies for that exclusively through private insurers; claim it enhances "competition," but prevent any public alternative that might put at risk channeling those $$ trillions exclusively through private insurers, and avoid "unreasonable" limits on how much they could skim off the top.

5. Work to ensure private insurers had sufficient flexibility in defining what acceptable coverage was to protect their profitability, irrespective of its effect on those required to purchase their products.

6. Emphasize efforts to "cut costs" and save money, while cutting private deals with drug makers, hospitals and other providers to limit their exposure to cost-cutting mechanisms; delay the effective date and the scope independent commissions and "pilots" designed to reduce payments to providers.

7. Shield all private industries — insurers, manufacturers, hospitals, providers — from competition, anti-trust enforcement or further price regulation.

8. Convince Democrats/liberals/progressives that this was their only chance at health reform — and make it "their bill." Work hard to increase the intra-party split and anger this would cause.

9. Claim credit for enacting "health care reform."

10. Let the Congressional Democrats take the hit in the mid-terms, as the Republican demogogued the bill’s already egregious features to help recapture one or both houses.

Seems a plausible strategy. I’m surprised no one has thought of it.