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I mentioned earlier that Republicans and Democrats seem determined to run the 2010 election as a referendum on Health Care Reform. Dems say they’ll run on claims that the GOP will repeal reform if they regain control; and Republicans will run on a promise that they’ll do just that. As I’ve said, the Dems have put themselves in a tough — probably needlessly tough position — by delaying implementation several years into the future. But I think this may be more difficult than Republicans think — if the Dems play their cards right … yes, famous last words.Larry Sabato notes that there are dangers on both sides for an election on in this way since there are very popular parts of the bill — end to denial of coverage for pre-existing conditions, recission, etc — and unpopular parts, mainly new taxes and mandates. The policy reality is that you can’t have one without the other. Without expanding the risk pools — which you can only really do by forcing everybody to get insurance — you can’t force carriers to insure sick people for affordable rates. This isn’t really a complexity you can hope for from a political campaign.

But Republicans are getting a lot pressure from the right to demand total repeal. And given the nature of their opposition it will be hard to get much traction pushing for anything less than total repeal. After all, if it’s really the end of the universe, America and Apple Pie, as Republicans have been suggesting, it’s hard to say you just want to tinker at the margins. Democrats are going to need to break it up and reduce it to its constituent parts. They should be asking Republican candidates: “You really want to bring back denial of coverage for pre-existing conditions?” Do you really want to get rid of X, Y and Z? Or perhaps you flip it and just make it an assertion since anyone who wants to repeal reform by definition wants to get rid of those things too.

Given dynamics of political campaigns, I don’t think there’s any point getting into a discussion of the bill as a whole or defending the relatively small taxes. The key will be simply to trip the opposition up and get them taking really unpopular positions — wanting the bring back the most unpopular parts of the health care system or caviling and waffling over wanting repeal but not wanting to repeal parts of the bill that are only possible with the whole bill.

The key is the totalness of the Republicans position. Total repeal. This is more of an opportunity for Dems than many realize.

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