During an interview with ABC’s Top Line, Rep. Paul Ryan (R-WI) admitted that the Democrats have the “right” to pass health care reform through the reconciliation process. “It is their right. It is what they can do,” Ryan admitted.

But just because they can, doesn’t mean they should. “In order to have bipartisanship, you have to have collaboration and that means the party in power must want to willingly collaborate with the minority to actually write legislation from the beginning.” “Here in the House, there is no collaboration whatsoever. We are not invited to any meetings, we are not asked to participate in the legislative drafting of these bills,” he complained.

But as I argue here, Ryan has it backwards. While Democrats have been willing to consider dissenting opinion, Republicans are more interested in defeating reform than shaping health legislation. In fact, just yesterday “House Majority Leader Steny Hoyer (D-MD) said he plans to meet with Republican lawmakers informally this week to discuss some of the thornier parts of an effort to overhaul the U.S. healthcare system:”

Hoyer told reporters on Capitol Hill that he intends to meet with Rep. Roy Blunt (R-MO), chairman of the House Republican Health Care Caucus, this week to continue a discussion on comparative-effectiveness research and a public health-plan option—among other measures—that have proven to be sticking points between the two parties…I also believe that there is an opportunity for us to try to work together and come to an agreement on issues.’, [Hoyer said].

Meanwhile, Republicans are either reproducing the McCain campaign’s old health policy proposals or smearing progressive alternatives. The first draft of the so-called GOP alternative budget, for instance, echoed the the disingenuous attacks of Betsy McCaughey, Sally Pipes, and Conservatives for Patients Rights.

In fact, this report read like a Betsy McCaughey editorial (complete with a government-health care “horror stories” section):

- Will technological advances continue to spark cutting-edge medical treatments, or will price controls and federal regulation stifle innovation and prevent life-saving breakthroughs?

- Will doctors be able to decide the best treatments for their patients, or will government bureaucrats ration and restrict access to care in an arbitrary fashion?

- Will the federal government take action now to slow the growth of health costs and bring entitlement spending under control, or will expansive—and expensive—new government programs cripple future generations in an avalanche of debt?

- Democrats propose nearly $1 trillion in new spending on health care reform as a mere “down payment” for additional spending to come.

- In a government-run health care system, bureaucrats would exercise increasing control over all health care decision-making and would resort to rationing of care as the sole means to control skyrocketing costs. Such rationing would import not only the policies of other countries, but their horror stories.

- And while Democrats would encourage doctors not to prescribe treatments that could help their patients if a bureaucrat refused to approve it, their plan would do little to reform the skyrocketing medical liability costs that plague the American health care system.

Several reports have indicated that the GOP health care study group “plans to release a framework for overhauling the health care system.” But if this paper is any indication of the kind of serious policy thinking the GOP is willing to engage in, then bipartisanship will be difficult to come by.

Former Health and Human Services Secretary Michael Leavitt argues that a new Medicare-like public health care plan is a “trojan horse” for “government-run” health care. He fully explains the metaphor:

The story of the Trojan horse is familiar. After years of fruitlessly trying to enter the city of Troy, the Greeks boarded their ships and pretended to sail away. They left behind a huge wooden horse, which the Trojans claimed as a symbol of their victory and dragged into their mighty fortress. But the horse was full of Greek soldiers, who waited until midnight and then opened the gates for their invading army. Advocates for government-run health care are similarly pretending to sail away from “Medicare for all” or “universal coverage,” leaving before us the notion of a “public option.”

Single-payer advocates huddled in a horse, waiting only to break-out and force every American to enroll in a new public option? No…. that’s not quite it. What will actually happen, Leavitt contends, is that the public plan will do such a good job of keeping costs low that more Americans will abandon their current plans — under which they saw premiums increase by 117% over the past ten years — and choose to enroll in the new public option.

And this is supposed to be a bad thing?

Yes, because with a ‘public option’ that uses “Medicare-like reimbursement rates”, employers would bolt…the Lewin Group estimates that 118 million Americans would lose their private health insurance…no private insurance system would be able to survive, and the United States would have a government-run system like Medicare,” Levitt explains.

But why are private insurers so vulnerable to competition? Under some conceptions of the public plan, the new program could use its purchasing power to bargain with providers, but reimbursement rates that are too low would drive away providers and, by extension, consumers. The public plan would fold. In an environment where private plans are forced to compete with a new efficient public program, inefficient, over-bloated insurers will go out of business, but private plans with good networks of providers or better services will continue attracting new enrollees. In other words, the public plan may have the advantage in administrative efficiency and setting rates, but the private plans will most certainly find a niche to fill.

Also, as public plan architect Jacob Hacker explains over at The Treatment, Lewin’s findings do “indicate that the savings from having a public plan compete with private plans could be huge…[but] it has virtually no bearing on the question of how large enrollment in the public plan would be” under health care reform.

That’s because The Lewin Group study that Leavitt cites, “looked at a hypothetical proposal in which employers could buy into a national public plan by paying the plan’s premium. What’s more, in the hypothetical proposal that the Lewin Group examined, new rules would be imposed on employment-based health insurance that would vastly increase the cost for some firms of providing coverage….By contrast, all the proposals that are actually on the agenda today have employers buy into an “exchange” that has both a public plan and private plans as a choice within it. Moreover, all these proposals have at least large employers enroll their workers in the exchange by paying a payroll-based contribution, not the public plan’s premium.”

According to Lewin’s analysis of something that’s actually been proposed (i.e. Hacker’s proposal), “the public plan ends up with much lower enrollment in the public plan than projected in the Lewin Group’s new analysis (90 million versus over 131 million)”; “around 38 million people in the exchange would choose private plans instead of the public plan.”

When considering health reform, policy makers have a choice to make: restructure the health insurance market so that it provides affordable and comprehensive health benefits to all Americans, or protect the monopoly of private insurers and continue redistributing as much income as possible to the private insurance industry. I think we know where Leavitt stands.

The White House is strongly urging Senators to include budget reconciliation language in the health care section of the budget, a move Republicans have characterized as a “deceleration of war.”

Indeed, after pushing everything from the Contract with America, to welfare reform, to tax cuts targeted at the rich, to drilling in the Arctic National Wildlife Refuge, using reconciliation and even firing successive Senate parliamentarians who disagreed with their use of reconciliation, Republicans are now threatening to “trip up Democratic priorities — large and small” should reconciliation instructions be found in the final budget. According to The Hill:

The GOP might first go after White House nominations. Republicans could require each appointee to get a separate hearing and a separate roll call vote. They could stop attending committee hearings, and decline to provide “unanimous consent” to move forward on even the most benign issues or routine Senate business. Republicans could also demand that the text of bills, which are often hundreds of pages long, be read aloud. These tactics could grind the Senate to a virtual halt, Republicans say.

Of course, if you don’t give, you’re not gonna get and Republicans have shown only limited willingness to cooperate with Democrats on health care reform. Key Republicans voted against the popular SCHIP legislation, eight Republican senators (including health care heavy weights Grassely and Hatch) voted against Gov. Kathleen Sebelius’ nomination to head the Department of Health and Human Service, Republicans misrepresented the intent of health information technology and comparative effectiveness research in the stimulus, encouraged smear groups to lie about CER and health IT, invited Easter special Sally Pipes to testify about health care reform, and have already taken the public option off the table.

14,000 Americans are losing their health care coverage every single day and, instead of seriously considering the President’s proposal, Republicans are busy painting health care reform in red. They’re looking to win a political fight (not have a policy debate) and prevent a Democratic victory on health care. But why should Democrats concede reconciliation, when Republicans, who have made such good use of the procedure when in the majority, are offering them nothing in return?