Throughout the health care debate, the GOP relied on the doctors in their caucus to deliver the Republican talking points on reform. Rep. Tom Price (R-GA), Sen. Tom Coburn (R-OK) and John Barrasso (R-WY) became the party’s most prominent spokespeople against health care legislation, regularly referencing their medical credentials to pad their arguments. Coburn and Barrasso even hosted a twice-weekly internet doctors show to explain how reform would undermine patient care.

It’s unclear, however, how this strategy paid off. The rhetoric of Coburn, Barasso and Price was so extreme and contrasted so sharply with the tone of their professional organizations, it may have undermined the GOP effort. Consider, for instance, today’s appearance by Price on ABC’s Top Line:

PRICE: It will be destructive to the privately paying physicians. The doctors that you and I and virtually every American across this land sees for their routine challenges, for the specialty care that they receive, it will be destructive to the relationship to patients and the families of those doctors because the patient will not know any longer whether the doctor is doing what he or she believes is in the best interest of the patient or whether they’re doing what the government is telling them to do.

Listening to this, one wonders how long it took Price to memorize these arguments, because it’s hard to believe that he actually believes any of them. If you get the one bit of substance out of the way — the charge that the government will be making treatment decisions (which, as I’ve pointed out, is a gross interpretation of the provisions about comparative effectiveness) — his claims fall under the weight of their sensationalism. They’re also contradicted by almost every other group in the medical community.

The AMA, for instance, supports the bill for its expansion of coverage, new regulation of insurers and affordability measures. Doctors back the increase in payments to primary care providers under Medicaid, the loan forgiveness programs for primary care physicians who practice in undeserved areas and the increases in funding for the National Health Service Corp. They may be disappointed that the SGR fix isn’t part in the legislation or argue for stronger tort reform provisions, but they’re certainly not reading conspiracy theories about comparative effectiveness research or turning their backs to the significant access expansions.

This morning, Doctors for America — a group of over 16,000 physicians — held a march on Washington, calling on the Senate to finish the job and pass the reconciliation package. The event began with a kickoff and rally in Freedom Plaza and continued with a white coat and scrubs march to the White House. The doctors argued that the Senate bill, along with the reconciliation package, provided an important foundation to reforming the existing health care system and stressed the important role physicians can play in the process. “I think we are doing is we are re-making the fabric of our profession and we are doing it conversation by conversation, meeting by meeting, letter to the editor by letter to the editor,” Dr. Vivek Murthy, the groups’ founder, said. “I believe what we have done over these last few years, is usher in a new generation of practitioners…that is defined by spirit and vision.”

Indeed, we can only hope that future reforms will be informed by physicians who are doctors first and partisans second. Republican doctors have bombarded the health care debate, and it’s time for the “new generation of practitioners” to have their voices heard.

This morning, Sen. John McCain (R-AZ) took his ‘repeal the bill’ tour to C-SPAN’s Washington Journal. McCain began the program by reciting the usual talking points about the bill, but when a caller described his health care plan and asked the senator how he would be affected by reform, McCain assured him that it would:

CALLER: First of all, I would like to say I voted for you and I’m very sorry that you were not elected. I have right now a medical plan that furnishes me with hospitalization, physician’s care, drugs, eyeglasses and dental. Now, when this goes through, could I possibly lose my benefits from my employer? And will they be taking it away from Medicare?

MCCAIN: James, I’d have to know the plan and all of that, but it sounds to me like you have one of the “Cadillac plans.” In other words, a very generous benefits. There is no doubt there would be taxes on the so-called Cadillac health insurance policies that people have. I mean, that’s just part of the deal. I’d have to see your — you know, have a little more information, but from the sounds of it, it’s one of those “Cadillac programs” that would be subject to taxation.

Watch it:

Well, given the fact that McCain has been on one form of government health care or another at almost every stage of his life, he may not know that hospitalization, physicians’ care, drugs and eyeglasses are fairly standard benefits that don’t automatically fall into the “Cadillac” characterization. In fact, in the Democrats’ reconciliation bill, “a high-cost health plan is defined as costing more than $10,200 for an individual or $27,500 for a family” — far higher than the average cost of insurance. (In 2009, the total cost of the average family policy offered by employers was $13,375.)

The thresholds are even higher for early retirees or Americans in high cost professions and don’t include the cost of stand-alone vision or dental benefits. The tax “would not be imposed until 2018, giving health plans more time to benefit from possible cost savings from other reform measures” and would only affect a very small percentage of Americans.

McCain’s comments however aren’t only irresponsible, but they also incredibly ironic. During the 2008 presidential campaign, McCain proposed taxing everyone’s health care benefits, putting forward a plan that would have replaced the current tax exemption for employer-based coverage with a one-size-fits all tax credit. He’s full of straight talk, alright.

Republicans are responding to last night’s historic passage of health care reform legislation by threatening to run a campaign to repeal it. In fact, moments after the House passed the bill, Rep. Michele Bachmann (R-MN) told protesters, “tomorrow, we’re going to file a discharge petition at the desk. We’re going to get every Republican to sign it and anybody else. If we get 218 signatures, Nancy Pelosi is forced to bring the repeal bill to the floor for a vote.” “Because we are putting the marker down now. We’re going to continue to fight to repeal this thing and we’re filing it tomorrow,” Bachmann added.

Some more, shall we say, moderate, leaders in the party agreed:

– ROVE: They also have the ability, and I hope they use it, to stand up and say as one that it will be the first priority of a Republican House and a Republican Senate to repeal this bill.” [Fox, 3/21/2010]

– ROMNEY: “For these reasons and more, the act should be repealed. That campaign begins today.” [The Corner, 3/22/2010]

– MCCAIN: “We’re going to try to repeal this and we’re going to have a very spirited campaign coming up between now and November. And there will be a very heavy price to pay for it.” [GMA, 3/22/2010]

Republicans will certainly try to run the November campaign on a pledge to repeal the bill, but it’s unlikely that they’ll muster the necessary votes or convince Americans that they should re-open the doughnut hole, allow insurers to deny coverage to children because of pre-existing conditions and bring back lifetime spending caps. As former bush speechwriter David Frum pointed out, “No illusions please: This bill will not be repealed.” Former Senate Majority Leader Bill Frist (R-TN) also predicted that “repeal’s not going to happen” this morning on MSNBC.

If conservatives can’t find a way to repeal the bill in Congress, they will likely encourage the 36 states that are already considering suing the federal government for imposing an individual mandate, to proceed with their legal challenges. Today, Florida’s attorney general confirmed that he will “file a lawsuit with nine other state attorneys general opposing the health care legislation passed by Congress” and Virginia’s Attorney General Ken Cuccinelli has promised to file suit as soon as the ink dries. Virginia and Idaho have even passed legislation allowing their citizens to opt out of the individual mandate and Arizona is considering the question on its ballot in November.

But these lawsuits seem as frivolous as the tort cases Republicans rally against. As Professor Timothy Jost of Washington & Lee University School of Law explained this morning on Washington Journal, “under the constitution as it has been interpreted by the Supreme Court — and that is really our constitution. Everyone has their own interpretation, but constitutional law is made by the Supreme Court — over the last 80 years, I do not see any serious problem with this legislation, and Congress did not either.” Jost noted that the individual requirement, which does not apply to anyone who is under the filing limit of $12,000 for individuals or $16,000 for couples or levy a criminal penalty for those who go without insurance — will likely stand up to a constitutional challenge:

JOST: Well, what the Virginia law says is, ‘nobody can make our citizens buy health insurance.’ They can say what they want to. But under the supremacy clause, a sate cannot tell the federal government what to do…the Commerce Clause says Congress has the authority to regulate commerce among the states. And since the 1930′s, that power has been interpreted very broadly….basically, the law now is that if there is any kind of economic activity involved, Congress has the power to regulate it. And of course Congress does. We have lots of federal laws, regulating all sorts of economic activity. The decision of when to buy insurance — do I buy it now when I’m healthy or do I buy it once I’m in not ambulance on the way to the hospital — is an economic decision and Congress clearly has the power to regulate it. And once Congress has the power to do something under the supremacy clause, its laws are supreme to the laws of the states and the tenth amendment only provides that states retain powers that are not granted to Congress.

Watch Jost discuss the legal precedent:

Earlier today, during an interview with Barry Young & Michele Larson on 550 AM KFYI-Phoenix, McCain was asked how much confidence he had in the state lawsuits. After pausing, the senator said, “I don’t know, except to say we’ve gotta try it… We’ve got to try it. I really don’t know, except to say, if we don’t try it, we will regret that for a long time.”

Last night, Congressional Democrats, under the leadership of House Speaker Nancy Pelosi, accomplished what had eluded generations of leaders before them and passed comprehensive health care reform that would extend coverage to some 32 million Americans. “Tonight, we answered the call of history as so many generations of Americans have before us. When faced with crisis, we did not shrink from our challenge — we overcame it. We did not avoid our responsibility — we embraced it. We did not fear our future — we shaped it,” President Obama said last night. “This is what change looks like.”

As the Senate health care bill moves to the President’s desk, the reconciliation package enters the Senate, where Republicans are already threatening to derail it. “We will have a series of amendments on the substance of the bill that will highlight the massive Medicare cuts, the massive tax increases, and other deficiencies that we think are the reason the American people are against this bill,” Minority Leader Mitch McConnell, (R-KY) said Sunday on CBS’s “Face the Nation.”

The most substantive and immediate GOP challenge could occur as early as Tuesday, when the Senate plans to take up the bill. Republicans will try to send the reconciliation package back to the House by citing a rule that prohibits reconciliation measures from making ‘recommendations’ about Social Security. “The Congressional Budget Office found that the bill would have an ancillary effect on Social Security’s trust funds, and GOP lawmakers will argue that such a finding constitutes a ‘recommendation.’” They’ll be arguing that since the excise tax on high cost plans “would cause some employers to reduce the cost of their workers’ insurance and pay them higher wages,” workers would have to pay higher Social Security taxes, which would also have the effect of extending the life the life of the Social Security trust fund by $53 billion.

I asked Congressional expert Sarah Binder — a professor of political science at George Washington University and a senior fellow at the Brookings Institution — about the validity of the GOP’s point of order, especially in light of the Democrats’ carefully crafted reconciliation package. Remember, Democrats excluded various portions of the President’s proposal — the rate review board and the undercover patients — to comply with the Senate’s reconciliation rules. They ping ponged the bill with the CBO to ensure that it complied with the reconciliation spending targets. Could they have missed something?

Binder says it’s possible. “I think there’s a good deal of uncertainty about how the Senate consideration of reconciliation will go,” Binder wrote to me in an email. “There are two issues– how far the GOP will exploit the boundaries of reconciliation limits (i.e. demanding votes on amendments after the 20 hours of debate) and whether the soon to be House-passed bill has really been Byrd-proofed.”

Theoretically, the Vice President can over-rule the parliamentarian’s “advice,” but Binder described it as “highly unlikely.” “In fact, it would really be nuclear.” “With respect to the Byrd rule, if a point of order is raised against a provision, parliamentarian renders his advice on whether or not the point of order should be sustained (i.e. there’s a Byrd rule violation). If so, Democrats would move to waive the point of order, but that would require 60 votes. I really cannot see the presiding officer ignoring the parliamentarian and ruling that the point of order is not sustained,” she said. “If any provision IS stripped from the bill, then the bill has to go back to the House.”

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