Health reform prospects if Gov. Romney wins

I know that conventions don’t typically provide a lot of policy details, but my overall impression after Tampa is that Gov. Romney has further muddled his potential to undertake any significant health reform if he is elected President. The most consequential thing I heard this week along these lines was when Rep. Ryan seemed to say that a Romney administration would restore the Medicare cuts that the ACA enacted and that the House Republican budget passed, restoring the status quo. At the same time, Medicare is somehow still terribly unsustainable and we must do something…..but not for 10 years.

I understand that if they don’t win the election, they don’t even get a chance, but Republicans always seem to be playing for the short run political gain on health reform, and in doing so boxing themselves in by reducing their future options. Could they take an obvious simple deal?

A few weeks back I concluded a post assessing the impact on health policy of naming Rep. Ryan to the ticket in this way:

If Gov. Romney and Rep. Ryan win, then I assume that means Republicans will keep the House and retake the Senate. I fully expect under those circumstances that the ACA will be repealed. Lots of my friends are worried about what the Republicans will then put in place of the ACA. I am actually more worried that they would do what they have done the past 19 months in the House on replace: nothing.

Now I am worried that they have nearly pledged to do so. And that (nothing) would be easy to accomplish given the political inertia of a Republican controlled House and Senate that had come to power in large part by running against the ACA. From my perch, Republicans just don’t seem to be able to get beyond what they are against when it comes to health reform. To use a football analogy, they are pretty good on defense, but don’t seem to have an offense.

update: edited for clarity