Remember how opponents of the Patient Protection and Affordable Care Act (PPACA) vowed to “repeal and replace” the measure? It was and is a great slogan (I’m a sucker for alliteration, assonance and consonance) but it’s no surprise that the sloganeers have been slow to follow through on the replace part  –even as they retain enthusiasm for pushing repeal.

PPACA presents a fat target for opponents of an active federal role. It’s complex and ambitious, and even though at heart it is a very moderate (or even conservative) law, there are lots of hot button provisions to demonize. Health care is such an important emotional, personal and financial issue that people are justifiably nervous whenever something happens, and ready to listen to all kinds of claims.

Criticizing PPACA –whether over death panels, individual mandates, government takeovers, rationing or whatever– is fun and easy. It also obscures the fact that the health care system is drowning the country and really does need to be reformed one way or another. And that it’s very hard to do. As soon as PPACA opponents start listing out their “replace” ideas with any specificity they are going to be very vulnerable.

The Republican leadership knows this, and that’s why they haven’t issued any serious “replace” ideas. Now we hear from House Energy and Commerce Committee Chairman Joe Pitts (R-PA) that the replace ideas will come after the Supreme Court decision on PPACA’s constitutionality in June.

According to Pitts, here’s a taste of what’s in store: “giving the tax break for health insurance to the employee instead of the employer, medical liability reform, creating high-risk medical ‘pools’ and allowing insurers to sell their products across state lines.”

To which I reply, “That’s it? Those are tiny, insignificant tweaks.” Just to pick on these specific examples:

• Tax breaks don’t help people with low incomes –who are the ones who need help paying for health insurance
• Medical liability reform is a feel good measure that will have no appreciative impact on overall costs
• High-risk medical pools sound good but generally just stick government(!) with the bill for expensive patients
• Selling insurance products across state lines is just a way to trample on states’ rights to impose mandates

The Affordable Care Act is a serious response to real problems. From what I’ve seen so far, the “replace” ideas are a joke.

David Williams blogs regularly at the Health Business Blog.