Mike Leavitt, the former governor of Utah and Health and Human Services secretary under President George W. Bush, predicts that the realities of health care economics will constrain the party's ability to completely abandon the Affordable Care Act.
"The Republicans dined out for three elections in a row on the idea of 'repeal and replace,' " Leavitt told David Axelrod on "The Axe Files," a podcast from the University of Chicago Institute of Politics and CNN. "And I think it's to be expected that there will be a bill that will be titled 'Repeal and Replace,' and that's probably about the only thing we know with certainty."
Leavitt says the desire to retain popular elements of the Affordable Care Act and avoid negative impacts of precipitously unwinding the law will dictate more modest changes.
"There will be some new things, but for the most part it's going to be finding ways to make more functional that which we had before the ACA or that we have after," Leavitt said. "And then we'll have a fight about what actually happened and who deserves the credit."
While expressing reservations about the Affordable Care Act, Leavitt said the law brought needed reforms to a sclerotic system. He praised a number of its features, including the cost saving shift from fee-for-service to value-driven medicine. He suggested Republicans would be wise to acknowledge good ideas where they exist.
"We don't think of the ACA having anything that's bipartisan, but the reality is (health care) exchanges were an idea that had been to a large extent thought of as a Republican idea," Leavitt said. "The whole idea of value payment was not new; it was something that we had been working hard on."
That is for the good, Leavitt argues, because the United States has no choice but to address the growing economic challenge presented by the world's most costly health care system.
"There's no place on the economic leaderboard for a country that spends 25% of its Gross Domestic Product on health care," Leavitt said bluntly. "We have to fix this."
To hear the whole conversation with Leavitt, click on http://podcast.cnn.com
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