There’s an old adage: how do you eat an elephant?

I haven’t figured out if it’s a riddle or a joke or just a parable, but the answer is still the same: one bite at a time.

There’s also an expression with a similar message: “A journey of 1,000 miles starts with a single step.” Short-term victories build up and are often more feasible than large, overly ambitious ones. In football, we call this strategy short passes – they’re not as much fun or showy as Hail Marys, but they move the ball up the field.

This idea – whether the metaphor is a journey, a football game, or an elephant dinner – has been going through my mind recently in light of the highly publicized Republican failure to “repeal and replace Obamacare.”

See there’s a lot of pressure in the early days of an Administration to deliver a quick victory, to reward your supporters and silence (or better yet win over) your critics. JFK started the Peace Corps in early 1961. Barack Obama unrolled the stimulus package in early 2009. George W. Bush rolled the dice with No Child Left Behind in 2001 – the policy worked even if he doesn’t get credit for it, as I wrote a few weeks ago.

So when a highly publicized policy fight doesn’t end up in the win column, an administration’s enemies are going to pounce on it. Salon went so far as to declare the health care fumble “a sign of the deeper existential crisis of conservative politics,” which is a really weird thing to declare a few months after Republicans won all the elections and control all of the states that don’t rhyme with “Balifornia.”

However, cheers over the health care failure may be one where the majority of Americans agree with the (openly) liberal press. A recent Quinnipiac Poll found that Americans oppose the GOP’s failed health plan by 56% to 17% – that’s an uninspiring three-to-one – with 26% undecided.

That’s the kind of data that would make a House Republican health staffer start thinking even more seriously about law school than Hill staffers usually do. But if you scroll down a bit (to question #38), there’s a line in there that shows the way forward.

The question is should Republicans repeal part of Obama, all of it, or none of it?

Quinnipiac University, March 23, 2017

Looking at the total of all respondents, you see that while 27% say that none of Obamacare should be repealed, and an even fewer 20% say all should be repealed, a whopping 50% say parts of it should be repealed. So that means 70% of Americans agree that at least parts of Obamacare should be repealed.

Walk along that line and you’ll see that basic math holds for most demographics. The only one where it doesn’t is registered Democrats – and even then a combined 46% agree at least parts of Obamacare should be replaced.

So in the interest of helping the GOP get back up, dust itself off for the 2nd down, and move the ball up the field, allow me to suggest a short pass.

IPAB: federal policy malpractice

TRIGGER WARNING: I am about to criticize one (1) aspect Obama Administration’s health care policy. It is only because I am, in fact, a hobgoblin more evil than a dozen Hitlers. (How else could someone oppose “free” health care?) That point is the Independent Payment Advisory Board (IPAB).

IPAB is basically the Mission Impossible: Rogue Nation of health care policy. It’s a board of unelected, unaccountable bureaucrats specifically exempt from accountability to either the Congress or the President. The board can deny care by choosing what will get reimbursed and what will not. If IPAB deems a procedure is too expensive, it can force price controls – the enemy of the free market and innovation.

The board is explicitly forbidden health care rationing, but they can force actions that result in rationing. Dr. Jeremy Lazarus, MD, president of the American Medical Association, has blasted the IPAB:

This new, arbitrary system is not what we need when patients and physicians are already struggling with a looming cut of nearly 30% from the broken Medicare physician payment formula. Ending the ongoing threat of drastic cuts from the physician payment formula and preventing new cuts from IPAB are important first steps to stabilize the Medicare system for patients.

Furthermore, CBO doesn’t even predict IPAB will save Medicare any money. Projected rates of spending growth dwarf saving rates: “under current law, the IPAB mechanism will not affect Medicare spending during the 2011-2021 period.” (You can find that gem hidden in a CBO report here.)

IPAB must be dismantled. Republicans will struggle to repeal and replace the entirety of Obamacare, because – very much like when the policy was introduced and we had to pass it just to know what was in it – it’s too big of an issue for one bill. But they can approach health care piece by piece, starting with this unaccountable fiefdom that doctors hate. This component of the Obamacare legacy must be sent to the morgue.

So good luck moving forward, GOP. Remember the elephant: one bite at a time.