Advocates of health care reform who are fearful -- or hopeful, as the case may be -- that Republicans will be able to repeal the Patient Protection and Affordable Care Act (aka "Obamacare") need to understand that the GOP has no real intention of repealing it.

The rhetoric of repeal is just a smoke screen to obscure the real objective of the "repeal and replace" caucus: to preserve the sections of the law that big insurance and its business allies like and strip out the regulations and consumer protections they don't like.

The rhetoric is necessary, of course, to keep fooling the people they fooled in the first place (with a corporate-funded campaign of lies and deception) into thinking that repeal would be in their best interests. For the same reason, it will be necessary for the Republican-controlled House to pass the two-page bill their PR consultants drafted to repeal the law. (Calling it the "Repealing the Job-Killing Health Care Law Act" is a tactic that comes straight out of the playbook I describe in my book, Deadly Spin [3].)

By now, lobbyists for the insurance industry undoubtedly have met behind closed doors with every one of their new members of Congress to make it clear what insurers really want. Those meetings were necessary because it's likely that some of the newly elected representatives of the insurance industry, who told us that the law was a "government takeover of health care," had actually begun to believe their own talking points. You know the old adage: Tell a lie often enough and you'll begin to believe it.

The real concern for advocates of reform should not be repeal. What we will wind up with, if the insurers' demands are met, is much worse.

Insurers got what they needed out of the reform debate: a requirement that all of us who are not eligible for a government-run program like Medicare will have to buy their increasingly inadequate products. That was job one. Job two was to get the public option, which they knew would be a formidable competitor, excised from the bill. The insurers were desperate to have the individual mandate included in the bill because their current business models are not sustainable. They cannot continue raising premiums and shifting more costs to their customers through ever-increasing deductibles and expect employers and regular folks to buy what they're selling.

Shifting costs is now the only way the for-profit insurers can ensure Wall Street of the expected return on investment. The problem, of course, is that you can't keep shifting costs to consumers indefinitely and expect them to buy your products -- unless, of course, the government forces them to.

Insurers helped finance the "government takeover" [4] fear-mongering campaign not because they wanted the law repealed but because they hoped it would enable the GOP to regain at least one chamber of Congress. They fare much better when Republicans are in control. They also are not too worried about the challenges to the law's constitutionality because insurers had a hand in writing the individual mandate provision to ensure that it could ultimately withstand a court challenge.

What insurers don't like are the provisions of the law that restrict their ability to shift costs to us and that require them to spend at least 80 percent of premiums on our medical care. They also don't like being told they can't charge women and older people a lot more than men and younger people. And they are not at all happy that Congress finally outlawed some of their most anti-consumer practices, like dumping sick enrollees and refusing to sell insurance to people with pre-existing conditions. So the GOP's real agenda is to restore those "freedoms" to insurers and keep the individual mandate in place. We can only hope that reform advocates figure how to counter the lies -- the deadly spin -- and that Democrats in Congress will protect our best interests.