In the 1972 movie “The Candidate,” Robert Redford plays a California senatorial candidate who has no chance of winning, so he runs by tweaking the political establishment. On election night, when he wins in a stunning upset, he pulls aside his campaign manager, played by Peter Boyle, and famously asks, “What do we do now?”

As an inside-the-Beltway lobbyist for insurance brokers, I can do little more than express conventional Washington wisdom. Short of an unforeseeable, “black swan” event, it looks as though Republicans are going to have a very good November. 

As Charlie Cook, the best independent analyst in the country, recently wrote, “Nationally, voters who have all but given up on Democrats’ efforts to fix the economy are showing no signs of budging. Even Democrats who have aired unanswered ads sport polling numbers that seem stuck in a ditch; if anything, they are getting worse.”

Let’s assume, as does Cook, that Republicans will win back the House and make significant inroads in the Senate. With the generic ballot edge for the GOP up to a historic high and disillusion pervasive among likely Democratic voters, that scenario doesn’t seem like much of a stretch.

So what would Republicans do with John Boehner as Speaker of the House? 

First of all, let me say that I am a big fan of Boehner, the Cincinnati Republican who has served in the House since 1990. As chairman of the Education and the Workforce Committee and in a variety of leadership positions, he has been smart, informed, aggressively pro-business, and engaged on a wide variety of insurance issues. I could quibble with his historic antipathy toward, say, the Optional Federal Charter for insurers, but I doubt that issue would significantly advance in the next couple of years in any case.

I’ve heard a number of my colleagues argue the case that Republicans need to get close to re-taking the House but fall just a little short. The rationale is that Democrats would find it exceptionally difficult to govern (inflating the importance of moderate Blue Dogs) and that Obama would have no “foil” in a Republican Congress, as did Bill Clinton in 1995-96 (which led to his cakewalk re-election). Such a weakened Democratic Congress could lead theoretically to a massive reversal of power in 2012.

I think such a scenario is too cute by half. The most compelling reason for Republicans to win back the House in 2010 (and, in a perfect storm, perhaps the Senate) is their willingness to roll back the enactment of healthcare reform. Remember when the bill passed and Democratic leaders were expressing confidence that by election day, the public would warm up to the reforms and all of its new benefits? You don’t hear that anymore. Healthcare reform is unpopular, and most of its massive new subsidies don’t kick in until after the next presidential election. So-called mandates are hard to gauge, but if voters embrace Republicans in November, they’re going to want to see action in scaling back healthcare reform.

No doubt, such an effort would be perilous, and if Republicans do it the wrong way, they’ll wind up in the same spot that Newt Gingrich occupied after picking, and losing, the fight with President Clinton over the government shutdown in 1995. The conventional mantra is that you can’t put the toothpaste back in the tube when it comes to government entitlements. In September, official Washington was abuzz and indignant over the comments of Deficit Reduction Commission co-chair (and former senator) Alan Simpson that “we’ve reached a point now where it’s like a milk cow with 310 million tits!” He was talking about Social Security, but he could have been talking about healthcare reform subsidies, exchanges and insurance market reforms.

In late September, the “slacker” provision, mandating family coverage for dependents up to age 26, kicked in, and other market reforms are already occurring. Indeed, they will be hard to reverse. And repeal of healthcare reform truly is not going to occur as long as President Obama wields the veto pen (under no scenario will Republicans have the two-thirds majorities necessary to overturn a veto). But GOP control of the House of Representatives would mean that Republicans could use the appropriations process to scale back the Department of Health and Human Services, limiting the agency’s ability to enact regulations to enforce the law. What would ensue would be a political battle royal with profound consequences.

Yet history has shown us that sometimes you can put the toothpaste back in the bottle. The Medicare Catastrophic Coverage Act became law in July 1989 (passing, not incidentally, with bipartisan support, unlike this year’s healthcare reform). The measure provided seniors on Medicare with protection against catastrophic medical expenses and coverage of prescription drug costs. The benefits were to be paid for exclusively by the elderly receiving them, with high-income seniors paying an extra premium surtax. Angry mobs of Social Security recipients turned on Congress, even flipping over the car of then-Ways and Means chairman Dan Rostenkowski. The act was promptly repealed.

If healthcare reform is to be truly scaled back, Republicans will need a spectacular election night in November—not at all a sure thing. And then they’d have to navigate a minefield of difficult political terrain against a president who views healthcare reform as his legacy. Only a groundswell of tremendous popular support could pull such an effort through. My view is that if those stars align, John Boehner is up to the task.