Last week, congressional Democrats unveiled their sweeping legislation to reshape the American health care system. It contains new regulations concerning who private insurers must cover and at what cost, a mandate forcing individuals to purchase health insurance, expanded Medicaid eligibility, and a public option to serve as a gateway to something more closely resembling a “single payer” system akin to Canada’s national health care system.
The Health Care for America Now coalition intends to spend at least $40 million promoting the plan. Liberal activists are mobilized, sensing an opportunity for lasting health care reform.
House Speaker Nancy Pelosi and Majority Leader Steny Hoyer are trying to unify the Democratic caucus. President Barack Obama is working to hold together an alliance of doctors, insurers, and employers to prevent a replay of the “Harry and Louise” opposition from the 1990s.
How will the Republicans respond? Short answer: They’re not sure. Some senior Republicans still seem to be holding out hope that they can meaningfully influence the shape and content of a final health care bill.
“I agree with President Obama and lawmakers on both sides of the aisle who see that the time for reforming America’s health care system is now,” Sen. Mike Enzi, R-WY, the ranking member of the Senate Health, Education, Labor, and Pensions Committee, told the conservative Heritage Foundation in May.
As recently as last Wednesday, Enzi was predicting that a bipartisan health care reform bill was still possible, though he expressed serious misgivings about the Democratic plan. “I believe there is a way forward that can get the support of 75 to 80 Senators, but the bill Democrats released yesterday doesn’t cut it,” he told reporters. Enzi urged Democrats to “start listening to Republican ideas.”
Sen. Charles Grassley (R-Iowa), the ranking member on the Senate Finance Committee, is also working behind the scenes for a bipartisan bill, though he does draw the line at the public option favored by many Democrats.
Speaking to Bloomberg News about his ongoing negotiations with Senate Finance Committee Chairman Max Baucus (D-MT), Grassley said, ” The biggest challenge [Baucus] has in his own caucus is that a large share of Senate Democrats really want the government to run everything.”
No Republican collaboration with the Democrats on health care policy would be complete without Sen. Orrin Hatch (R-Utah). Hatch has partnered with Sen. Ted Kennedy (D-Mass.) on many similar initiatives and has said that now is the time for “meaningful reform.”
“That sound of silence?” writes Kimberly Strassel of the Wall Street Journal. “That’s what’s known as the united Republican response to President Barack Obama’s drive to socialize health care.” The American Spectator‘s Philip Klein concurs: “Republicans are bringing notepads to a gunfight.”
Political reality will probably force the Republicans to behave in a more principled fashion. Democrats don’t really need Republican votes to pass health care reform and don’t have much to gain from watering down a bill to win them.
The congressional leadership has paved the way to use the expedited reconciliation process to fast-track a health care bill. If they do so, there will be little debate and no possibility of a Senate filibuster. With only 40 votes, it’s far from certain the Republicans could sustain a filibuster anyway.
These dynamics make it exceedingly unlikely that the Democrats will drop their insistence on a government-run public option, which Enzi, Grassley, and Hatch all oppose.
Combined with the procedural hardball being played by Democratic leaders, the public statements of Republican senators who still yearn for a bipartisan solution have hardened considerably against the reform process. Hatch even promised that if the Democrats use reconciliation to pass health care “they’re gonna look like fools.”
Such statements may be driven by politics, but a genuine debate between two competing health care visions is the right thing for the country. It is a debate, however, that hasn’t been taking place for the past 20 years.
Conservative think tanks and policy analysts have worked tirelessly to interest Republican politicians in creating a purer free market in health care, as opposed to a more government-controlled system.
Republican congressmen occasionally introduce bills along these lines while the issue arises. GOP presidential candidates tout these plans on the campaign trail — in 2008, John McCain had a very good one, though it was subjected to negative attacks.
Once the campaign season ends, these free-market alternatives are put back on the shelf. Even the Republicans’ heroic effort against the Clinton health care plan in 1993-94 — when they were able to defeat an initially popular program while in the minority — was no sure thing.
Initially, then Senate Minority Leader Bob Dole (R-KS) tasked liberal Sen. John Chafee (R-R.I.) with coming up with a Clinton-lite alternative for universal coverage. Sen. James Jeffords (R-VT) signed up as a cosponsor of the Clinton plan.
Once again, politics helped Republicans rediscover principle. Business opposed Hillarycare’s employer mandate. Senior Democrats balked at having the bill written by the White House.
When Sen. Phil Gramm (R-Tex.), who would vie with Dole for the Republican presidential nomination, decided to kill rather than compromise on health care reform, it forced the Senate minority leader’s hand.
The remainder of the Republican health care record is less heroic: the Kennedy-Kassebaum bill, the State Children’s Health Insurance Program, and, most expensive of all, Medicare Part D.
Although health savings accounts exist on the positive side of the ledger, most of these policies have helped put the country on a path toward national health care rather than presenting a free-market alternative.
Such an alternative is what the country needs. In the meantime, the country also needs Republicans to put away their hopes of bipartisan compromise on this issue. They need to do what an opposition party is supposed to do: oppose.
W. James Antle III is associate editor of The American Spectator.
