As the debate over health reform enters its decisive stage, there is a lot of talk about the need for compromise between Democrats and Republicans. That was a sensible point to make in years past when Republicans offered alternatives for reform to compete with Democratic proposals. But this year there are two problems with the idea of bipartisan compromise. The first is that Republicans in Congress have not even made a pretense of offering constructive alternatives. The second is that the Democratic proposals are built around the ideas that Republicans used to favor -- those proposals already are bipartisan compromises. Unfortunately, they are compromises with a Republican Party that no longer exists.
In the late 1940s, when Harry Truman proposed legislation for national health insurance (what today would be called a single-payer plan), a group of Republicans including Congressmen Richard Nixon and Jacob Javits advocated a system of government--subsidized, private nonprofit insurance, with premiums scaled to people's incomes.
In the 1960s, when Democrats were calling for a program of government hospital insurance for the elderly, Republicans countered with a plan for voluntary insurance for physicians' bills. The Democratic proposal became Part A of Medicare; the Republican proposal became Medicare Part B (which is government-run but voluntary).
In 1974, as president, Nixon sent to Congress legislation for universal coverage that relied on private insurance to cover the employed and a federal program to cover the rest of the population. National health insurance, Nixon declared, was "an idea whose time has come in America," but because of Watergate his own time had gone. If he had only been wounded instead of destroyed by scandal that year, he might well have struck a deal with Sen. Ted Kennedy, by that time the leading Democratic advocate of national health insurance.
As recently as the early 1990s, when Bill Clinton and other Democrats were again pushing for universal coverage, President George H.W. Bush and such leading Republicans as Sens. Bob Dole and John Chafee countered with their own proposals for reform. Their bills would have expanded coverage by subsidizing private insurance, and Chafee's plan called for an individual mandate -- a requirement that individuals carry health coverage.
Republicans offered these proposals, to be sure, only when Democrats were pressing for reform, and the plans were often merely for show. In 1993, Sen. Dole backed out of two health bills he co- sponsored before they could become the subject of negotiation. When in power, the GOP dropped the issue entirely.
If the long line of GOP reform proposals prior to 1993 truly represented the Republican position today, a bipartisan compromise would be a reasonable prospect. After all, the Democrats have moved toward what once was the Republican position. Their proposals would preserve private, employer-based insurance. For people without employer-based coverage, the proposals don't go as far as Nixon in 1974 and create a federal program -- no, that would be too radical. Instead they create an "insurance exchange" that would enable people to choose among competing private insurers and a public option.
Historically, conservatives objected to Social Security and Medicare on the grounds that those programs should be optional. This year's proposal for a public option is just that -- optional -- but today's Republicans don't like it any better. And it's not as though they are offering to support reform if Democrats will just drop the public option. Rather than searching for common ground, they have tried to arouse a climate of fear about reform, hoping to do to Barack Obama what their party did in 1994 to Clinton -- humiliating a newly elected Democratic president by utterly defeating him on his leading domestic initiative.
Health-care reform has long been an ideological flash point. From the 1930s to the battle over Medicare in the 1960s, the American Medical Association and other health-care interests denounced government-financed health insurance as "socialized medicine." This year, however, the interest groups aren't fanning the ideological flames; the AMA has supported the Democrats' approach, and other key interests such as insurers and pharmaceutical companies are more interested in negotiating a deal for themselves than in attacking reform. Now the flames are being fanned by the GOP and its media echo chamber.
As Sen. Kennedy lay dying this year, some Republicans said if only he were present in Congress, some compromise might be reached. That was a tribute to him but a convenient fiction for the Republicans. The moderates in their party who might have been negotiating partners are largely gone. Instead, the Democrats are negotiating down reform with themselves, doing bipartisanship in one party. That is what our politics have come to.
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