The Republican Health Care Failure

Why the GOP should save a share of blame for itself

Republicans fault President Obama for plans that would greatly expand federal outlays on health care, enlarge the federal role in the provision of medicine, doom private insurance, and wrestle Aunt Sally into the grave. They have some valid points. But while they're heaping blame on Obama, they need to save a share for someone else: themselves.

His GOP critics in Congress, after all, have proposals to help the uninsured and curb health care costs. During his speech to Congress Wednesday, they waved their own bill at him. But for four years under President Bush, we had not only a Republican president but also a Republican Congress.

And what happened? Nothing. Republicans left health care reform to wait until the Democrats regained power, and now the Democrats have.

One reason the president has a good chance of getting ambitious legislation passed this year is that so many health care failures have gone unaddressed for so long. Obama and his allies can justify their program partly because the GOP has been so slow and tepid in offering alternatives. If the choice is between the quite imperfect Democratic plan and nothing, the public may prefer the Democratic plan.

It didn't have to be this way. Republicans actually have some plausible ideas for improving the health care system. Let small businesses band together to buy insurance? Sure. Medical malpractice reform? Bound to help. Giving federal subsidies to help low-income individuals buy coverage? Go for it.

But for Republicans to propose all these measures brings to mind my friend who, new to Chicago, approached a city transit officer and said he'd like to get to State and Randolph streets. The frosty reply: "Buddy, who's stopping you?" The only people who stopped Republicans from putting these ideas into practice were Republicans.

Former Reagan administration official Joseph Antos, a health care expert at the conservative American Enterprise Institute in Washington, is among those who wonder why. "The sad thing is Republicans have been talking about these things for a long, long time," he told me.

You may have forgotten that George W. Bush made a big deal of proposing tax credits of $7,500 per person or $15,000 per family to purchase medical coverage. He did that in 2007, only to be spurned by a Democratic Congress. Why did he wait till the seventh year of his term? He didn't. He had offered the idea in 2004, only to encounter raging indifference in his Republican Congress.

The truth is Republicans just can't muster an interest in the subject until a Democratic president comes along and offers legislation, which is their cue to wake up and scream in horror. They solemnly agree the existing system has a host of serious flaws. But they can never get excited about fixing them—only about making sure Democrats don't get to.

"The passion you need to drive health care reform through Congress has not been present with Republicans," laments Gail Wilensky, who headed the agency that runs Medicare under President George H.W. Bush and advised both George W. Bush and John McCain. "Even liability reform—they couldn't get that through."

Stuart Butler, a veteran health care expert at the conservative Heritage Foundation in Washington, shares her frustration. When I asked him whether he blamed Republicans for not adopting sensible innovations when they held power, he replied, "Absolutely! They just don't get it. They just feel that it's not something they do, somehow. Republicans missed a tremendous opportunity."

Actually, they did worse than miss an opportunity. They stimulated the public appetite for lavish federal spending on health care while catering to the illusion that it can be provided painlessly.

"They put in prescription drug coverage for Medicare," Butler complains, "the biggest entitlement since the Johnson administration." That program is projected to cost nearly $1 trillion in federal outlays over the next decade, most of which will be paid for by sending the bill to our children.

So now we have the GOP railing against Obama because he rejects their good ideas, busts the budget and enlarges the government's role in our lives. No wonder they're mad. Heck, if that's what the American people wanted, they could have left Republicans in power.

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