Could the GOP have preempted ObamaCare?
posted at 12:12 pm on April 8, 2010 by Karl
Some influential bloggers seem to think so, including Ed Morrissey:
The GOP had total control of Congress from 2002 to 2006, and the only significant plan they put forward on health care was the creation of the Medicare Part D entitlement that did little but to speed the coming collapse of Medicare. In that effort, the Republican majority did everything that the GOP has rightly accused the Democrats of doing this time around – such as using statist solutions to a problem where market-based solutions existed, and fudging the numbers to fool people into believing it wouldn’t cost too much.
Not once during that period did the party seriously attempt to reform the health-care cost structure, let alone through the use of market-based strategies now expounded by Paul Ryan, among others. Why? First, Republicans did attempt to reform Social Security in 2005 with market-based strategies and got demagogued by Democrats for making the effort. But it wasn’t really that reason that kept the GOP from engaging on health-care reform. That issue was widely seen as a Democratic strength, and Republicans didn’t want to engage heavily on their turf.
What we see now is the result of leaving that vacuum on a major issue. Since the GOP refused to engage on it, they wound up with lower credibility. More importantly, by not accomplishing reform when they had their chance, Republicans left it on the table for when the Democrats got complete control of Washington.
Patrick Ruffini similarly blames GOP inaction in part for the passage of ObamaCare, while raising related points addressed below. Certainly, a defeat the size of ObamaCare ought to prompt some self-examination on the Right. However, the suggestion that the GOP could have preempted ObamaCare during the Bush Administration is too clever by half.
Consider how difficult it was for Democrats to pass a healthcare reform law. The Dems required a large majority in the House and a filibuster-proof majority. Those large majorities were necessary to find the minimum number who — through a combination of ideological zeal, party loyalty, payoffs and threats — would squeak through bills in the face of public opposition. The opposition from the right is understandable. The opposition from the non-ideological middle is likely traceable to the consistent public opinion polling showing (as it did when ClintonCare failed) that the large majority have health insurance, and a large majority of them are fairly satisfied with that insurance. In addition, the polling consistently showed that the public simply did not trust politicians’ assurances (from Pres. Obama on down) that people would be able to retain their own coverage and doctors — or their assurances that costs would be reduced.
During the G.W. Bush Administration, the GOP never held as many seats in the House as the Dems hold today. More significantly, the Senate was divided 51-49. And that razor-thin margin was far from ideologically pure, including Sens. Snowe, Collins, Specter, Hagel, Graham, etc. Ed may discount the 2005 failure of Social Security reform as an example, but the fecklessness and disarray of the Congressional GOP then suggests a lack of the ideological and partisan commitment necessary for a project like healthcare reform.
Next, consider Ruffini’s diagnosis of the GOP’s policy problem:
On health care, I have no idea what our basic guiding principle is. Seriously, I don’t.
We have tried ineffectively to stretch free market rhetoric to health care without appreciating that health care is already too far removed from a free market for the analogy to make sense. Real markets are sensitive to price. Health care isn’t. The insurance companies hide the cost of actual care from the consumer.
What we have lacked in this debate is a simple clarion call to address an aching need — bringing free market principles to bear to improve tangible health outcomes.
However, if the problem is the current health insurance system — largely provided by employers, more like prepaid medical care than catastrophic insurance — it follows that reforming that system will almost certainly involve disrupting the current arrangements of the people in that system. (This includes not only healthcare consumers, but also the various interest groups later bought off by the Obama Administration.) Selling that scale of change to a non-ideological middle that remains (rightly) skeptical of government promises likely would have proven every bit as difficult for the GOP then as it was for the Dems last year.
Next, for the sake of argument, let’s assume that the GOP — against all odds and history — produced a conservative/ libertarian version of healthcare reform, and had the ideological zeal and party unity, and somehow got it through the Senate via budget reconciliation, regardless of public opinion. Would it have stopped Democrats from pushing something like ObamaCare? That’s another of Ruffini’s arguments:
We don’t talk much about education at the federal level these days. There is a sense that the problem was “solved” by NCLB, which is now nearly a decade old. Likewise, no one will try to move welfare reform legislation because the successful 1996 reform law substantively and politically took the wind out of the sails of that issue.
Unfortunately, this claim is counter-factual. Pres. Obama’s first budget took steps to undo welfare reform. In year two, he is working on watering down NCLB. There may not have been a lot of talk about these efforts, as the focus was on big-business bailouts and ObamaCare — but they are happening. Just as the Right’s is fired up to repeal (or replace or whatever) ObamaCare, even if it takes several election cycles, it seems unrealistic to assume that passage of a GOP healthcare bill in the 200os — or anytime — would have caused the Left to give up on their decades-old dream of socialized medicine. The lesson should be that if the Right wants to deny the Left that dream, it will need to build large majorities and broadly convince the public that the problems of government controlled health insurance (and thereby healthcare) are not cured by still more intervention. In the best of worlds, the GOP would achieve the former by achieving the latter.