Could the GOP have preempted ObamaCare?
[Posted 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.
–Karl
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.
Keep in mind that the primary domestic polcy proposal of the GOP during that time was Ted Kennedy’s fantasy of an amnesty open-borders bill. It’s not that the GOP lacked ideas – it’s that the ideas they were committed to were stupid ones borrowed from the far left.
Morrissey, influential centerist shmuck that he is, was solidly on board with the GOP’s priorities during that period. I don’t recall him ever suggesting, “Hey, let’s drop this amnesty nonsense and try to fix health-care!”.
Subotai (5abcfd) — 4/8/2010 @ 10:05 amDouble post. You might want to remove one of the two duplicate posts so all the comments end up on the same post.
Robin Munn (fca9e9) — 4/8/2010 @ 10:08 amThe idea that BarckyCare is a Republican loss or defeat is BS. It may be considered a win by the Left Dems, but they did not have to defeat anyone other than themselves in order to pass this monstrosity. I think if the R’s had tried to pass something under Bush, to pre-empt this kind of travesty, it would have just softened the battlefield, and would be even easier for subsequent Congresscritters to push this kind of Euro-weenie soft socialism on the rest of us.
JD (d55760) — 4/8/2010 @ 10:17 amGreat post as usual, Karl. I think that the GOP’s failure to reform health insurance and health care, as well as their failure to reform entitlements, can be traced to a major overriding factor in each of Bush’s two terms. In his first term, President Bush was largely engaged with the War on Terror, and to this day I think there was some sort of tacit understanding with the Democrats that if Bush did not try to address any of the major domestic programs, the Dems would give him a (relatively) free hand in the GWOT. After Bush was reelected, the political atmosphere was so poisoned that there was no way Democrats would have compromised on any aspect of domestic policy.
JVW (08e86a) — 4/8/2010 @ 10:21 amThe GOP have no power with this ram down. I agree with you that the GOP could not have prevented this. The Democratic Leadership was determined to pass Health Care Reform and they did it with partisan determination.
Where the GOP failed was in not keeping their majorities in Congress and losing the Presidency. Don’t want socialism? At least have a divided Congress. The GOP lost because they lost their conservatism. Liberalism light given way to Out-of-Control Liberalism.
Debatable (ea4bfa) — 4/8/2010 @ 10:35 amBS is correct re this conjecture. My mottor is: The only good legislation is no legislation. My favorite politicians, Republicans only, feel the same way.
“W” wanted to take a stab at social security during his second term and was stopped dead in his tracks. Curing our major entitlements one at a time is the way to go, but good luck in the attempt.
Mazzuchelli (0be5b4) — 4/8/2010 @ 10:35 amThey wouldn’t be doing it on their own. They could have gotten pretty much their plan from the 1990’s implemented, with tort reform and without the medicaid increases here. Hell they could have gotten that last summer if they promised to deliver votes for it.
imdw (842182) — 4/8/2010 @ 10:39 amSubotai,
I wouldn’t call Ed a schmuck.
I would note that he voted for Romney in the 2008 primary, which suggests that RomneyCare wasn’t a deal-breaker for him.
Ruffini, otoh, notes that the Bush Admin did have some hcr proposals that weren’t bad — but chose to focus on Medicare Part D instead.
Immigration didn’t move to the front-burner until Bush’s second term.
Karl (f07e38) — 4/8/2010 @ 10:41 amKarl
Think Bush tried with the Prescription Drug Plan – which naturally got Kennedized as all legislation did as we never had a functioning Senate Majority in the Bush era
EricPWJohnson (f5fc2c) — 4/8/2010 @ 11:05 amKarl
I think Bush tried that with the prescription drug plan, which, like all legislation during the Bush era got Kennedized as the Republicans did not have a functioning majority during GWB’s years
EricPWJohnson (f5fc2c) — 4/8/2010 @ 11:13 amTyranny marches ceaselessly. Those who advance the progressive viewpoint will never stop attacking individual Liberty. Never.
Liberty lovers, I hope you are prepared to fight for it every day, and for all time.
Marko (97c5c7) — 4/8/2010 @ 11:35 amYou are right, Karl, this is just nonsense squared.
SPQR (26be8b) — 4/8/2010 @ 11:38 amHad the Republicans tried any free market reforms the Democrats would have filibustered any plans. Bush never had anywhere close to the numbers in Congress Obama does.
Eric is right that any plans Bush put forward would have been worse than doing nothing. The Democrats complain about the cost of Part D but that’s because they wanted to spend more (think donut hole that they have now closed). I shudder to think what they could have done with health care reform.
Had Bush signed a bastard health care reform it would be impossible for Republicans to reverse it now.
MU789 (00e597) — 4/8/2010 @ 12:25 pmI would also add to Eric’s statement that the Bush health care bill also created HSA’s. While Ed denies that any market-based solutions were followed, there was one that was created, and is probably the best one out there… at least until Obamacare destroys it.
I could be wrong on this, but hasn’t part D come in cheaper than expected? I am no fan of Medicare, and even less so of Medicaid, but if we are stuck with an entitlement then it makes sense to improve it.
http://online.wsj.com/article/SB126282080941818727.html
A.G. (0e0d51) — 4/8/2010 @ 3:59 pm[…] averted. Instead, we are left with socialized medicine.Karl of Patterico’s Pontifications argues that the GOP would have had an equally difficult time passing their own version of the bill a…, and the GOP never enjoyed the majority that the Democrats did. I disagree with this premise, […]
The GOP Could Have Prevented ObamaCare | Axis of Right (d9d9d4) — 4/8/2010 @ 6:18 pmMorrisey and Ruffini are basically right in their exercise of hindsight.
Karl effectively points out reasons why a GOP health care reform package would have been difficult, but so, too, have been many other great legislative battles of the last few decades — not least among them the authorizations for Bush-41 to pursue the first Gulf War and for Bush-43 to pursue operations in Afghanistan and Iraq. “Difficult” isn’t “impossible”; “difficult” certainly doesn’t mean “not worth bothering to try.”
I’m actually for radical change in the healthcare system — in the opposite direction of Obamacare.
I simply don’t believe that incremental reform would have been enough, or will be in the future. Incremental reform comes in two varieties, neither satisfactory: The first variety, which many Republicans have proposed, consists of the “smaller, less ambitious steps” that are politically less ambitious. (E.g., opening up interstate competition among insurers; tort reform.) The second variety consists of lopsided unfundable mandates, sometimes wishfully (but unrealistically) referred to as “only taking the good parts [hah!] of Obamacare.” (E.g., forbidding insurers to set rates and/or deny coverage based on traditional underwriting, including preexisting conditions). Either of these sorts of “reform” would leave untouched the massive looming problems with the existing Medicaire/Medicaid systems. And the first ignores genuine perversities — like employer-linked coverage — that indeed do need reforming, not to turn healthcare into a right but to restore a range of competitive alternatives that government intervention has suppressed.
(You can buy, for example, long-term whole life insurance with built-in contractual protections, at a price, against rate increase, or you can gamble on rate changes and buy much cheaper term life insurance that leaves you vulnerable to future rate increases. You, not government and not your employer, choose how much risk is appropriate for you and your family in buying life insurance. It should be the same for health insurance, but the government-subsidized system of employer-provided health insurance has stunted those potential markets and the competitive benefits they’d have brought.)
No, reform has to be market-based and comprehensive. Eggs will be broken and oxen will be gored. It will piss off significant constituencies when we undo the systemic distortions created by government. They will think it harsh medicine when we undo the provisions of the tax code and related laws that created the current employer-intermediated system — a catastrophe that has encouraged consumers to think of health insurance as “free” and a “right” (instead of something for which someone, anyone, is actually paying).
To have succeeded in such a daunting undertaking, the GOP would have to have first done that which the GOP will still have to do now in order to repeal Obamacare: a systematic program of public education, built on real-life examples, to explode our comfortable myths. Once that’s done, however — once a sufficient segment of the public understands that someone is going to have to make choices which include sometimes saying “no” (a/k/a “rationing” healthcare reimbursements) — then voters can communicate to their representatives their well-informed choices about who they want to be making those decisions: Do they want it to be government-run panels, like the current and badly disfunctional Medicaire/Medicaid systems and the nationalized healthcare systems in the UK and Canada? Or do they want it to be informed consumers who make determinations of how much risk they are willing to take, who make commercial choices in a truly competitive and well-informed marketplace, and who then have to live with the consequences of those choices?
Dubya failed to lay the educational groundwork to pull off the failed so-called “privatization” of Social Security. He let the Dems, who rely on public ignorance and misconceptions and the resulting fears, misframe the issue. And maybe the public just wasn’t ready yet to be educated on what the real issues are; perhaps only the ugly reality of Obamacare will finally actually open enough minds and sufficiently motivate them that they can become receptive to a free-market/individual responsibility-reliant transformation in which government mostly and eventually gets the hell out of the way of our healthcare. Only the enlightened, and perhaps the embittered, can understand that we all suffer when we let either government or a combination of big employers and insurers try to allocate resources; because of the “knowledge problem” (see, e.g., Hayek), there’s no way that either can succeed, and the least-worst (and therefor best) alternative is relies macroscopically upon the free market and microscopically upon decisions of self-interest decisionmakers exercising personal responsibility and choice.
Beldar (9fbe63) — 4/8/2010 @ 6:38 pm[…] Not So Law-Abiding and Classy As Media Paints Them (video) Patterico’s Pontifications: Could the GOP have preempted ObamaCare? Another Black Conservative: Well what do you know Tea Partiers are people too VotingFemale: Marxist […]
Sen. Harry Reid’s Shame: Nevada Gov. Gibbons Sets Up “Constitution Defense Fund” for State Lawsuit Against ObamaCare, AG Masto Refused to File on Behalf of State « Frugal Café Blog Zone (a66042) — 4/8/2010 @ 6:41 pmBy the way, the Hayekian education needed as a predicate for GOP healthcare reform will also serve the GOP in good stead when it comes to other entitlement reforms. If we can get people to re-embrace our traditional national ideals of self-reliance and of personal and family responsibility, we’re more than half-way to being able to reforming Social Security, too — another area where the math makes the need for strong medicine inevitable. Even if Social Security were really an investment program instead of a Ponzi scheme, individuals making the proverbial “dartboard” retirement investment decisions would do better in the long run than the government has. It does not serve the GOP well in the long run to pretend, like the Democrats and Scarlett O’Hara, tomorrow is another day (and we’ll surely think of something less dreadful in the meantime).
Beldar (9fbe63) — 4/8/2010 @ 6:54 pmI think it’s equally important to look forward, and not just backward.
Will the GOP be able to preempt full implementation of ObamaCare?
I agree with Cal Thomas that this will be extremely difficult without a “Plan B” to replace Obamacare. So far as I am aware, the GOP proposals so far would not make a very large dent in the number of uninsured people in this country.
Andrew (f5ffb8) — 4/8/2010 @ 7:21 pmIs that the only metric that is important, Andrew?
JD (18e145) — 4/8/2010 @ 7:27 pmLet’s say that insuring the uninsured was the most important and primary goal of this entire process. Wouldn’t it have been way cheaper, and way more simple, to simply purchase a standard health insurance policy for all of the uninsured?
JD (18e145) — 4/8/2010 @ 7:31 pmI think Karl is right that believing the GOP could have done more about health care in the early 2000’s is wishful thinking or even revisionist history. In the 2004 Bush vs Kerry Presidential race, a DePaul law professor who specializes in health law surveyed the candidates’ areas of agreement on health care:
As stated at the link:
Their areas of disagreement:
Weren’t several of the areas where they agreed addressed during the Bush years?
DRJ (daa62a) — 4/8/2010 @ 8:03 pmDemocrats labored mightily, corruptly, and largely incompetently, spent trillions and by their own over-blown claims, are only covering a bit less than two-thirds of the “uninsured”.
And that not for four years.
SPQR (26be8b) — 4/8/2010 @ 8:09 pmDRJ – Yes, many of the areas of agreement were addressed.
daleyrocks (718861) — 4/8/2010 @ 8:42 pmJD, no, insuring the uninsured is not the only important goal or metric in this entire process. But it’s one of them, at least with regard to basic catastrophic coverage.
The preferable solution would be to bring costs down sufficiently, and provide incentives or disincentives, so that costs to the taxpayer are minimized and everyone is able and willing to cover themselves. That would not be accomplished by having the government simply purchase a standard health insurance policy for all of the uninsured.
Andrew (f5ffb8) — 4/8/2010 @ 8:53 pmThe preferable solution would be to bring costs down sufficiently, and provide incentives or disincentives, so that costs to the taxpayer are minimized and everyone is able and willing to cover themselves. That would not be accomplished by having the government simply purchase a standard health insurance policy for all of the uninsured.
Nor did any of that happen in this monstrosity, except they managed to do it for trillions of dollars.
JD (18e145) — 4/8/2010 @ 8:57 pmWell, that’s why I opposed Obamacare, and continue to oppose it. But Cal Thomas is correct that it’s a losing battle until the GOP comes up with a Plan B.
Andrew (f5ffb8) — 4/8/2010 @ 9:03 pm[…] Off Campaign Tour In Searchlight To A Crowd of Approximately 100 Patterico’s Pontifications: Could the GOP have preempted ObamaCare? Another Black Conservative: Well what do you know Tea Partiers are people too VotingFemale: Marxist […]
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