RSS Feed MenuA familiar narrative has emerged on the Republicans’ prospects for slowing down the coming Democratic health care proposal.
In short, we’re not in 1993 anymore, and the GOP is in trouble.
In 1993, Republicans triumphed over Clintoncare with the support of insurers and their advertising dollars. Today, however, insurers, doctors and drug-makers are supportive of reform. The business community, the unions, and interest groups are all holding hands and standing with the President. And until some of those stakeholders jump ship, the Republicans are sunk.
Republicans seem to have internalized this story. They believe they are done-for unless industry gets on their side, as it did in 1993.
It is time for Republicans to set this story aside.
The fact is, Republicans have a real opportunity to derail Democrats’ efforts, and the model is their 2007 defeat of immigration reform.
In 2007 the stars were aligned for immigration reform. The business community supported it because it provided cheap labor. The unions supported it because it promised increased dues and new voters. The President supported a bill. The Senate Democratic leadership supported a bill.
And yet it was defeated with two populist arguments on behalf of the middle class. First, the proposed reform would further undercut middle class prosperity. Poor immigrants and the business community would benefit, as would an upper class dependent on the services provided by immigrants. Yet the middle class would wind up holding the bag, paying for increased crime and social services, the consequences of expanding the ranks of a poor and unskilled workforce. While pitched as a matter of simple justice, this reform effort was actually driven by politicians seeking electoral advantage and groups promoting narrow economic interests.
Second, if politicians were truly interested in addressing mass illegal immigration, they should do so through a two-step process – enforcement before amnesty.
Against the odds, this bill was defeated when congressional Republicans and their few Democratic allies, with the help of talk radio and cable television, made a strong populist case against the interest groups, businesses, unions, and politicians advancing this legislation at the expense of the middle class.
Conservatives should return to this playbook as they prepare for the coming fight over health care.
As with immigration, the stars are aligned in favor of health care reform. Business and the unions are supportive of efforts by the President and Congressional majorities. And while publicly promoting a modest and just end – universal coverage and decreased costs – these stakeholders are in fact prepared to cut a deal that will serve their own bottom-line to the detriment of middle class families. While pitched as a moderate reform, the Democrats’ creation of a government option will lead businesses to drop coverage for millions of middle class employees who are relatively happy with their health care. Those individuals will then be forced into a system where coverage and care are dictated by a government bureaucracy. For the privilege of this decrease in quality, the middle class will eventually pay more in taxes. And meanwhile, the truly wealthy will retain their ability to pay extra for any health care needs they have.
The President will no doubt speak of the need for shared responsibility to expand coverage, but Republicans need to reject a hasty reform cooked up among interest groups and politicians that will unduly burden middle class Americans.
And just as they argued “enforcement first” with immigration, the GOP can argue that government must control health care spending before creating any new entitlements to health coverage. At one point the President promised to prioritize reductions in costs over expanded coverage. But to date, negotiations on the Hill have been almost exclusively on the design of a public option, while the President promotes empty promises of future savings. Unless this changes, the middle class will inevitably be forced into a health care system for which it will pay more and receive inferior care.
A country already weary of bailouts and excess spending on behalf of wealthy interest groups at the expense of those who actually pay their bills will likely be open to a populist appeal on behalf of fiscal responsibility and middle class prosperity. Republicans need to stop waiting for a rerun of 1993. The example of 2007 should demonstrate that when it stands with the middle class, the GOP can succeed even without business allies.
sinz54 // May 23, 2009 at 7:16 am
danbmil99: I would certainly like to see some elements in health care reform that incentivize wellness. With auto insurance, you get a discount on your premium for being a “safe driver.” And your premiums are calculated based on your risk–your age, the neighborhood you live in, the amount of driving you do, etc.Something like that could be carried over to health insurance premiums. Discounts for not being overweight or underweight; discounts for not smoking (we already have that discount with life insurance), discounts for not using illicit drugs, etc.But health insurance isn’t like auto insurance in one big respect: Most folks junk their autos at some point and buy other ones. Whereas with your body, you are forced to keep getting medical care (and filing health insurance claims), as long as you can live. It’s like maintaining a 70 year old antique car. It’s going to be expensive.
liv&win // May 23, 2009 at 12:48 pm
sinz54: your not exactly correct about eliminating pre-exisiting condition limitations. We did away with them in the small group market 10 years ago in CA. there was no mandate and we even limited rate increases to 10% above the standard risk rate which are filed and approved by the DOI. Insurance companies want the mandate, but it is not necessary. I can explain later.”You yourself said that many Americans, particularly younger Americans, don’t even bother to purchase coverage because they think they’ll be healthy forever. ” Actually what I said was that 25% of the uninsured are young 18-25 year olds. 40 million uninsured, 25% is 10 million. 10 million out of 150 million insured is not “MANY” it is just the opposite, is it “very few”.Spartacus: what I propose for cost control in the secondary care area I discussed is complicated. At the core is transparency, freedom of choice, quality measurements and competition. It looks like this: you see your primary dr and you are told you need to see a specalist. Right there you get to see the availability and quality of all the specialists in the health care district. The specialist with the highest quality rating will probably not have an appt for 45 days. the specialist with the lowest quality rating might have an open appointment next friday. The patient gets to choose.Competition for quality outcomes and the reward is compensation. The lowest quality doctors get 100% of medicare reimbursement. The highest get 200% of medicare and then there are 4 levels in between (1.0, 1.2, 1.4, 1.6, 1.8 and 200%). Your selection of insurance plan includes a choice on what quality level the plan will reimburse. So if you choose a plan that reimburses at 100% of medicare and you see a doctor that has earned through quality care 200% of medicare, that difference between the charges and the reimbursement would be the copay/deductible/out of pocket cost or whatever you want to term it.
liv&win // May 23, 2009 at 1:05 pm
Spartacus: Yes, I would mandate the secondary insurance coverage. And because you are taking billions of primary care transactions out of the picture, the cost of the coverage would be reduced in both administration and pure insurance costs.The purchasing decision on the insurance is chiefly financial for the individual: do you want prescription drug coverage for generics only, formulary only, or full coverage. do you want level 1, 2, 3, 4, 5 or 6 specialist coverage. do you want 100-10000 deductible for facility care? It is so straight forward that you can even build your policy starting with how much you can afford to pay. You want to pay $150 a month? You can afford level 2 specialist coverage, formulary rx and a $5000 facility deductible. I have to say that I envision this replacing all current plans and programs currently being used. I am philosophically opposed to any legislation that does not apply to everyone. I think where laws are concerned, every citizen should be equal.