The Secret History of the Republican Party

January 5th, 2011 at 12:33 am David Frum | 26 Comments |

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Ben Smith posted yesterday a document that turns the spade on a lot of hastily buried Republican history.

It has to be read in full to be appreciated:

Marco Rubio just announced a staff led by Mitt Romney’s former policy director, Sally Canfield, and a reader sends over Canfield’s spirited November, 2007 defense of Romneycare — which now reads like a relic of a forgotten Republican era:

It should be a shock to no one who believes in deregulation and individual choice that premiums are falling as competition is introduced into the health care market. As a result, today, in Massachusetts, residents can obtain comprehensive, quality health care insurance for as little as $175 a month.

In bringing free-market forces to Massachusetts, Governor Romney has won the praise of conservative organizations. One of the primary supporters of the Massachusetts plan was the Heritage Foundation. They have said, “Those who want to create a consumer-based health system and deregulate health insurance should view Romney’s plan as one of the most promising strategies out there.” The Club for Growth stated that “Governor Romney deserves credit for proposing a plan that encourages individually-owned health insurance…”

It’s the third paragraph that deserves to be reposted in red letters. The Heritage Foundation was more than just a “supporter” of the Massachusetts plan. It was to a great extent an author of the plan.

It would be easy to score “for it before they were against it” points here. But the real – and more exciting point – is this: policy creativity can and does exist in the Republican party. The next task is to nurture that creativity back to life. Here’s hoping that the brainy Canfield can help develop the Rubio office into a lively center of that dormant creativity.


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26 Comments so far ↓

  • msmilack

    I love your optimism, David. I can’t imagine Rubio (or anyone else connected to Club for Growth) voting against party line and choosing instead to improve the current health care plan, even though the vote to repeal is a waste of time. Why does none of them point out that since they won’t get Obama’s signature on it, their vote is symbolic. Pundits point it out but the elected officials don’t.

  • jquintana

    One of the most blatant falsehoods coming from the left is the assertion that Republicans aren’t interested in any kind of health care reform. They offered many ideas in the health care debate, such as 1) the ability to purchase health insurance across state lines and 2) tort reform, but they were virtually ignored by Obama/Reid/Pelosi.

  • jerseychix

    jquintana- Can you give one example of where tort reform has lead to meaningful decreases in health care costs?

    Does anyone think that if Ms. Canfield said the same thing now, she’d get drummed out of the GOP?

  • balconesfault

    jquintana: They offered many ideas in the health care debate, such as 1) the ability to purchase health insurance across state lines and 2) tort reform, but they were virtually ignored by Obama/Reid/Pelosi.

    Was there any indication that the GOP would have accepted a public option in exchange for cross-state line portability, or tort reform (ignoring, as jerseychix pointed out, the lack of evidence that those would actually do anything but promote the interests of the largest insurance companies)?

    Nope. Obama could have included both, and not only would he have gotten no GOP votes in favor of a package that included portability, tort reform, and a public option.

    So we ended up with a healthcare bill that was originally largely a GOP proposal, passed by the Democrats, over overwhelming GOP opposition. It certainly was not the most progressive HCR bill possible.

    That’s what happens when one side just says “hell no”. Compromise doesn’t happen, and compromise is often what improves a piece of legislation.

    In fact, I’ll go on record as believing that even without the public option, including portability and tort reform would have not have gotten significantly more GOP votes in the House or Senate.

    So what’s the point of the Dems making the legislation worse (in their eyes) if the GOP is still going to do their best to obstruct?

  • jquintana

    balconesfault // Jan 5, 2011 at 7:56 am

    “Was there any indication that the GOP would have accepted a public option in exchange for cross-state line portability, or tort reform?”

    Don’t be disingenuous—you know damn well there were many Democrats themselves who weren’t in favor of the public option, and a handful of Dems even needed to be bribed (Louisiana Purchase, Cornhusker Kickback) to pass that monstrosity that came out of reconciliation.

    If the Dems really want a public option, they should put it to a vote and watch it go down in flames. But at least they would stand on principle.

  • jquintana

    jerseychix // Jan 5, 2011 at 7:16 am:

    “Can you give one example of where tort reform has lead to meaningful decreases in health care costs?”

    On a national level, we will never know until we get large majorities of Republicans in both houses and a Republican in the White House. As long as Democrats are in power, it never will be tried, because they get a great deal of campaign cash from trial lawyers and they’re not going to tip that apple cart. But I think it’s worth trying, and it makes sense: reduce a health-care provider’s cost of doing business, and he/she will pass the savings onto the consumer.

    And, by the way, can you give one example of where this health care bill has lead to meaningful decreases in health care or health insurance costs?

  • nhthinker

    The Heritage Foundation took a look back on RomneyCare:
    http://www.heritage.org/Research/Reports/2010/09/Massachusetts-Health-Care-Reform-Has-Left-Small-Business-Behind-A-Warning-to-the-States


    The designs of the health insurance products offered through the Connector lacked creativity, were very similar to options available outside of the Connector, and sometimes were more expensive.[19] While plans were required to be rated using a mod­ified community rating similar to plans outside of the Connector, CP insurers were prohibited from re-rating a plan regardless of the characteristics of the final enrollees. Additionally, for employees choosing to deviate from the employer-selected benchmark plan, a list billing (or age rating) was used, making the switch unattractive to older workers.[20] The plans lacked network diversity as most plans allowed full access to all providers regardless of cost. At the time the legislature prohibited the Con­nector from offering mandate-lite plans to small businesses, prohibited pooling purchasing groups, and limited the program to employers with 50 or fewer employees. Finally, the Connector narrowly focused advertisements to employers not already offering insurance.

    Politics. The current policies reflect current political attitudes. The Connector Board, the gov­erning body of Massachusetts’s health insurance exchange, is composed of a voting majority of gov­ernment officials and union representatives.[25] Its actions have reflected the interests of its member­ship, not the interests of the Massachusetts small business community.[26] The sum effect of the board’s policy decisions is to provide expansive, high-cost, defined-benefit health insurance plans designed by state bureaucrats. The Connector and its governing board erred on the side of being pro­scriptive, instead of allowing flexibility and permit­ting market forces to operate.[27] The board’s efforts have focused on offering heavily subsidized insur­ance plans for low-income individuals and raising the floor of what it deems the acceptable minimum level of coverage. By contrast, states interested in helping their small business employees gain access to affordable health insurance should pursue mar­ket-based policies that encourage health insurance as a means of protecting individuals and families from the financial disaster of a serious and costly illness. The composition of the governing board is an important factor in reaching this goal.

    States looking to create state health insurance exchanges that are friendly to small business should design exchanges that allow defined contributions for health insurance, which will promote market choice and competition. They should include a mechanism that allows people to aggregate health care contributions from different employers, both for employees with more than one job and for cou­ples with different employers. Finally, state legisla­tures should reduce or eliminate health benefit mandates that drive up costs, and they should sta­bilize their health insurance markets by establishing risk-adjustment mechanisms to compensate for adverse selection.

    Massachusetts’s original design for health care reform held promise for small businesses, but policy decisions made during implementation have failed to deliver on that promise so far. Greater availability of state-subsidized coverage and rising premiums reduce employers’ motivation to provide coverage for their employees, and the incentives in the new federal health care legislation will certainly intensify that problem.

    The long-term sustainability of any reform plan will rest largely on the level of engagement with small businesses and cost relief delivered to them. It is imperative that each state move forward quickly in an informed manner to address the needs of the small businesses and their millions of employees. The future economic strength of the nation may be at stake given the depth of the current recession and the pressures placed on small businesses and their employees as they try to stay in business.

    —Joshua D. Archambault is a Graduate Fellow in the Center for Health Policy Studies at The Heritage Foundation and a recent graduate of the John F. Kennedy School of Government at Harvard University.

  • Nanotek

    – “Can you give one example of where tort reform has lead to meaningful decreases in health care costs?” –

    Exactly. And what “principle” of the right allows government to arbitrarily limit damages to $250,000 if the damage a doctor, perhaps while drunk and operating, maims a patient so badly she/he will need medical care for life? “Tort reform” — is an escape from liability.

  • Houndentenor

    Buying across state lines has some benefits for the smaller states where options are limited. But overall it would mean a rush of insurance companies to relocate to the states with the most lenient laws. Personally I would be okay with some form of tort reform (depending on what was in the actual bill, of course) in exchange for something else. But there was no willingness on the part of Congressional Republicans to offer any compromise on health care reform. Frum wrote about this (quite well, actually) at the time. Republicans had ample opportunity to offer some votes in exchange for some things they wanted in the bill. Instead they demanded changes and then voted against the bill in committee anyway. So why on earth did the Democrats bother to talk to Republicans at all.

    Tort reform and buying across state lines aren’t real solutions. And as for tort reform, I remember having to explain the lawsuit mania in the US to European friends. Often people with little or no health insurance, or with insurance that decides to delay or deny payment are left with no options to cover their medical bills other than lawsuits or bankruptcy.

  • TerryF98

    Never expect Conservatives to be consistent in their ideology. They will bend with the wind as Romney demonstrates almost daily.

    What was established GOP policy today becomes SOCIALISM tomorrow when the Democrats propose the same idea.

    No ideas, no clue, no integrity, no values, no morals. Nothing worthwhile.

  • balconesfault

    Houndentenor: Republicans had ample opportunity to offer some votes in exchange for some things they wanted in the bill. Instead they demanded changes and then voted against the bill in committee anyway.

    Exactly. “Compromise” to the GOP meant “include our ideas but we’ll still oppose you”. In fact, had the Dems suddenly included portability in the HCR bill, I fully expect we’d have seen Republicans running to microphones talking about Dems expanding the power of the Federal Government to squash states rights, since suddenly the interstate commerce clause would have required Federal regulators to take over what has largely been a state level enforcement of insurance contracts.

    jquintana: Don’t be disingenuous—you know damn well there were many Democrats themselves who weren’t in favor of the public option, and a handful of Dems even needed to be bribed (Louisiana Purchase, Cornhusker Kickback) to pass that monstrosity that came out of reconciliation.

    First, a bill with the public option passed the House – so we’re limited to talking about the Senate.

    Second, I never said that the Dems had to be unanimous behind a public option. Ben Nelson is an ex-insurance executive. Joe Lieberman’s wife lobbied for big insurance/big pharma. Evan Bayh represents a big pharma state, and his wife sits on the board of WellPoint and owns somewhere between 1/2 and 1 million in stock. There will always be Dems whose personal or local political situations make them adverse to progress.

    That’s the point with compromise. The GOP could have made Nelson and Landrieu irrelevant had a dozen of them signaled that they’d be willing to support a HCR bill that included a public option in addition to tort reform and portability. There would have been no need for the Cornhusker kickback.

    But the main goal of the GOP – giving Obama his “Waterloo” – would not have been accomplished.

  • Joe In NH

    All this talk about buying across state lines ignores the present day realities of health care in the USA. In this age of HMOs and PPOs a carrier needs to negotiate rates with major medical vendors such as hospitals and major practice groups which means the insurance company needs a large enough pool of customers in any particular geographic area to pay for the cost of negotiating these rates. Company A in my state isn’t going to bother to going into your state unless it thinks it can develop a large number of insureds in your area. They aren’t going to be competitive if only selling a few policies in an area. The HMO/PPOs will undercut the price any insurance company selling only a few policies has to charge. (Ever notice the difference between what your HMO pays and the medical vendor charges?)

    The thing that needs to be done regarding the health care legislation is find a way around the mandate. I do know that when you are eligible for Medicare you don’t have to take it but, unless you have private insurance that matches Medicare, when you do get sick and sign up you will have to pay a much higher premium. Maybe this setup could work for the health care legislation.

  • Watusie

    jquintana , I hate to break it to you, but the Republican idea of “tort reform” (i.e. capping damages to some arbitrary low limit) would increase the cost of health care. A doctor maims a patient and leaves them needing intensive medical care for life. “Tort reform” caps the patient’s damages at $300K. So who pays for the remaining years and years of care after that sum is used up? That’s right – the taxpayer.

    Also, regarding the ability to purchase health insurance across state lines – why would that lower costs? An insurer in South Dakota isn’t going to insure Manhattanites for the same rate they insure South Dakotans so long as they think the Manhattanite is going to get his treatment in Manhattan.

    However, you can be cheerful, becasue the best idea the Republicans ever had about lowering insurance costs – the individual mandate – has been implemented.

  • aed

    David draws exactly the wrong conclusion from this article. The only relevant piece of information here is the fact that free-market reforms that were conceived of, and approved by, conservatives [notwithstanding the Heritage Foundation's subsequent assessment of the implementation] have since been universally repudiated by Republicans. This should not be a ray of hope for David; it should depress him thoroughly because it simply confirms what everyone has been saying about the current Republican party – governing for the benefit of the American people is the furthest thing from their minds.

  • lessadoabouteverything

    And I noticed jquintana in her nonexistent understanding of health care has offered zero rebuttals. And she forgot the only other Republican solutions, HSAs and tax credits (which would not even buy a lousy plan)

    Romneycare has worked, Mass. has the lowest uninsured rate in the country and pays out far more in taxes than it ever receives, Texas has over a quarter of the people uninsured even though it has minimal regulations and did tort reform.

    It is simply way too easy to dismantle the silliness of jquintana it is not even much fun.

  • Elvis Elvisberg

    policy creativity can and does exist in the Republican party.

    Let me fix that for you: policy creativity did at one time exist in the Republican party.

    Tort reform is barely an idea: A “2004 report by the Congressional Budget Office said medical malpractice makes up only 2 percent of U.S. health spending. Even “significant reductions” would do little to curb health-care expenses, it concluded.” http://washingtonindependent.com/55535/tort-reform-unlikely-to-cut-health-care-costs See also Atul Gawande’s examination of post-tort reform Texas, which found that the threat of lawsuits had little to do with the price of procedures. (Google: “THE COST CONUNDRUM”)

    Anyway, Obama did move forward on limiting the ability of injured patients to recover in court: http://politics.blogs.foxnews.com/2009/09/10/hhs-plans-announce-tort-reform-one-month

    But the GOP doesn’t care about policy, only politics. So rather than working to advance a policy they claimed to support, then stood on their hind legs and barked their heads off about death panels.

  • Otto

    Purchasing across state lines is a red herring as well.

    Insurance companies can already offer insurance in different states, as long as they meet that state’s regulations concerning health insurance.

    That’s right, a state’s soverienty in deciding their own laws and how industry operates in that state is being applied to health insurance companies.

    What this means in reality is that those (R)s clamoring for the ability to sell across state lines are really clamoring to TAKE AWAY a state’s right to apply their own laws to those industries. In effect, they are clamoring to give more power to the Federal Government.

    Perplexing.

  • lessadoabouteverything

    Otto, right, Republicans scream for states rights when it comes to discriminating against blacks, gays, or hispanics, but God forbid a state have more stringent regulations than the Federal government. I do not find it perplexing however, just par for the course to the intellectual degeneracy of so much of the teabagging Republican party.

    The Heritage Foundation pretty much invented the concept of the insurance mandate, stating how it would get rid of free riders and bring back moral responsibility, now you can not even find any of that on their website, it is just pathetic, they are so cowed by the mob they forsake their own intelligence.

  • medinnus

    The GOP and their healthcare reform is an unserious joke.

    It won’t pass the Senate, and if it did, Obama wouldn’t sign it

    In the meantime, they suspend their own rules about paying as they go to cover the CBO’s $100 billion dollars of projected savings.

    They aren’t serious about being fiscally responsible; that would entail examination of defense spending.

    Pandering to Fox’s audience with pointless symbolic bills waste their time in office, and if they don’t do something of substance, look for another landslide in 2012. So far, all they seem to be serious about is their same worn tactic during the Clinton administration – waste time and money to tie up the Obama administration with pointless investigations…

    Of course, I expect nothing less from the current crop of GOP No-Sayers.

  • Miami’s Marco Rubio becomes new Florida senator – MiamiHerald.com | Conservatives for America

    [...] …Marco Rubio takes his place as Florida's newest United States SenatorTampabay.comThe Secret History of the Republican PartyFrumForumMarco Rubio takes his seat in the US Senate WednesdayTampabay.comTallahassee Democrat [...]

  • COProgressive

    jquintana wrote;
    “jerseychix // Jan 5, 2011 at 7:16 am: “Can you give one example of where tort reform has lead to meaningful decreases in health care costs?”

    “On a national level, we will never know until we get large majorities of Republicans in both houses and a Republican in the White House. As long as Democrats are in power, it never will be tried, because they get a great deal of campaign cash from trial lawyers and they’re not going to tip that apple cart. But I think it’s worth trying, and it makes sense:”

    Tort reform! Tort reform? You’re joking of cause.

    I could see what would have happened had a Dem suggest, or had Tort reform been added to a national Health Care Reform bill. The same R/C’s who keep bringing it up now would have been the first SCREAMING “Obama is taking over health care AND state courts too!”, or “The Dems are interferring in state court jurisdiction!” , or “States Rights!”, “States Rights!”, “STATES RIGHTS!”

    Are you trying to tell us that you would accept the Federal government’s takeover of the state court’s jurisdiction on ruling on medical malpratice?

    Yeah, I didn’t think so.

    Sorry guy, you can’t have it both ways.

    Tort reform is a RED HERRING. Tort reform is a states issue and many states have already paased reforms.

    “A conservative believes nothing should be done for the first time.” – Thomas Fuller

  • Nanotek

    “jquintana , I hate to break it to you, but the Republican idea of “tort reform” (i.e. capping damages to some arbitrary low limit) would increase the cost of health care. A doctor maims a patient and leaves them needing intensive medical care for life. “Tort reform” caps the patient’s damages at $300K. So who pays for the remaining years and years of care after that sum is used up? That’s right – the taxpayer”

    exactly, Watusie — the Republican idea of “tort reform” is little more than socialism for medical malpractice because injured patients are denied reasonable compensation for being maimed from the person who injured them so they have to turn to the government for care for the rest of their life.

    I’ve seen many frivolous defenses in law suits — but those are never chirped about by the righties.

  • torourke

    Elvis,

    A more recent CBO report found that tort reform had the potential to save more than $50 billion over ten years. This is still a small percentage of our overall health spending, but it is not nothing, and it’s worth pointing out that Douglas Elmendorf endorsed many of the theories behind tort reform. It lowers malpractice insurance premiums, and lowers costs by reducing the number of needless medical steps doctors take to avoid lawsuits. Notice that most of these savings would be reduced in the areas of Medicare.

    http://www.washingtonpost.com/wp-dyn/content/article/2009/10/09/AR2009100904271.html

    And I just read Gawande’s article, and it doesn’t quite fit your description. He described how the town of McAllen, TX saw a surge in health care spending, even post tort-reform, and how much of this had to with the amount of care that was provided. He went on to question the efficacy of much of this care, given that cities like El Paso spend much less and do not appear to have lower health care outcomes. It was an interesting article, but it didn’t really tell us much about what impact tort-reform has had on Texas as a whole. We do know that doctors are now flocking to Texas to take advantage of the limits on medical malpractice claims and the resulting lowering of malpractice insurance premiums they have to pay–which they could theoretically pass on to their customers. As a result, Texas now has more doctors, particularly specialists, in areas that did not have them before, and that can be particularly beneficial in certain cases. Prior to tort reform, it was so expensive to practice medicine due in part to the insane premiums doctors had to pay for malpractice insurance, that many places did not have access to specialists, and if someone needed emergency surgery, they would have to be flown to another city, which was time-consuming (read, it could mean the difference between life or death in some cases), and expensive. This problem has been mitigated in Texas, at the expense of states that have more trial-lawyer friendly policies.

    But this leads to the issue that people like COProgressive bring up, which is whether it’s wise to pursue tort reform at the national level, or let states reap whatever benefits (or problems) tort reform yields at the expense of the states that don’t. Personally, I would prefer the state level approach.

  • torourke

    Otto,

    “That’s right, a state’s soverigenty in deciding their own laws and how industry operates in that state is being applied to health insurance companies.”

    Your appeal to the principle of state sovereignty is touching, but in reality states (like say, Massachusetts under Romneycare) collude with lobbyists to define minimum coverage of their states’ health plans to include things like IVF, which drives up the costs of health plans, and means people have to pay higher premiums for things they neither want nor need. Don’t have a problem conceiving children? Too bad, because your health plan has to cover it, which means you pay higher premiums. Which means reduced take-home pay. Which means ever stagnating wages. Isn’t this something liberals are supposed to care about?

    “What this means in reality is that those (R)s clamoring for the ability to sell across state lines are really clamoring to TAKE AWAY a state’s right to apply their own laws to those industries. In effect, they are clamoring to give more power to the Federal Government.”

    This is complete nonsense. Massachusetts could continue to collude with lobbyists to ram minimum coverage mandates like IVF down the throats of its people, but Massachusetts residents looking to escape these onerous mandates and the higher premiums they cause could purchase policies from states like Wisconsin that don’t require that every policy covers IVF.

    lessadoabouteverything,

    I asked you in a previous thread to explain to me how purchasing policies across state lines violates any theory of states rights. Maybe you could take up the challenge this time. Ideally, you would do it without the childish race-baiting and homosexually-tinged insults.

  • torourke

    Otto et al.

    Read the link provided by nhthinker and the impact Romneycare has had on small businesses. With respect to minimum coverage mandates, there’s this:

    “Costly Mandates. State-mandated benefits dis proportionately burden small businesses. Larger companies that span multiple states or countries and self-insuring companies are regulated under federal law and are therefore exempt from state mandates.[39] In 2005, Massachusetts health care mandates accounted for $1.32 billion (12 percent) of premium prices. That number has certainly risen as the Con nector and the legislature have added numerous mandated benefits over the past five years. A report that examined plans exempt from state health care mandates estimated that “the marginal direct cost” of mandates in 2005 added at least 19 percent to the increase in premium costs of plans subject to state mandates.[40] Massachusetts business leaders have similarly argued that current mandates cost 15 cents of every new health care dollar spent.[41]
    The Massachusetts legislature has responded by expanding the list of mandates to include prosthetic devices, hypodermic needles, mental health cover age,[42] and coverage of autism services.[43] The autism law, the most recent expansion, is expected to drive up annual spending per insured person by $14.64 to $29.40, adding $340 million in addi tional premium costs.[44]”

    So more mandates, more expensive plans, higher premiums (meaning stagnating wages), and a heavier burden for small businesses, which create most of the jobs in the state. But no, anyone who might have initially supported Romneycare and has now changed their mind is purely playing politics.

    Can I go ahead and adopt the smug, sweeping, Manichaean attitude that pervades most of the posts by the lefties on this thread and simply dismiss their ideas out of hand by suggesting that they simply don’t care about rising premiums? They simply don’t care about stagnating wages? They simply don’t care about job creation? It would certainly be easier than doing any actual thinking.

  • Elvis Elvisberg

    torourke– thanks for reading those links, and for your thoughtful comment.

    From the WaPo article at your link, quoting the CBO: “A package of reforms that included a $250,000 cap on damages for pain and suffering and a $500,000 cap on punitive damages “would reduce total national health care spending by about 0.5 percent.”

    Well, that is better than a sharp stick in the eye, for sure. Assuming that these laws would not make it more difficult for patients to find representation (for all I know, a complex suit against a negligent health care provider costs a plaintiff $100,000, or $1,000), it sounds like a good plan. Do you have a link for your details about the positive impact of anti-jury award laws in Texas? I wonder what the trade-ooffs have been. I would not tend to have the same reticence that you do about enacting it at a federal level, for what it’s worth.

    That CBO study, and the experience of the hospitals Gawande investigated, suggests that tort reform is not one of the top 50 most important matters in bringing health care costs down. Doesn’t mean it’s not worth doing, but it does mean that arguments against the Heritage Foundation-based reform that we just passed that are grounded on tort reform are unserious.