As the Senate health care bill lurches toward enactment, how much blame should Republicans bear? Ross Douthat says, "Between the defeat of Clintoncare and the election of Barack Obama, the Republicans had plenty of chances to take ownership of the health care issue and pass a significant reform along more free-market, cost-effective lines. They didn't." Ramesh Ponnuru responds, "Let's not forget that at no point during that period did the Republicans have anything like the Democrats' current strength in Washington.... the collapse of Lehman Brothers did more to get Democrats to this point than any strategic mistake of the GOP on health care."
There's truth in both viewpoints: The Republicans never had the opportunity to pass something as sweeping as the Democratic health care bill. Their majorities were too narrow, arguably even after the 2004 elections, when they were soon adrift as a result of Iraq and Katrina in any event. But it's equally true that the Republicans never worked very hard to popularize the idea that a free-market alternative existed in the first place. When they did pass big health care legislation, initiatives that reinforced the Democratic health care vision -- Kennedy-Kassebaum, SCHIP, and the Medicare prescription drug benefit -- loomed larger than modest expansions of health savings accounts and the drug benefit's Medicare Advantage component.
Republican free-market health care plans tend to get proposed during presidential campaigns or efforts to defeat Democratic legislation, and then quickly shelved after the election is over or the Democratic legislation is defeated. That might not be the only or even the most important reason the Democrats seem likely to pass a health care bill, but it surely didn't help.
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