In my column on today’s main site, I ding the Democrats — even the “deficit hawks” among them — for backing procedural maneuvers that would allow a national health care reform to be rammed through Congress along a straight party-line vote. This is not what reconciliation is intended for nor has it historically been how most durable pieces of sweeping reform legislation have been enacted. But as important as it is to criticize the Democrats for this naked power play, the substance of the reform legislation is even more important than the process by which it is passed.
That’s where Republicans deserve some criticism. It has long been clear that the status quo won’t hold in America’s health care system. There are two options: moving toward a system where there is more government control and a larger federal role, or introducing truer free market in the delivery of health care. The first approach has since World War II had a consistent advocate in the Democratic Party. The second approach has had not been reliably advocated by the GOP, and the party has paid a price for it’s lack of vision.
Don’t get me wrong. Republican legislators sometimes introduce fine health care bills as alternatives to the Democrats’. Republican presidential candidates talk about free-market health care reform during their campaigns. Even John McCain had a decent, if easily demagogued, plan in 2008. But these proposals are only used as damage control when the Democrats make a serious health care push in Congress or when GOP candidates need to talk about health care on the campaign trail. They go nowhere legislatively and are immediately shelved the minute a Republican president takes office.
Republicans have succeeded in expanding health savings accounts, a modest free-market health care reform achievement. But the bulk of the Republican record on health care consists of half-measures like Kennedy-Kassebaum, SCHIP, and Medicare Part D, — none of which satsified the public’s desire for reform and most of which moved us closer to a federally run health care system. Broader free-market reforms have been left to the op-ed pages, white papers, and congressional backbenchers.
Process isn’t everything. While many experts believe Hillarycare was doomed once Robert Byrd wouldn’t support its inclusion in reconciliation, another factor in its defeat was that the public turned against it. Republicans made arguments against its likely effects that eventually sank in with the American people. Reconciliation or no, that’s what needs to happen with Obama’s health plan today. But arguments against Democratic policies aren’t enough. Republicans have to have an alternative vision and argue for it as seriously as the Democrats contend for theirs.