Are the wheels coming off the Democratic plan to revolutionize American health care? We can only hope so. But as Republicans resist the new controls, new taxes, and new government expansion proposed by Democrats, they need to be very careful to avoid the opposite mistake: defending an indefensible status quo.
The American health-care system is a costly and inefficient quagmire. It spends dramatically more than any other health-care system on the planet, while producing (at best) only marginally better results. Wages are stagnating for middle-income Americans because of the surge in health -are costs. Fear of losing insurance deters many from switching jobs or striking out on their own. The uninsured get sicker, and the inadequately insured worry that illness will lead to financial ruin.
Many of these problems bear especially heavily on groups Republicans are generally expected to champion: small businesses and the self-employed. At the beginning of the summer, I was talking to a small-business owner and lifelong Republican who said: "If Barack Obama will take my health-care costs off my books, he can charge me whatever he wants in personal income tax—it'll be worth it."
What is the competing offer from Republicans?
Though you wouldn't know it from the current debate, Republicans actually have an inventory of useful ideas to offer Americans concerned about the rising cost of health coverage. Republicans have proposed allowing the sale of insurance products across state lines, enabling people in expensive states like New Jersey to benefit from the less expensive regulatory regime in, say, Kentucky. Republicans have proposed creating health-care exchanges—like the one fashioned by former Gov. Mitt Romney in Massachusetts—to enable the self-employed to buy insurance with untaxed dollars, just as larger businesses can. The first President Bush proposed an audacious series of subsidies for the uninsured, to be paid for by taxing the benefits of the most generous employer-provided health plans.
Unlike President Obama's grand schemes, these measures represented incremental changes to the status quo; they could have been implemented gradually, allowing everyone time to assess their effect while giving the system time to adjust. That's the way to make big changes to something as vital and complex as American health care.
Despite these good ideas, the GOP failed to make health-care reform a priority when it held power. As a result, we Republicans forfeited our credibility on the issue. Strikingly, the Republican with the biggest health -are story to tell—Mitt Romney—declined to trumpet his achievements in the 2008 Republican primary contests, having accurately gauged that they would do him little good. (The Romney plan had trespassed conservative orthodoxy by including, among other offenses, a mandate that imposed a tax on individuals who failed to buy one of the new health policies created by the plan.)
Republicans are in danger of forgetting one of the primary rules of politics: Voters do not care what you know until they know that you care. On health care, we do not look like we care.
So as the Hydra-headed Obamacare lurches through the halls of Congress, we can be confident in our opposition; the president is overreaching horribly. He seeks to herd millions of Americans into a government-operated plan. His promises of cost control are pure assertion, fantasies based on hope and guesswork. He will pile new taxes on small business and crushing new regulations on America's most innovative industries. He has a bad plan, deserving of intense opposition.
But if Republicans prevail, as I hope we do, then what? Can we provide a vision larger than merely inflicting defeat on a Democratic president and Congress? Can we offer a better alternative? And will we do the hard work to make health care a priority after Obamacare is beaten back, assuming it is? If Republicans can play a constructive role on the toughest of issues, we'll have taken our first important step on the road to political recovery. If not, a victory over an ambitious president may prove an empty one, both for Republicans and for the country.
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