It's About... Losing Elections

Although Michael Gerson can't quite bring himself to being explicit in that admission, he does effectively concede that Republican obstreperosity on healthcare reform has its roots in their fear of losing elections.

Critics of all things Republican insist that these objections are merely a cover for politics - that the GOP has decided to defeat Obama, no matter what the content of his health reforms. But concerns about America adopting the fiscal practices of a banana republic are not merely an excuse, they are a wave. And it is not cynical for Republicans to recognize the ideological stakes that Obama has raised. The passage of a massive health entitlement would change the relationship of Americans to their government.

On the evidence of nations such as England, a national health system places a conservative party at a permanent ideological disadvantage. Every proposal for tax reductions is attacked as undermining the eternally hungry public health system. Every failure of that system becomes an excuse for greater spending and government involvement. The tide of government grows, and the ebb weakens, until no one can fight the flood.

This is the main explanation for Republican resistance to Democratic health reform - and the reason that Sen. Snowe is likely to remain a lonely heretic.

While Gerson supposedly fears the slippery slope that will result from an effective national healthcare program, this is the same slippery slope argument Republicans have been making since the dawn of the New Deal. Republicans have repeatedly tried to tear down Social Security, yet somehow they have managed to survive, thrive, and at times dominate the American political culture since that program's passage. The same is true of Medicare. In fact, if Gerson recalls, G.W. Bush massively expanded Medicare, without the same sort of right-wing hand-wringing about budget deficits and transformation of the American way of life.

Gerson, as usual, doesn't know much about his subject. Perhaps he has forgotten Maggie Thatcher, who somehow managed to smash unions, privatize government-controlled entities and public housing, and (get this) lower taxes during her tenure, despite the existence of that nation's National Health Service.

Similarly, his reinvention of himself as a deficit hawk the moment Bush stepped out of office doesn't exactly give credibility to his supposed concern about this nation turning into a Banana Republic. Let's see... the son of a mediocre former President takes over the country, mismanages pretty much everything he touches and runs up huge deficits, but we're at risk of looking like a Banana Republic the moment he leaves office?

But perhaps more to the point, the "deficits" of the Democratic plan could actually be remedied by following a Canadian or European model for a national healthcare plan:

• "First, it will make the average insurance plan more expensive." Here, of course, we are speaking in averages. It follows inexorably that if a pool that once excluded people for pre-existing conditions, and scoured past medical records to disqualify people for benefits based upon "undisclosed" prior conditions (both real and imagined), the cost of insurance within that pool will go up. But for people getting employer-sponsored health insurance, where pre-existing conditions are already covered, it's not likely to have an effect. This could be mitigated or remedied by regulating the insurance industry, requiring health insurance companies to operate as nonprofits, or by having a national healthcare plan that competes with or supplaces private coverage. The Republican "solution", on the other hand, appears to be to allow insurers to continue to deny coverage to people with pre-existing conditions - Gerson's "compassionate conservatism" in action.

• "Second, while Democratic reform does expand health-care access, it does little to address the issue of cost inflation". Well, here's the thing. All indications are that with a national healthcare plan we would experience both cost savings and a reduction in healthcare inflation. Yet Republicans fight tooth-and-nail against even a modest public option to compete with private insurers. Some Republicans do offer a "solution" to healthcare inflation (with no evidence that it would work), by giving everybody much worse health insurance and making people pay for more of their own care out-of-pocket; that might be a hard sell, though, for a party that's propagandized against Democratic healthcare reforms on the premise that most people like their current insurance coverage.

• "Third, the Medicare cuts assumed by the Finance Committee are dishonest." Well, maybe so, but welcome to government. I'm curious - did Gerson try to advance this concern about government honesty when he was writing speeches for President Bush, because.... But seriously, this is one of the perils of trying to have a healthcare bill that's everything to everyone - we shouldn't be trying to address every issue and concern relating to the future of healthcare in a single bill.

If Republicans truly wanted a system that demonstrably would reduce premiums, reduce inflation, reduce the overall cost of healthcare, they would be actively looking to other Western nations and insisting that we adopt a program modeled after the most successful, most competitive national healthcare plans already implemented in other nations. But for all of Gerson's hand-waving, the fact is that to the Republican Party this is all about future elections - and they see an electoral advantage in running for office in a nation where millions of people are uninsured and millions more are underinsured.