"[It] is not," Winston Churchill said after the British military
victory at El Alamein, "the end. It is not even the beginning of the
end."
Unfortunately, misguided moderate Republican support for the Kennedy-Kassebaum
health care legislation now before the Congress may, in fact, be the beginning
of the end.
Through a strange twist in events, moderate Republicans are guiding the
direction of the fading conservative revolution in Washington, resulting
in compromises right and left - but mostly left.
To begin with, Republicans did not campaign on health insurance reform in
1994. After two years of fighting the Clinton health plan, Hillary's health
care task force, and a plethora of Democratic charges that Republicans are
insensitive to the needs of the uninsured, conservative Republicans soundly
defeated the attempt to bring socialized medicine to America through the
front door. And they then swept into control of both Houses of Congress.
Two years later, in 1996, the Republican revolutionaries, now controlled
by moderates, are letting in through the back door the very health care
socialization they barred at the front door. In the name of "good government"
(which means the passage of something is more important than its contents),
the conservatives seem to be surrendering. Or, in the words of New Jersey
Republican Congresswoman Marge Roukema, "A modest bill that can be
passed today is of far greater value than an ambitious bill that might take
months or years to pass."
Three changes would be needed to begin socializing the American health care
system: (1) Anyone ought to be able to get health insurance when they want
it at an affordable price (if not free); (2) the federal government should
be overseeing the process to make sure there is full compliance; and (3)
consumers absolutely cannot be allowed to control their health care dollars
and make decisions for themselves. The Kennedy-Kassebaum legislation now
before the Congress incorporates all three concepts.
First, the key to any system of socialized medicine is that people can get
health insurance whenever they want it. Of course, no insurance company
can stay in business if it must sell a policy to someone after a tragic
event has occurred. Everyone understands that if people were able to purchase
auto insurance after a car wreck, everyone would just wait until they were
in an accident before they called an insurance company. Yet Kennedy-Kassebaum
would require any insurer selling in the small group market to accept any
group, and any insurer selling in the individual market to accept any individual,
who applies for health insurance regardless of health status. Oh, the legislation
throws in a few hurdles, just so it isn't full-blown government control.
Call it socialism with a prudent face.
Second, in a nationalized health care system, the federal government must
take a strong, guiding hand. Under Kennedy-Kassebaum, the Department of
Health and Human Services gets the final say-so on - and veto power over
- state attempts to create programs that meet the needs of the uninsurable.
This approach runs counter to the entire Republican revolution, which has
been seeking to return power to the states.
Most of all, what any government cannot permit when socializing a health
care system is giving individuals any control over their own health care
dollars. Whoever controls the money controls the system. That's why President
Clinton, most Democrats, and even some moderate Republicans have stated
their opposition to Medical Savings Accounts (MSAs).
While I can understand why liberal Democrats and even moderate Republicans
would oppose MSAs - since their availability would mean people, rather than
the government, would control the health care system - it is unthinkable
that conservative Republicans would compromise on this point, the one free-market
provision that would at least mitigate some of the damage the other provisions
would do.
And yet, they are. In the words of Speaker Gingrich regarding MSAs: "I
want the House to know that if the president sends up a veto signal, we
are not going to risk vetoing coverage for all Americans."
Since nationalizing the health care system is what so many conservative
Republicans fought against just two years ago and won, and since fighting
to pass MSAs has been the primary health care offensive battle plan for
the conservatives, you would think they would stand firm. Instead, they
have been mostly waving the white flag of surrender, afraid that Democrats
and the media will call them cold-hearted if they don't compromise with
the liberals.
Abandoning principle cost Bush Republicans the White House in 1992. Standing
for principle won conservative Republicans the Congress in 1994. So why
are they abandoning principle again in 1996?
Beats me, and if the Republicans aren't careful, it will beat them in November.
The National Center for Policy Analysis is a public policy research institute
founded in 1983 and internationally known for its studies on public policy
issues. The NCPA is headquartered in Dallas, Texas, with an office in Washington,
D.C.