Health-Care Reform Could Kill the GOP

Can policy be both wise and aggressively partisan? Ask any Republican worth his salt and the answer will be an unequivocal yes. Ask a Democrat of the respectable Beltway variety and he will twist himself into a pretzel denying it.

For decades Republicans have made policy with a higher purpose in mind: to solidify the GOP base or to damage the institutions and movements aligned with the other side. One of their fondest slogans is "Defund the Left," and under that banner they have attacked labor unions and trial lawyers and tried to sever the links between the lobbying industry and the Democratic Party. Consider as well their long-cherished dreams of privatizing Social Security, which would make Wall Street, instead of Washington, the protector of our beloved seniors. Or their larger effort to demonstrate, by means of egregious misrule, that government is incapable of delivering the most basic services.

That these were all disastrous policies made no difference: The goal was to use state power to achieve lasting victory for the ideas of the right.

On the other side of the political fence, strategic moves of this kind are fairly rare. Instead, for most of my lifetime, prominent Democratic leaders have been chucking liberalism itself for the sake of immediate tactical gain.

Former President Bill Clinton, who is widely regarded as a political mastermind, may have sounded like a traditional liberal at the beginning of his term in office. But what ultimately defined his presidency was his amazing pliability on matters of principle. His most memorable innovation was "triangulating" between his own party and the right, his most famous speech declared and end to "the era of big government," his most consequential policy move was to cement the consensus on deregulation and free trade, and many of his boldest stands were taken against his own party.

The results were not pretty, either for the Democrats or for the nation.

Still, conservatives have always dreaded the day that Democrats discover (or rediscover) that there is a happy political synergy between delivering liberal economic reforms and building the liberal movement. The classic statement of this fear is a famous memo that Bill Kristol wrote in 1993, when he had just started out as a political strategist and the Clinton administration was preparing to propose some version of national health care.

"The plan should not be amended; it should be erased," Mr. Kristol advised the GOP. And not merely because Mr. Clinton's scheme was (in Mr. Kristol's view) bad policy, but because "it will revive the reputation of the party that spends and regulates, the Democrats, as the generous protector of middle-class interests."

Historian Rick Perlstein suggests that this memo is "the skeleton key to understanding modern American politics" because it opens up a fundamental conservative anxiety: "If the Democrats succeed in redistributing economic power, we're screwed."

In the Clinton years, of course, it was the Republicans who succeeded. And the Democrats' failure -- the failure to deliver national health care that is, not the act of proposing national health care -- was a crucial element, in Mr. Perlstein's view, in the Republican Revolution of 1994. Assessing the accomplishments of the "party of the people" after those first months of Clintonism, middle-class Americans were left with what? A big helping of Nafta. Mmm-mmm.

Fourteen years later, we find ourselves at the same point in the political debate, with a Democratic president-elect promising to deliver some variety of health-care reform. And, like a cuckoo emerging from a clock, Mr. Kristol's old refrain is promptly taken up by a new chorus. "Blocking Obama's Health Plan Is Key to the GOP's Survival," proclaims the headline of a November blog post by Michael F. Cannon, the libertarian Cato Institute's director of Health Policy Studies. His argument, stitched together from other blog posts, is pretty much the same as Mr. Kristol's in 1993. Any kind of national medical program would be so powerfully attractive to working-class voters that it would shift the tectonic plates of the nation's politics. Therefore, such a program must be stopped.

Liberal that I am, I support health-care reform on its merits alone. My liberal blood boils, for example, when I read that half of the personal bankruptcies in this country are brought on, in part, by medical expenses. And my liberal soul is soothed to find that an enormous majority of my fellow citizens agree, in general terms, with my views on this subject.

But it pleases me even more to think that the conservatives' nightmare of permanent defeat might come true simply if Democrats do the right thing. No, health-care reform isn't as strategically diabolical as, say, the K Street Project. It involves only the most straightforward politics: good government stepping in to heal an ancient, festering wound. But if by doing this Barack Obama also happens to nullify decades of conservative propaganda, so much the better for all of us.

Thomas Frank's column, The Tilting Yard, appears every Wednesday at OpinionJournal.com

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Comments

[Clavis]

I got nothing against letting the private sector be in charge of building widgets.

But when my 5-year-old daughter has a cough that won't go away, or my grandfather can't remember who I am, or I see a mole on my arm I don't recognize, that ain't widgets.

[Mixpixlix]

For the first time in our 40 year struggle to bring Universal Healthcare to these shores, we have an administration, population, employers and unions agreeing that the current system can't continue. Even the mouthpiece of the health insurance companies America's Health Care Plans acknowleges that the current system can't stand (beware the fox in the henhouse).

One to be addressed is end of life care that doesn't enhance outcome. Too many people in the finally months of their lives receive high tech, expensive care that doesn't do one iota of good. This too must stop. Keeping people pain free, clean and able to maintain their dignitty to the end is the best parting gift you can give a loved one.

Anyone particpating in the healthcare reform discussion should make sure they have a living will and designated health care surrogate.

I worked in the heathl care industry corporate side and the greed, stupidity and I got mine, screw you mentality was everywhere. I saw doctors refuse their case manaement obligations unless a check was attached to the file. This is America and we've made everything all about money and that mindset is destroying us.

Why are we so unkind to each other? Why is it that only now when major companies are going bankrupt, millions losing their jobs and homes AND health insurance are we finally waking up?

It's too bad it takes the worst economic climate since the Great Depression for Americans to realize we're all in this together.

[Montanagramma]

The underlying problem in our country is greed. You can trace every problem we have, and for that matter, every problem we have ever had, back to greed. Sadly, that is how our present system is set up, and the decent thing to do is seen as a loss of the power of that greed.

Health Care? Greedy Ins. cos and big pharma get rich. Sick people? Too bad!

Wall Street? Ponzi schemes that stick everyone else with the risk, and the quick ones with the money. Taxpayers bail them out.

War? In the early days of this country, the Indians had the land. Not acceptable to the greedy, so steal it. Indians fight back? Kill them. Iraq? Oil companies want the oil. Kill and take it. Illegal Immigrants? Use em up, make money, and leave the tax payers to pay the bills. To say nothing of the military industrial complex, and mercenaries making big bucks, paid for by the taxpayers.

As we spread our way of business to the world, they too got greedy, and now we all are falling together.

[Thevail]

How about everyone just take a deep breath and admit this..It is no wierder, or bizarre, or outside the mainstream..to be a liberal democrat than it is to be a conservative republican.

Why can't anyone do what's best for this country AND it's citizens. Please...there are about 10% of the public that are "left wing liberals" and about 10% of the population that are "right wing conservatives".

The rest of us..80% of the population..are along a spectrum in the middle.
And we're broke..out of jobs, paying too much for everything, wages lagging behind inflation pretty badly..etc. Just FIX IT.

[JimGroom]

Health care reform could kill the GOP. Is that a question or a prediction? BTW, is there a down side to such a pronouncement? The GOP will actually finish the job of killing their brand with or without health-care reform. The modern GOP has failed this country and the rubes have finally figured it out. They have been fooling the uninformed for decades and getting away with killing off the middle class and to a very large extent the union movement. I hope that the Demos' don't screw up their chance to reverse the negative trends since Reagan, but I'm not convinced they won't.

[vippy]

I am not so sure both parties are not in this together. Remember the high gas prices, they were briefed on the outcome but they did nothing. While they were making money they did not want to
stop it. Yes, they saw this coming, both of them, and both gave Bush whatever he asked for.
They are ALL enablers.

[MCTSilverlakeCA]

Having worked for many years in the health care disability end of Insurance, I have an insight that many others lack. I agree wholeheartedly that this Nation needs a National Basic Health Insurance Plan, or at least a Basic Emergency and Sickness Prevention Medical Care Plan for every US Citizen.

I also have had personal experience at nationalized medical care - I was once taken by ambulance after some food poisoning in London, UK made me feverish and dizzy. I can honestly say that the treatment at Charry Cross Hospital was very prompt, courteous, caring, efficient, and honest. - and no one told me I was interfering with their golf game schedule. They didn't care if I had insurance or not - they said (quoting) "we'll worry about that later, every human being needs medical care, and that's why we chose medicine as a career". I later received a bill for about $150, which I sent to my U.S. insurer, who paid it.

Now...if THEY CAN DO IT, in that small a country - WE CAN DO IT - of course, we WILL have to do away with outrageously high physician salaries and medicine for profit --and that will make Big Medical sulk a lot, but you know... it's time we stop treating Medicine as something only the Wealthy are entitled to...

[douc66]

I have to agree with MCTSilverlakeCA on this one. I lived in Germany for 10 years. Even though their system is somewhat different, I had a similar experience. I had went to a clinic for a skin infection. They ran tests, treated me and sent me off with a prescription. I later got a bill in the mail for the equivalent of $70.

When I had later gotten married, I was under my ex-wife's insurance. I could see any doctor that I had wanted and the service was great.

It seems that the only people who highly critical of 'socialized medicine' are the people who never lived anywhere WITH socialized medicine...

And, by the way all of you haters, what you are not being told (either through willfullness or ignorance) is that many of these countries have a PARALLEL SYSTEM OF PRIVATE INSURANCE.

[LiberalDem]

In 1993 while vacationing in Germany I developed an ear infection-through our hotel we found an English-speaking doctor within walking distance of the hotel. I saw the doctor promptly, was examined and sent on my way with a prescription-total cost was around $35.00 dollars.
We didn't have to wait for the prescription at the pharmacy either-they stock their pharmacies with medications pre-packaged. It was a very easy, no-stress business.

[mlaiuppa]

Wow, a twofer. Healthcare and death of the GOP. Go for it!

[Bagger]

It's the main reason I vote Democratic. Health care should not be an obstacle to starting a business or raising a family. Our health insurance system in this country needs to be provided to anyone and anybody period.

[VikingQuest]

Why could it kill the GOP?

My only thought is this:

If you put 51% of people on the government welfare/handout program I guess you make the reliant on government.

[snesich]

Let me get this straight: You're calling a guarantee of health care coverage for all American citizens a "government welfare/handout program"? Are you ignorant of the facts or are you just a conservative who wants to spread distortions and fabrications?

I'm a small business owner. The biggest impediment I face to growing and expanding my business is the lack of health for my potential employees. If my business were based in the UK, or France, or Canada, or Taiwan, or many, many, many other countries, I'd be able to hire more people, grow my company and the people working for me would be healthier, happier, more economically secure and more able to contribute to my company.

Only right-wing extremists---and those who have been infected by their propaganda---are still fighting universal health care at this point.

President Obama: PLEASE take advantage of this golden opportunity in the next year to pass a universal health care program. If you delay, you'll blow it, like the Clintons did, and set us back who knows how many years. Seize the moment and by doing so, you'll not only make the lives of millions of us much better, but you'll also, as Frank indicates, be driving the conservative opposition and their ideas into the garbage heap where they belong.

[degenerate1991]

Yes, health care coverage would be considered a welfare/entitlement program. And no, you likely wouldn't be able to employ more employees due to the fact that corporate taxes would have to be raised much higher.

[ThePeacemakers]

Viking,
Just a touch a research outside right wing radio and Fox news would show you that the corporations are the ones reliant on government handouts. The bailouts these days are just the freshest on our minds:
From Lockheed in the 1970s to AIG and others today, tax payers have not only kept businesses in biz, but , with all the tax breaks, paid them to hire us.
Not a handout at all - some fair share for a change.

And Good point Snesich.

[vippy]

ask yourself why we are paying taxes in the first place, surely not to pay these outrageous salaries with huge benefits to the congress and senate? We want our roads and bridges safe, etc.
but that has been neglected. Where is our money going and yes, we are entitled to some for the
common good.

[VikingQuest]

Think about it, if your taxes went to the necessities and not the entitlements or waste . . . your rate would be under 5%.

[racetoinfinity]

You wrote (and this is a great condensing to a good usable sentence):

"Or their larger effort to demonstrate, by means of egregious misrule, that government is incapable of delivering the most basic services."

I just want to emphasize, if necessary to anyone, that this "egregious" misrule was 90% (or more, probably) deliberate and conscious, and no doubt included picking unqualified cronies to pay off or just get a fat paycheck for incompetence, which furthered their aim of proving government incompetent and impotent.

[Articulator]

The people the Bush administration appointed to head each govt department were put there with one purpose. To tear down that department. The basic economic policy of the Bush administration is to eliminate any cost from business. That means getting rid of rules from govt entities like the EPA, the FDA, and so forth that cause business to spend extra money. It costs money to properly dispose of toxic waste instead of pouring it down the drain. It reduces costs if downer cattle can be used in the food supply, it would be so much more profitable to be able to put melamine in baby food and lead in paint. Every govt department was placed under the control of a Heckuva job Brownie. That's what happens when you put those in control of govt that hate govt. They were backed by big business lobbyists with big cash and also less well off conservatives that are paranoid that one cent of their tax money will go to welfare and therefore they say they hate govt. That is the M.O. of the Bush admin. John Bolton was sent to the UN to tear it down because they made it difficult to go to war with Iraq when their inspectors said there were no WMD's.

[littlebuddylouie]

Bush was the perfect stooge to carry out the slash and burn, anti-everything that isn't good for big business policies that started in earnest under Reagan. The proverbial chickens have finally come home to roost, and it's a shame that President Elect Obama is going to have to spend so much effort just trying to uncover and repair the damage.
Anybody that thinks big business will ever do anything that is in the interest of the environment, the general public, or their employees without being forced is sadly mistaken. Not everything needs to be privatized and deregulated, and I hope America is beginning to figure that out.

[racetoinfinity]

And that's why "free market" "free trade" extreme (FULLY or close to fully unregulated) capitalism is IMMORAL, not to mention perhaps out of whack with reality, which is we are all individuals in context with our communities, with the environment, with the Planet - you can go up the chain.

But the hyper-individualism of unregulated capitalism may be a half-view, (of those of the Grover Norquist persuasion, and that includes Rove and Cheney) and thus, a delusion; no wonder it comes to a bad end. (It's infected neo-liberals as well - Clinton signed the main bulldozing of the major financial firewalls FDR had put up, and here we are, sad to say.

[Giordano Bruno]

Mr. Frank, I very much admire you, and frequently quote your insights from WTMWK. As a physician, I find myself very worried about the welfare of my pediatric patients in the current health care (non) system. The same conservatives who bemoan "socialized medicine" and increased taxation as a result of universal health care, ignore the fact that their medical bills are frequently inflated far beyond value received in order to pay for the unfunded mandates by the governement to provide expensive emergency services to all comers in our overcrowded ERs. What really breaks my heart is when my less fortunate patients start asking which of multiple medications needed they must eliminate due to cost considerations. It is shameful and immoral. And if this is the end result of free market capitalism, I happily through in with the socialists. The issue has very much been obfuscated by invective and oversimplistic rhetoric. It is high time we started providing all of our citizens with improved, more available and cost effective health care, something which the current system has failed to do. The status quo is no longer an option. In fact it is an abomination. Giordy

[Rog49Thomas]

After the NHS was introduced in the United Kingdom, Ms. Thatcher enjoyed a long reign as prime minister.

Universal health care in the US is not going to end the Republican Party.

[georgeeparker]

The NHS was introduced in Britain in 1946 by the Labor Party then in power. Thatcher didn't become PM until nearly thirty years later. The Conservatives then in power tried to defund the system. In spite of its problems, the NHS still provides every citizen with guaranteed health care. Obviously, the same cannot be said about the US.

[snesich]

Universal health care isn't going to end the Republican Party; but it will drive them into the wilderness for a generation or more. That's one of the reasons that they're so hysterical and unhinged in their opposition: they know that if this passes, it will undercut their constant lies about "If government gets involved it will only make things worse."

Also, get your history right. Thatcher came to power about 3 decades AFTER the NHS was introduced in the UK. But even she wouldn't seriously touch it. It's too popular. People like it.

And I'm sick and tired of people saying "Yeah, but the health care program in (fill in the blank country) isn't perfect either. They've got their problems too..."

Duh.

No system is "perfect". But for too long the lack of "perfection" in the UK, or Canada, or Japan or France or Norway has been used as a tactic to try and get people to turn away from the idea of universal health care in the USA. Don't fall for this nonsense. No system---public, private or some hybrid---is perfect and will never be perfect.

But anyone who thinks that it's better to let people die or go bankrupt rather then provide universal health care is either selfish, or stupid, or maybe, a little of both.

It's time to pass universal health care---hopefully before the end of 2009.

[Rog49Thomas]

Thanks yours.

(1) Perhaps, health care will drive the RP into the wilderness for some time. Perhaps some other factor will. There are cycles in political fortunes and fashions -sometimes caused by events/policies and sometimes arising for other reasons. This is particularly true when dealing in countries with a relatively low level of political maturity like the USA. In such countries it might be the candidate's appearance that results in victory or defeat.

(2) My history is precisely right. The article states that UHC in the USA will "kill" the RP. The NHS did not "kill" the CP in Great Britain. Do we have a disagreement here on the meaning of the word "kill" as opposed to the word "harm"?

(3) As I expressed no point of view on health care systems in other countries, I assume that perhaps you are "venting" or replying to someone else's post.

[degenerate1991]

Yes, but the entire political scale in Britain moved to the left. Thatcher would still have been considered a liberal as opposed to Reagan. The GOP would still survive, but they would no longer be able to feasibly run a conservative platform. That is, unless our government screws up health care like they do everything else.

[MCTSilverlakeCA]

Rog49Thomas ... you said "Universal health care in the US is not going to end the Republican Party", and you are right... but it WILL end Medicine for Profit over Medicine to help sick and injured people- which will be a good thing... and it will also end the For Profit deliberate cut backs in the amount of physician as a medical career seeking students that Big medical Schools engage in to keep the numbers of newly trained and licensed physician's down... which also keeps their fee's - UP... one of the main contributory reasons that medicine costs so much.

[Rog49Thomas]

Should the US take the dangerously radical step of introducing a rational health care system in this country, there could still be an opportunity for excess profit in the system.

[valkyrie607]

"Continuing to F*ck The Middle Class is Key to the GOP's Survival."

Ahh truthiness!

[jfor]

First you have to actually believe that elected Democrats are any different than elected Republicans, they are not. Democrats and Republicans in office feather their own nests, raise tons of cash for the sole purpose of getting re elected, have no desire for term limits when they finally get elected. Do not fulfill thier oath to the Constituiton or show any loyalty other than to themselves and those who keep them in power, like republicans they put corporations and other power players ahead of tax payers, they pay lip service to regular folks while surrounding themselves with people who inflate their egos. They perjure themselves and refuse to hold each other accountable or responsible for lapses in judgement all in order that they all may remain in power and screw over the rest of us who keep hoping and voting that things will change.

[snesich]

Are you a conservative trying to discourage and demoralize people with this BS? Or are you just a cynic, who prides himself on his "know it all" attitude?

Either way, what you're saying is completely wrong.

If you can't tell the difference between dark black and several different shades of gray, you've got serious perception problems.

[Myshkin57]

Ah... predictable cynical rhetoric with no substance. It's infuriating but comforting in it's familiarity.

[FogBelter]

Mr. Frank, the miserable state of our economy offers Obama a chance to implement Universal Single Payer Health Care paid for by a national consumption tax immediately. I know, I know Obama was never publicly for Single Payer, but that was then, this is now. With the implementation of Universal Single Payer Health Care the burden of future Medicare costs, the miserable state of Veterans Health care, the seniors having to chose between medicine or food, the health related bankruptcies, the financial burden on business will end. This is really a no brainer. It needs to get done.

The best way to attack it is to absolutely overwhelm the Republicans with legislation from day one of the Obama Administration. Push, Push, Push. Hit the GOP with diverse levels of legislation so it splits what remains of their coalition and drives them into the type of open, internecine party warfare they are already on the brink of. Furthermore, identify the Moderate Republicans and let them know there is a place for them in the Democratic caucus and that their ideas will be seriously considered and acted upon ... in other words, let the reasonable Republicans know there is a place for them as something more than lockstep obstructionists.

Whether or not it is damaging to the GOP is besides the point ... the US has needed universal single payer health care for generations. Now is the time to do it.

[TRYKER]

FogBelter...you're right.
Universal single payer would be the boon to American businesses, large and small. With that headache out of their hair, they could project and plan and hire and breathe again. Everyone would benefit.
That is the best stimulus Obama could give this nation...One Giant Problem OFF OUR BACKS!.
When I think of it in action, immediately, It takes my breath away. My back stops aching.
I agree too with the idea of overwhelming them, running right over them...open up on so many fronts they won't know -- who to call. Their word-fights aren't going to cut it, they are going to have to get real...or perish.
Some of the Repubs have to have some sort of common sense, one would think, so doing right might be to their benefit. DUH!
They look like a fit enough selection of appointees...when they hit the ground running, I hope they spread out and impress us, Big Time.

[ThePeacemakers]

Obama's plan isn't single payer.
But right now,don't need a lot of people losing jobs in insurance industry. Although many other businesses would love a way to stop having to pay to administer healthcare costs.

[slemay]

With apologies to our Canadian friends, who are often vilified by the right, a more socialized system is not the only alternative. We spend 16% of GDP on health care, about double the percent for other industrialized nations. Switzerland has a system that is arguably more market-oriented than ours, seems to satisfy most of its citizens, and covers everyone--for 8% of GDP.

An important factor in this process would be getting the cost of health care off the corporate books--not as important, however, as getting health care for more people.

[Daksian]

Yeah, as was suggested in another comment thread, my country (Canada)'s system is far from perfect. I have a Swiss friend who explained their system to me...and it is workable, but it's never been tried in larger countries. It'd certainly be an interesting approach that might work for the US, however.

Even so, I'd take my socialized system over your private system. Health insurance companies are motivated by profits, not service. The less service they provide, the more profit they generate.

[slemay]

To tell the truth, our system is so fouled up, almost any change will be an improvement. And, really, our system isn't that private; it's mainly disorganized and overwhelmingly stupid. But, yeah, I'd take yours over ours. In fact, send it over. It's warmer here.

[FreedomBeforeDemocracy]

How about instead of the whole US trying the Swiss system, just the individual states that want to try it actually try it. Then the our (US) federal government can go back to just doing the things they are legally (based on the constitution) allowed to do. If the system works out for one state, I'm sure others will adopt the practice.
Health insurance companies (like all for-profit companies) are for profit. However, they are for profit based on service. You claim "The less service they provide, the more profit they generate." So you think an insurance company that provides no claims is going to make the maximum amount of profit?