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Will Marshall Headshot

RIP Compassionate Conservatism

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The Republican message on extending health care coverage can be summed up in two words: "Bah, humbug."

In taking a purely obstructionist stance, the GOP has evinced scant empathy for tens of millions of fellow Americans who lack basic protection against illness or injury. So much for compassionate conservatism.

On Saturday, not a single Republican voted to allow the Senate to even consider a bill to expand coverage and reform health insurance markets. When the House passed its version of health reform, just one Republican voted aye. He is Rep. Joseph Cao, a freshman from normally Democratic New Orleans.

Republicans, of course, are under no moral or political compunction to support Democratic proposals for health reform. But since they haven't offered any credible alternatives of their own, it's reasonable to conclude that they don't care all that much about fixing America's broken health care system.

Sure, House Republicans proffered their version of "reform" earlier this month. It would spend just $61 billion over 10 years and leave the percentage of insured Americans in 10 years exactly where it is today -- at 83 percent. Thanks to population growth, there would actually be more uninsured people than today.

In opposing serious efforts to expand coverage, Republicans say they are trying to protect Americans against runaway deficits, not to mention death panels, publicly financed abortions and other confected horrors. They rail against President Obama and the Democrats for proposing to pile a costly new health care entitlement atop others we don't know how we'll pay for.

That's actually a valid concern, one that progressives should take more seriously. But the GOP's newfound fiscal piety would be more convincing if President Bush and party leaders had not muscled through Congress a massive new Medicare drug entitlement just six years ago.

Showing their customary solicitude for America's haves -- Medicare offers all seniors the basic health coverage the uninsured lack -- Republicans insisted on creating a universal entitlement, rather than targeting help on truly needy seniors. At first projected to cost $534 billion over 10 years, revised estimates in 2005 put the bill's price tag at $1.2 trillion. That's several hundred billion dollars more than the bill passed this weekend by Senate Democrats. David Walker, former U.S. Comptroller General, called the 2003 prescription drug bill "probably the most fiscally irresponsible legislation since the 1960s."

In contrast, the Senate Democrats' bill is paid for. In fact, the Congressional Budget Office estimates that it would cut the federal deficit by $130 billion in the first decade and by more than $500 billion in the second decade.

But there's a hitch, and it's a big one. Cutting future deficits refers only to the public costs of expanding medical coverage and reforming U.S. health care markets. That's not at all the same thing as "bending the curve" of health care cost growth. Slowing the unsustainable pace at which medical costs in America are growing requires confronting the perverse incentives and inefficiencies that plague health care delivery. It also means rebalancing the big entitlement programs, as retiring baby boomers swell the number of people receiving Medicare benefits.

This is the big piece of unfinished business facing both health care reformers and President Obama. The Senate bill expands coverage and cuts the federal deficit. According to some leading budget analysts, however, it doesn't do enough to slow down the rising health costs that plague the vast majority of U.S. workers and that handicap many U.S. firms in global competition.

They deserve some compassion, too.

Marshall is the president of the Progressive Policy Institute. This item is cross-posted at