The last time this country undertook a serious debate over health-care reform, back when Hillary Clinton put together her proposal in 1993, the Republican strategy could have been summed up in three words: Just say no. This time around, however, the clamor for fundamental change of a system that covers too few and costs too much has grown to the point where the minority party knows that simple obstructionism is a dangerous route to take. "The status quo is no longer acceptable," political strategist Frank Luntz wrote in a confidential memo to congressional Republicans earlier this month. "The overwhelming majority of Americans believe significant reform is needed and they see Republicans (and the insurance companies) as the roadblock. If the dynamic becomes 'President Obama and congressional Democrats are on the side of reform and Republicans are against it' which is exactly what Obama has already started to promote the public will side with the Democrats and you will lose both the communication and the policy."
What kind of health-care reform would Republicans like to see? Four conservative GOP lawmakers Senators Tom Coburn of Oklahoma and Richard Burr of North Carolina, along with Congressmen Paul Ryan of Wisconsin and Devin Nunes of California introduced a proposal on May 19 that looks a lot like the one John McCain advanced during his presidential campaign as well as an idea George W. Bush advanced as President.
But it also includes the kind of rhetoric more generally associated with the Democrats. A 15-page summary of the bill begins: "It is time to publicly admit that the health-care system in America is broken. Costs are rising at an unacceptable rate more than doubling over the last 10 years, which is nearly four times the rate of wage growth. Too many patients feel trapped by health-care decisions dictated by HMOs. Too many doctors are torn between practicing medicine and practicing insurance. And 47 million Americans worry what will happen to them or their children if they get sick."
The GOP plan would make the health benefits that companies provide their workers count as taxable income, and then use that money to provide tax credits with which individuals could purchase their own health coverage. Economist Douglas Holtz-Eakin, who advised the McCain campaign, said the new plan goes further than previous Republican offerings. For instance, it would provide new incentives for insurers to offer coverage to people who now have trouble buying it because they have pre-existing health conditions. It also puts more emphasis on preventive care and sets up "state exchanges" similar to the one now operating in Massachusetts in which individuals and families could comparison-shop for insurance plans. (Read "Baucus Predicts GOP Votes for Health Care Reform.")
However, that Republican bill does not purport to assure coverage to all or even most of the 47 million or so Americans who now lack it. It does not, for instance, impose a requirement that employers provide coverage to their workers or that individuals who do not get health benefits at work buy them on their own. The tax credits that it provides $2,300 for individuals and $5,700 for families fall well short of the average annual cost of a health policy, which is between $10,000 and $12,000 per family, says Robert Blendon, professor of health policy and political analysis at the Harvard University School of Public Health.
Coburn, a practicing physician, disputes Blendon's analysis of his bill. "In the vast majority of cases, our credit will more than cover an employee's share of a health plan's cost, which is about a third of a plan's total cost, or $4,000," Coburn says. The plan would also aim to move people off of medicaid, giving low-income Americans subisidies to purchase their own coverage. "The people who will benefit the most are the people who need help the most low-income families and the unemployed. If you don't have a job or you get no help with your health insurance, if our bill passes you'll get up to $5,700," Coburn says
This is not likely to be the last word from the GOP on health-care reform. Also in the works is a proposal by moderate House Republicans that assures that the government would not interfere with medical decisions now left to doctors and their patients. But one thing seems clear: Republicans have figured out that, this time, the debate over health-care reform is not one they are going to win simply by saying no.