George Bush could have proposed the Senate health bill. If he had, those Republicans who now loathe the measure would be at the barricades defending it. And those Democrats who backed Obama-care for the past year would have been hoisting their pitchforks and demanding its demise.
Leave aside the million details that are grist for the Washington policy mill and think for a minute about the framework of this bill. As I’ve written before, it is pretty simple and not very radical. At its core is a health system that relies on employer-based private insurance to cover most working people. The old would continue to be insured by Medicare and the poor would be covered by Medicaid, just as they are today.
The changes: Insurance companies would have to offer coverage to all, regardless of pre-existing conditions; everyone would have to obtain basic coverage or pay a penalty; exchanges would enhance the individual insurance market; the government would subsidize premiums for those who cannot afford them, including both individuals and small businesses; and Congress would take some small steps to slow the growth of health costs.
None of these ideas are new and most used to sit comfortably in the GOP mainstream. The Senate bill mimics the framework of the 2006 Massachusetts health reform, an idea that was pushed by Republican then-Governor Mitt Romney and, as we know by now, was supported by new Massachusetts Senator Scott Brown. This is what Romney said about the bill after it passed: "Every uninsured citizen in Massachusetts will soon have affordable health insurance and the costs of health care will be reduced." Sound familiar?
The Bay State model was so important in the Washington debate that congressional health negotiators privately described their road to a final bill as “going down Massachusetts Avenue.”
And the Massachusetts plan was not just Romney’s idea. Staffers at the conservative Heritage Foundation provided extensive technical guidance, and the broad outlines (if not all the details) were widely praised by the right—at least until the 2008 presidential campaign, when Romney denied parentage of his own reform bill.
But this model was around long before 2006. In 1993, Republican senators Bob Dole and John Chafee proposed a reform that included an individual mandate, cost controls, and generous government subsidies. In 1994, a bipartisan bill sponsored by Chafee and conservative Democrat John Breaux included many of the same elements—including an exchange, individual mandates, and cost containment. Blue Dog Representative Jim Cooper (D-Tenn) proposed a similar measure. Back then, the unions and many liberals opposed Breaux-Chafee because they disliked both its individual mandate and its tax on high-cost employer sponsored insurance. They still hate the tax, but seem OK with a mandate in a Democratic bill.
The bottom line is that much of the battle over health reform is not about substance at all. If it were, Democrats and Republicans could have gotten together last year and reached a workable consensus reform that, indeed, would look a lot like the Massachusetts—or the Breaux-Chafee—design. But that, it seems, was never in the cards. It was politically much more productive to caricature the plan as a government take-over of health reform or a big new tax on working people.
