Commentary

Republicans Retreat On National Health Care

On no issue is the retreat of the Republican Congress more apparent than on health care. It was just over three years ago that a Congress with a Democratic majority rose up and rejected President Clinton’s plan for a government takeover of the American health care system. That battle set the stage for the Republican takeover of Congress. Yet today, step by step, a Republican-controlled Congress is reconstructing Clintoncare.

The first cracks appeared at the end of the last Congress. Desperate for a pre-election display of federal compassion, Congress enacted the Kennedy-Kassebaum bill, which forced insurance companies to provide coverage to individuals regardless of their health. That mandate will result in substantially higher insurance premiums for most Americans and could cause many small businesses to drop their employee health coverage. Even worse were little-noticed anti-fraud provisions, which established draconian new penalties for doctors who make paperwork errors, and the creation of a privacy-threatening national health care database — provisions lifted almost word for word from the Clinton health plan.

President Clinton also wanted a standardized national benefits package, which would have forced all Americans into a cookie-cutter health insurance policy that would have disregarded individual preferences and raised costs. The Democratic Congress said no. The Republican Congress seems eager to play national insurance underwriter. Last year Congress mandated 48-hour hospital stays for women who give birth, and a host of additional insurance mandates are pending.

The worst is yet to come. Using as its excuse a phony crisis of uninsured children, Congress is poised to enact Kidcare, a vast new entitlement program for the middle class. That, despite the facts that insurance for children is extremely inexpensive and approximately 15 percent of uninsured children are in families with incomes of over $40,000 per year. An additional 30 percent are already eligible for Medicaid, but their parents fail to claim the benefits for one reason or another. Most the remainder are uninsured for only a brief period.

But congressional Republicans seem unwilling to let a few facts stand in the way of their desire to show their “compassion.” Sen. Orrin Hatch, R-Utah, has become the latest to join Sen. Ted Kennedy in advocating an expansion of government involvement in health care. Who would have predicted that the most influential senator on health care in a Republican Congress would be Ted Kennedy?

Meanwhile, advocates of free-market health care reform are all but invisible. For example, the House currently has one bill to expand the use of medical savings accounts. It is sponsored by three Democrats.

On Medicare, Sen. Phil Gramm, R-Texas, wages a lonely battle for fundamental reform of a system rushing toward bankruptcy. The rest of Congress seems inclined to punt, to accept tougher price controls and accounting gimmicks in order to buy a few more years for the beleaguered system—at least long enough to get through the next election.

“Incremental” health care reform has become a Capitol Hill mantra. But the road to hell still goes there even if you take small steps. The battle over national health care is more than a series of isolated votes on incremental reforms. It is one of the fundamental philosophical debates of our time. It is a question of whether we as Americans believe that the era of big government really is over, whether we really believe in free markets and individual liberty, or whether we believe that the answer to our problems lies in still more government programs, taxes, and mandates.

Question to Congress: is it too much to hope for a little leadership on an issue of such importance?

Michael Tanner is director of health and welfare studies at the Cato Institute.