"[It] is not," Winston Churchill said after the British military victory at El Alamein, "the end. It is not even the beginning of the end."
Unfortunately, misguided moderate Republican support for the Kennedy-Kassebaum health care legislation now before the Congress may, in fact, be the beginning of the end.
Through a strange twist in events, moderate Republicans are guiding the direction of the fading conservative revolution in Washington, resulting in compromises right and left – but mostly left.
To begin with, Republicans did not campaign on health insurance reform in 1994. After two years of fighting the Clinton health plan, Hillary's health care task force, and a plethora of Democratic charges that Republicans are insensitive to the needs of the uninsured, conservative Republicans soundly defeated the attempt to bring socialized medicine to America through the front door. And they then swept into control of both Houses of Congress.
Two years later, in 1996, the Republican revolutionaries, now controlled by moderates, are letting in through the back door the very health care socialization they barred at the front door. In the name of "good government" (which means the passage of something is more important than its contents), the conservatives seem to be surrendering. Or, in the words of New Jersey Republican Congresswoman Marge Roukema, "A modest bill that can be passed today is of far greater value than an ambitious bill that might take months or years to pass."
Three changes would be needed to begin socializing the American health care system: (1) Anyone ought to be able to get health insurance when they want it at an affordable price (if not free); (2) the federal government should be overseeing the process to make sure there is full compliance; and (3) consumers absolutely cannot be allowed to control their health care dollars and make decisions for themselves. The Kennedy-Kassebaum legislation now before the Congress incorporates all three concepts.
First, the key to any system of socialized medicine is that people can get health insurance whenever they want it. Of course, no insurance company can stay in business if it must sell a policy to someone after a tragic event has occurred. Everyone understands that if people were able to purchase auto insurance after a car wreck, everyone would just wait until they were in an accident before they called an insurance company. Yet Kennedy-Kassebaum would require any insurer selling in the small group market to accept any group, and any insurer selling in the individual market to accept any individual, who applies for health insurance regardless of health status. Oh, the legislation throws in a few hurdles, just so it isn't full-blown government control. Call it socialism with a prudent face.
Second, in a nationalized health care system, the federal government must take a strong, guiding hand. Under Kennedy-Kassebaum, the Department of Health and Human Services gets the final say-so on – and veto power over – state attempts to create programs that meet the needs of the uninsurable. This approach runs counter to the entire Republican revolution, which has been seeking to return power to the states.
Most of all, what any government cannot permit when socializing a health care system is giving individuals any control over their own health care dollars. Whoever controls the money controls the system. That's why President Clinton, most Democrats, and even some moderate Republicans have stated their opposition to Medical Savings Accounts (MSAs).
While I can understand why liberal Democrats and even moderate Republicans would oppose MSAs – since their availability would mean people, rather than the government, would control the health care system – it is unthinkable that conservative Republicans would compromise on this point, the one free-market provision that would at least mitigate some of the damage the other provisions would do.
And yet, they are. In the words of Speaker Gingrich regarding MSAs: "I want the House to know that if the president sends up a veto signal, we are not going to risk vetoing coverage for all Americans."
Since nationalizing the health care system is what so many conservative Republicans fought against just two years ago and won, and since fighting to pass MSAs has been the primary health care offensive battle plan for the conservatives, you would think they would stand firm. Instead, they have been mostly waving the white flag of surrender, afraid that Democrats and the media will call them cold-hearted if they don't compromise with the liberals.
Abandoning principle cost Bush Republicans the White House in 1992. Standing for principle won conservative Republicans the Congress in 1994. So why are they abandoning principle again in 1996?
Beats me, and if the Republicans aren't careful, it will beat them in November.