Political differences masquerading as philosophical ones

"There's a philosophical difference in how we do this," Sen. Tom Coburn said at the Blair House Summit. "It does have to do with the philosophical difference," Rep. Eric Cantor agreed. "There are very deep philosophical differences in how we approach health-care reform," Rep. Marsha Blackburn emphasized. "There really is a difference between us," explained Rep. Paul Ryan. "And it's basically this. We don't think the government should be in control of all of this."

It's true, of course, that there are some philosophical differences between Democrats and Republicans. But Republicans did something interesting yesterday: They turned a lot of policy differences into questions of first principles. And it's harder to compromise on a first principle.

When Cantor pointed out his philosophical differences, for instance, he was talking about how "the Secretary defines what a health benefit package should be." That overstates the role the secretary of health and human services has in setting a floor for insurance in the exchanges, but nevertheless: When Republicans created health savings accounts, they had the government define what the package would be. And when they created the Medicare Prescription Drug Benefit, they had the government define what the package would be. And when Rep. Paul Ryan created his proposal, he set the minimum value of a benefit package. "You need to define what insurance is," Ryan told me. "I agree with that."

Marsha Blackburn was saying that Americans "want us to give them the ability to hold insurance companies accountable. One of those ways is through very robust competition." Her solution, and the GOP's, was "across-state-line purchasing of insurance." Other methods of competition -- from exchanges to a public option -- were not included.

But even purchasing across state lines is not always a matter of philosophy for the GOP. In 2009, the Credit Cardholders' Bill of Rights passed the House, with Blackburn voting for it. The bill preempts many state regulations on the credit card industry and replaces them with federal regulations. So even if you could get a credit card cheaper from a state that allowed companies to increase rates in the first year of a card, or apply payments to the lowest-interest balances first, you're no longer allowed to. The philosophic appeal of letting South Dakota decide the regulatory standard for the rest of the nation collapsed in the face of the practical problems.

The charge here is not hypocrisy, exactly. The GOP surely supports the policies it says it supports, at least at the moment. But they have elevated a variety of policies that they're willing to compromise on in other contexts to the level of philosophical difference. That makes compromise very difficult. After all, if you believe in purchasing across state lines (which means the national standard is equal to that of the laxest state) and I believe in federal regulation, a compromise could be that each state handles its own regulations (which is what we have now), or that states can choose to enter into compacts with one another that will allow insurers in one state to sell to all participating states (which is what is envisioned in the bill). But if this is a philosophical difference, well, too bad.

Similarly, if the question is the precise method of figuring out how to define insurance, than a compromise can surely be reached. After all, if Ryan's plan demands actuarial values equal to Blue Shield/Blue Cross and the Senate plan actually allows for more variation in actuarial values but says that certain categories of treatment (pediatrics, for instance) need to be included, that seems custom-designed for compromise. But if, as Cantor says, this is really about "a deep philosophical difference," then compromise is unlikely indeed. You don't bargain with Aristotle.

It was during the Cantor exchange that Joe Biden finally had enough. "Mr. President, can I have 10 seconds?" He asked. "Literally 10 seconds." The president nodded, or didn't answer fast enough to head Biden off. "We don't have a philosophic disagreement," Biden said. "If you agree that you can't be dropped, that there has to be dependent coverage, that there's no annual or lifetime cap, then, in fact, you've acknowledged that is the government's role. The question is how far to go."

But because the Republicans in the room didn't want the question to be "how far to go," they drew philosophical battle lines that will be erased next time they're in power, or find a bill they want to vote for. This was most clear, possibly, in Sen. Lamar Alexander's opening remarks, in which he explained that "we've come to the conclusion that we don't do comprehensive well."

Alexander's argument on that point is detailed and sophisticated, but it's telling that he came to the conclusion when Democrats took power and began proposing bills, rather than when he voted for the undeniable comprehensive Medicare Prescription Drug Benefit or co-sponsored Wyden-Bennett (in July, Alexander said "we should support legislation like the Wyden-Bennett plan I’ve co-sponsored," which is much more comprehensive than the legislation the Senate eventually passed).

Like the philosophical objections preceding it, Alexander's argument is not that this bill should be structured differently, but that it, and bills like it, should not be done at all. You can fashion a compromise between someone who supports the structure of Wyden-Bennett or the Prescription Drug Benefit but has qualms about the Senate bill. Alexander's argument against all comprehensive legislation, however, is a philosophical position about the proper workings of the United States Senate, and it is not one that he held in the majority, and it is not one that permits space for compromise now that he's in the minority. I'm not accusing anyone of insincerity on these points, but just as many people discover religion in the face of tragedy, the GOP appears to have discovered philosophy in the face of a Democratic majority.

Photo credit: White House Photo by Pete Souza.