Why bipartisan health-care reform has proven impossible

By Ezra Klein



"Every time we moved toward them, they would move away." -- Hillary Clinton, 1995.

As an addendum to the previous post, it's worth thinking about partisanship and health-care reform not in terms of President Obama, but in terms of presidential efforts over the last century or so. And that story has gone something like this: Democrats moved right every time they failed. And Republicans moved further right every time Democrats tried.

The original idea, of course, was a national health service run by the government. Harry Truman proposed it and fell short. Lyndon Johnson got it for seniors and some groups of the very poor. But Republicans said that was too much government, and it was unacceptable for the whole country. They proposed, through President Richard Nixon, an employer-based, pay-or-play system in which the government would set rules and private insurers would compete for business.

That didn't go anywhere, because Democrats, led by Sen. Ted Kennedy, weren't ready to give up on a national health service. By the 1990s, they were. President Bill Clinton proposed an employer-based, pay-or-play system in which the government would set rules and private insurers would compete for business. Republicans killed it. Government shouldn't be telling businesses what to do, they said, and it shouldn't be restructuring the whole health-care market. Better to center policy around personal responsibility and use an individual mandate combined with subsidies and rules making sure insurers couldn't turn people away. That way, the parts of the system that were working would remain intact, and the government would only really involve itself in the parts that weren't working.

That was what Sen. John Chafee -- and Bob Bennett, Kit Bond, Chuck Grassley, Orrin Hatch and Richard Lugar -- proposed in 1994. It's what Mitt Romney passed in Massachusetts. And so it was what Democrats proposed in 2010. The Republican answer? "Hell no, you can't!"

By this point, there were no more universal health-care approaches for Republicans to hold out as alternatives. So they just turned against the idea entirely. Cato's Michael Cannon organized "the anti-universal coverage club." John Boehner released a bill that the CBO said would cover 8 percent as many people as the Democrats' plan.

So over the last 80 years or so, Democrats have responded to Republican opposition by moving to the right, and Republicans have responded by moving even further to the right. In other words, Democrats have been willing to adopt Republican ideas if doing so meant covering everybody (or nearly everybody), while Republicans were willing to abandon Republican ideas if sticking by them meant compromising with the Democrats. But because Democrats were insistent on getting something that would help the uninsured, they've ended up looking like the partisans, as they keep pushing bills Republicans refuse to sign onto.