November 15, 2013
The Healthcare.gov website is displayed on laptop computers arranged for a photograph in Washington, D.C., U.S., on Thursday, Oct. 24, 2013. The failure of Obamacare's website to process millions of applications drew fire from contractors who said more time was needed for final testing and from lawmakers who traded criticism over political motivations. Photographer: Andrew Harrer/Bloomberg
The HealthCare.gov Web site.  (Andrew Harrer/Bloomberg)

For those who believe that providing health insurance to all Americans is a moral imperative, there is something even more depressing than the Obama administration’s failure to get the health-care Web site working.

There can be no evasion, of course, of the shock that the administration would let its most significant initiative be jeopardized by its own profound failures of execution. As National Journal’s Ron Brownstein pointed out, universal coverage was always seen by progressives as a way of enhancing confidence in government’s ability to do good. It was not supposed to undercut popular faith in Washington’s capacity and competence. So President Obama was right to take responsibility for this snafu on Thursday in the most remarkable expression of presidential penitence of his term in office — and, perhaps, of any recent presidency.

But in a better political world, the president’s political opponents wouldn’t simply be trying to wreck the prospect of getting health insurance to millions of uninsured Americans. They would be joining in efforts to make the system work better. This is what happened when Massachusetts went for universal health care, led Republican Mitt Romney. As has been widely reported, there were early problems with the Massachusetts effort, too. But both parties were committed to making the system work, and they did.

The proposal offered by Rep. Fred Upton (R-Mich.), cast as a way of providing relief for those in the individual insurance market who had their policies canceled, was actually a Trojan horse. It was not a “fix” at all. It was designed to gut the core provisions of Obamacare.

In the meantime, most Republican governors refused to set up state insurance exchanges, and many rejected the Medicaid expansion, depriving 5 million to 6 million lower-income Americans of a chance to get insurance.

It is because of this parade of horribles that I was so moved by a letter to The Post this week from James V. Rives of Arlington, Va. Mr. Rives was responding to a column I wrote asking why members of the right-to-life movement were not speaking up forcefully in favor of requiring maternity coverage in all health insurance plans. I argued that one of the best ways to bring the abortion rate down was to provide women and the children they chose to bring into the world with full medical coverage.

In his letter, Mr. Rives described himself as a “pro-life conservative,” and my hunch is that he might well disagree with the first several paragraphs I have written here.

But Mr. Rives did something that has happened all too rarely in the health-care debate: He offered a clear and quite interesting proposal:

“Routine prenatal, labor and delivery care would make an ideal test-case for a universal single-payer system,” he wrote.

“No taxpayer would be unfairly burdened; Mr. Dionne rightly pointed out that both men and women play essential roles in creating pregnancies. So make maternity care an American entitlement. If it succeeds, patients and doctors might be less resistant to further health-care reform. Unlike the sweeping overhaul being attempted, a trial of single-payer maternity coverage could be a reasonable baby step.”

Obviously, Mr. Rives and I disagree on the ambitions of the Affordable Care Act. He is a skeptic. I believe we can and should make it work. But to see a pro-life conservative willing to follow his convictions all the way to supporting what might be seen as a new dose of socialism in the American health-care system was inspiring. Indeed, whether you are for or against the Affordable Care Act, his idea might well be worth trying.

May other conservatives follow Mr. Rives’s example. Trashing Obamacare is not a policy, and returning to the health-care system that existed before it was passed is not an option we should choose.

E.J. Dionne writes about politics in a twice-weekly column and on the PostPartisan blog. He is also a senior fellow in Governance Studies at the Brookings Institution, a government professor at Georgetown University and a frequent commentator on politics for National Public Radio, ABC’s “This Week” and NBC’s “Meet the Press.”