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Health care's federal future, brought to you by the GOP

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Thursday, February 3, 2011

"Good afternoon, I'm Brian Williams reporting from Washington, where it looks like October 26, 2017, will be a day that truly goes down in history. In a few moments, at a table not far from where I now stand, President Hillary Clinton will sign into law the universal health-care legislation - "Medicare for All," as she calls it - that completes a journey Mrs. Clinton began nearly 25 years ago. Back then, as first lady, her attempt to reform the health-care system proved a fiasco that cost Democrats their hold on power. Who would have thought then - or later, when President Barack Obama's big health reform was overturned by the Supreme Court in a controversial 5 to 4 ruling in 2012 - that today's bipartisan bill would be the result? For some perspective on the twists and turns of history, we're joined by NBC's David Gregory. David, health reform seemed dead in the water in 2012. How did we get from that Supreme Court ruling to today?"

"Brian, when historians look back on this period, they'll see it as a classic case of shortsighted politics - of Republicans winning the battle but losing the war. It really dates to the fight to overturn Barack Obama's health reform. There's no question the GOP got a boost from that 'victory' - it galvanized their base, and, combined with high unemployment and the dollar crisis right before the 2012 election, denied President Obama a second term.

"But some Republicans now say the trouble was that their party never acknowledged that health care wasn't just about politics - it was a major policy problem that needed real solutions. President Mitch Daniels, of course, had to spend virtually all of his term in office getting America's fiscal house in order, what with the International Monetary Fund and the rating agencies telling Washington the jig was up. The new carbon and value-added taxes he enacted, and the spending cuts he muscled through, left Daniels respected but hardly popular.

"Meanwhile, as you know, Brian, health costs kept soaring, employers kept dropping coverage they could no longer afford, and by the 2016 campaign, with 70 million Americans uninsured, something had to give. It was Hillary Clinton's moment, Brian."

"David, it seems hard to recall now, but back in the fight over Obamacare, Republicans only offered plans to insure 3 million of the 50 million who were uninsured back then. Today, most Republicans have signed on to Mrs. Clinton's plan to have government provide every American with basic coverage, with a much more modest role for private insurance as a supplement. What accounts for the change?"

"Well, Brian, a cynic might say that when you get to 70 million uninsured, some of them are actually Republican voters! But the key difference was the way business and labor came together behind Mrs. Clinton's approach. Top chief executives agreed companies shouldn't be expected to bear these costs anymore and backed the modest taxes needed to move health costs from private payrolls to public budgets, as happens in every other wealthy nation. The unions finally took a larger view, too. Instead of moaning about the 'loss' of a benefit they'd bargained for, labor leaders accepted that most workers had gone years without real wage increases, because health costs were devouring every penny available for compensation. Having government fund health care was the only way to give Americans a raise."

"What seems so ironic, David, is that Republicans now endorse a much more 'liberal' solution than they would have had if they'd supported Barack Obama's approach years ago."

"That's right, Brian. Obama modeled his reform on Mitt Romney's in Massachusetts. It had an individual mandate because of something Republicans privately understood: The only way to reach universal coverage through private health plans that cover folks regardless of health status is to require everyone to be in the insurance pool. If people are free to wait until they're sick to buy in, premiums soar and coverage erodes. Republicans who knew better assailed the mandate not because they really cared about some constitutional defect - after all, that could have been fixed easily by structuring incentives to buy coverage as opposed to a mandate. They did it because it was a way to take a bite out of Obama. In the near term, it worked. In the long term, they lost the chance to preserve the private-sector role they claimed to cherish in health care."

"Ironic indeed. We're getting word that President Clinton is about to speak. We join her now in the Rose Garden."

"Thank you all for being here. It's hard to imagine a better 70th birthday present for a president than the law I am about to sign. . . ."

Matt Miller, a senior fellow at the Center for American Progress and co-host of public radio's "Left, Right & Center," writes a weekly column for The Post. He can be reached at mattino2@gmail.com. Follow him on Twitter at @mattmillernow.


© 2011 The Washington Post Company

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