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Republicans need to take a stand on health-care reform

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Saturday, March 19, 2011; 11:39 AM

It's put-up-or-shut-up time for Republicans. They managed to make it through the health-care debate without offering serious solutions of their own, and - perhaps more impressive - through the election by promising to tell us their solutions after they'd won. But the jig is up. They need a health-care plan - and quickly.

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The GOP knew this day would come. In May 2009, Republican message-maestro Frank Luntz released a polling memo warning that "if the dynamic becomes 'President Obama is on the side of reform and Republicans are against it,' then the battle is lost." Repeal, Luntz argued, wouldn't be good enough. It would have to be "repeal and replace." And so it was.

That, however, is easier said than done.

To understand the trouble the Republicans find themselves in, you need to understand the party's history with health-care reform. For much of the 20th century, Democrats fought for a single-payer system, and Republicans countered with calls for an employer-based system. In February 1974, President Richard Nixon made it official. "Comprehensive health insurance is an idea whose time has come in America," he said, announcing a plan in which "every employer would be required to offer all full-time employees the Comprehensive Health Insurance Plan."

In a moment of historically bad judgment - Ted Kennedy later called it his greatest political regret - Democrats turned him down. They thought they could still get single payer. They were wrong.

By the 1990s, they had learned from their mistake. Bill Clinton took office and, after a wrenching year of negotiations, announced legislation similar to Nixon's.

"Under this health-care security plan," Clinton said, "every employer and every individual will be asked to contribute something to health care."

But Republicans again balked, calling instead for a system of "individual responsibility." Senate Republicans quickly offered two bills - the horribly named Health Equity and Access Reform Act and the Consumer Choice Health Security Act - based on the idea that every person who has the means to buy health insurance should have to do so. We now call that concept "the individual mandate."

Both bills attracted 20 or more co-sponsors. Neither passed, as Republicans yanked their compromise legislation the moment Democrats became desperate enough to consider it. The individual mandate, however, didn't go away. It kicked around conservative health-care policy circles, racking up endorsements from the conservative Heritage Foundation and the libertarian magazine Reason. A year later, the mandate showed up in a law that then-Governor Mitt Romney signed in Massachusetts. And then it was in the bipartisan proposal that Utah Republican Bob Bennett and Oregon Democrat Ron Wyden introduced in the Senate. And next, it was the centerpiece of the Democrats' health-care reform push. Consensus, it seemed, was at hand.

Or not. Republicans turned on the individual mandate again. Senators who'd had their names on a bill that included an individual mandate - Orrin Hatch, Chuck Grassley, Bob Bennett, Mike Crapo, Bob Corker, Lamar Alexander, Olympia Snowe and Kit Bond, to name a few - voted to object, calling the policy "unconstitutional." Romney had to explain away his signature accomplishment as governor of Massachusetts. And Republicans found themselves without a fallback.

The party's current mood on health-care policy is perhaps best expressed by the efforts that Michael Cannon, an influential health-care wonk at the libertarian Cato Institute, has made to enlist members in his "anti-universal coverage club."

Enter Wyden-Brown, an Affordable Care Act amendment that the White House has made a big show of endorsing: It says that any state that can produce a credible plan to cover as many people, with as comprehensive insurance, at as low a cost as the Affordable Care Act can wriggle out of all the law's mandates but still receive all the law's money. Vermont's governor, for one, is stoked: He wants to try a single-payer proposal.


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