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The Moderate Republican: An Endangered Species
Boy, the Republicans know how to make Barack Obama look good. What are they going to do now, threaten to repeal a law that forces insurance companies to cover the sick? Or block the provision that allows you to keep your out-of-work kids on your policy until they are 26? Whatever the failings of the bill-and they are real, especially in the area of cost control-its proponents will clearly have an advantage over those left bemoaning the loss of the untenable status quo. Particularly so during the first years, when its very sensible restraints on the insurance industry go into effect.
The bill that the president signed into law is limited and hardly provocative, but it unquestionably gets us over the first huge hurdle, already surmounted by every other economically advanced nation, to finally regard health coverage as a societal obligation. We already do with the rules governing admittance to hospital emergency rooms, but now that obviously humane assurance carries the majesty of landmark law. For that achievement, Obama and the Democrats who supported him have secured their marker in the nation's history, and the Republicans, without exception, should be remembered only as wannabe spoilers.
As Rep. Dennis Kucinich, D-Ohio, observed correctly in holding his nose and casting a vote for a bill that is at best a work in need of much progress, it is "castor oil," which may not do much to improve our health but certainly won't make it worse. It's also pro-business; that's why the stock market boomed Tuesday in a 17-month-high rally led by a 4.1 percent rise in the value of Caterpillar, the company that claimed the bill would hurt business interests.
Quite the opposite, actually, and even the health industry will do very well. Just as the auto insurance companies benefit from the requirement that all drivers have insurance, the health industry will have plenty of opportunity to make profits off the broad new market of captive consumers with no serious threat of effective government cost controls. The public option that might have provided an attractive cost-control alternative has been banished, and it won't take the health insurance companies long to figure out how to game those new insurance exchanges to increase profits.
This is a bill that an Eisenhower Republican of old would have gleefully endorsed, following the lead of the American Medical Association and the hospital industry, but such moderates no longer exist in the GOP. If they did, they would have backed this bill and claimed its very limited stab at health reform as their own. Instead, they are now recast as tea party zealots and naysayers, and while that may bring a short-term electoral advantage, in the long run it defines the GOP as incapable of moderate governance.
Watching those Republican state attorneys general pressing their states' rights claim to overturn this bill, you had to wonder whether they were unaware that many of the 16 million now to be covered by an expanded Medicaid live in the states they claim to represent. Have they checked with hospital directors in the poverty centers of Florida and Louisiana to see if they truly don't want the feds to help cover the uninsured poor they are now legally required to treat?
The immediate impact of the law is that, from the moment of the president's signing, state governments will be prevented from cutting their Medicaid and Children's Health Insurance Programs (CHIP). Arizona just did the latter, resulting in a loss of insurance for 47,000 kids in low-income families. Since that state's senior senator, John McCain, is so upset with this bill's passage, will he now have the honesty to boast that Arizona may have gotten its version of health reform in under the wire before Obamacare could save insurance for his home state's children?
For progressives, the preservation of existing Medicaid and CHIP rules until the new system is fully operational in 2014, as well as the expansion of Medicaid to an additional 16 million needy souls, should be sufficient to regard this new law as progress. It's a pity that not a single Republican in Congress could evince a similar pragmatism, despite the stunning victory of anti-choice forces in securing the president's sweeping executive order. Of course, the smart but evidently elusive rational political course for Republicans would have been to crow over the new law's summary rejection of a public option and claim that as their own win.
As it is, however, the lock-step march of the Republicans in radical resistance to even the most modest proposals to heal a deeply ailing nation leaves the Democrats as the only party that matters. The Republicans are a party of incoherent rage, and while they might temporarily succeed as demagogues, they are now acknowledged strangers to fact and logic-not to mention compassion.