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.