The GOP’s lost health care conscience
WASHINGTON — I really miss liberal Republicans. People like Mitt Romney.
No doubt the former Massachusetts governor would be aghast at being called such a thing. Of course Romney is not a liberal in any conventional sense. But 11 years ago — it now seems like a lifetime — Romney acted in the great tradition of liberal Republicans. He saw a problem and tried to solve it in the most business-friendly way possible. The result was the Massachusetts health care plan.
At a celebration for the new law, as recounted in a 2011 New Yorker piece by Ryan Lizza, Romney tried to explain why his approach was in line with his party’s history. “It’s a Republican way of reforming the market,” he declared. “Because, let me tell you, having 30 million people in this country without health insurance and having those people show up when they get sick, and expect someone else to pay, that’s a Democratic approach.”
A bit demagogic? Sure, especially when one of the politicians who helped Romney pass his bill was the late Sen. Edward M. Kennedy, for whom universal health coverage was the cause of his political life.
But Romney’s definition of a plausible path for his party on health care was compelling. “The Republican approach is to say, ‘You know what? Everybody should have insurance. They should pay what they can afford to pay. If they need help, we will be there to help them, but no more free ride.'”
Yes, requiring everyone to buy health insurance on the private market and providing adequate subsidies so lower-income citizens could afford it really was a conservative idea. It was an alternative to liberal calls for a single-payer approach that would have the federal government take over the health care system.
The mandate was seen not as oppressive, but as an endorsement of personal responsibility. If you can be required to buy car insurance (because everybody is at risk of getting into an accident), why not require people to buy health insurance (because everybody is at risk of getting sick)? But since health coverage is financially out of reach for so many, the fair thing is to ask them to pay what they can and have government fill in the rest.
The debacle that is Trumpcare, aka Ryancare — both President Trump and House Speaker Paul Ryan own this thing — is a reminder that conservatism has gone haywire. Romney looks like a liberal because conservative Republicans (with a few honorable dissenters) have largely abandoned trying to solve social problems, except for offering free-market bromides as if they are solutions.
Even Romney usually played down the greatest achievement of his governorship when he ran for president in 2012 because President Obama had the nerve to learn from the Massachusetts experience: The Affordable Care Act is rooted in the principles and policies of Romneycare. This was awkward for a Republican presidential candidate because repealing Obamacare had become GOP dogma. So, like a repentant heretic, Romney dutifully bowed to the new orthodoxy.
We already know that any promise Trump makes is meaningless (my colleague Eugene Robinson memorably observed, “He even lies about his own lies”), but it’s worth remembering that Trump has consistently tried to cast himself as more 2006 Romney than 2017 Ryan. “We’re going to have insurance for everybody,” Trump told The Washington Post in January. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”
Actually, that is exactly what happened when Trump found himself issuing ultimatums on behalf of a bill that deprives an estimated 24 million Americans of health coverage (while cutting taxes on the affluent). Thus has Trump betrayed the working-class supporters he hides behind while pursuing the interests of his rich friends — as well as his own.
The United States is the only wealthy democracy in the world that doesn’t provide health coverage to all its people. Republicans used to recognize this as a problem. Now, their ideology forces them to pretend it doesn’t exist.
In his definitive piece on Romneycare, Lizza noted that in the hardcover edition of Romney’s book “No Apology,” he had said of his health plan: “We can accomplish the same thing for everyone in the country.” Lizza observed that “in the paperback, that line had been deleted.”
Many in the GOP seem ready to edit out part of its conscience. The Trump/Ryan health care bill crashed on Friday because at least some Republicans refused to acquiesce in desecrating their party’s tradition.
E.J. Dionne’s email address is [email protected] Twitter: @EJDionne. (c) 2017, Washington Post Writers Group