A Mistaken Recrimination

by Ramesh Ponnuru

Reihan Salam writes, “Had congressional Republicans taken pragmatic steps on health reform between 1994 and 2008, PPACA wouldn’t have happened. President Bush’s reform of the tax exclusion for employer-provided health insurance alone would have made a significant difference, as would his plan for giving the states greater control over Medicaid. If you believe that the 111th Congress made many bad calls, Republicans in previous years deserve much of the blame.”

I don’t agree. I wrote on the subject (sub. req’d.) right after PPACA–the Democrats’ health-care law–was enacted.

[T]he actual Republican record on health care belies the do-nothing label. A Republican Congress passed a health-insurance-portability law in 1996 and created the children’s-health-insurance entitlement in 1997. In 2003, a Republican Congress and a Republican president created tax-sheltered Health Savings Accounts, a prescription-drug benefit for senior citizens, and a market-friendly component of Medicare.

Not all of these policies were wise, so Klein’s criticism has more force: “While they were in power, Republicans squandered an opportunity to push free market health-care solutions.” But how much opportunity was there, really? Republicans were unable to overcome Democratic filibusters of their proposals to reform medical-malpractice laws and to allow small businesses to band together across state lines to buy insurance. There is no reason to think that bold, free-market reform would have fared better. Republicans should still have tried. It might have helped educate the public about the issue and thus prepared the ground for the Obamacare debate. But Republicans never had enough senators to reform health insurance.