On Bush-Era GOP Coverage Expansion Efforts

In light of my recent exchange with Josh Barro on conservatives and health reform, I thought I’d mention both that his recent post on how to think about coverage expansion (“Some Health Care For All, but not Too Much“) struck me as very convincing and, separately, that the notion that Republicans did nothing on coverage expansion between 2001 and 2007 is not quite right, as Ramesh Ponnuru noted in 2010:

I agree that the Republicans should have done more (and often said so at the time, for whatever that’s worth). In hindsight it is easy to see that President Bush should have spent the first half of 2005 on a big push for an incremental, free-market health-care reform rather than on trying to fix Social Security. But it’s also worth noting that Republicans did some significant things on health care and tried to do more.

A Republican Congress passed the Kennedy-Kassebaum portability legislation in 1996 and created the federal-state program for children’s health insurance in 1997. A Republican-controlled government established Health Savings Accounts and a prescription-drug benefit for seniors in 2003. You can certainly maintain that not all of these policies were wise–as I do–but they’re not part of a pattern of inaction on health care.

It’s also worth noting that Democratic opposition doomed fairly modest Republican health-care initiatives. Medical malpractice reform and association health plans (an attempt to let small businesses band together to buy insurance across state lines) fell victim to Democratic filibusters. (The system was broken!) It’s hard to believe that more sweeping initiatives would have gone anywhere. That’s not to deny Republicans should have tried; but it’s context worth remembering.

And of course the Bush administration proposed a coverage expansion effort in January of 2007, ably described by Avik Roy, that never went anywhere. The fact that it never went anywhere could lead us to question conservative devotion to the cause. One could also see it through the same lens as the center-left failure to successfully advance carbon pricing legislation: it is really hard and it wasn’t a sufficiently high-salience issue for core constituencies — this, however, is not a permanent condition, and can change in response to sustained arguments and changing circumstances. Sweeping, expensive social legislation tends to fare better in times of economic prosperity, for example. 

Reihan Salam — Reihan Salam is executive editor of National Review and a National Review Institute policy fellow.

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