A bum rap on health care

Washington buzzes with health-care politics this week, and many believe Republicans are about to get stung. The State Children’s Health Insurance Program (SCHIP) takes center stage in the current debate, but it’s only one element in a much larger, contentious issue. Most agree health care will dominate the domestic electoral agenda in 2008. Republicans need to step up and more clearly articulate their own vision of health care — something many in the party have been reluctant to do. But that’s slowly changing.

Failing to provide concrete ideas on health care indeed presents a political risk — but it’s an avoidable hazard. The seeds of many new options have been planted, but these ideas need further fertilization and a more systematic communications plan. Without such a strategy, Republicans will repeatedly find themselves on defense as next year’s election approaches.

The GOP’s short-term SCHIP dilemma is complicated by internal splits in the party’s ranks. Forty-five Republican House members and 18 Republican senators joined the Democrats in passing a $35 billion expansion of the program that President Bush vetoed earlier this week. The House will sustain the White House position. But doing so, according to conventional wisdom, is risky.

The politics of the current SCHIP controversy, some say, tilt heavily toward the Democrats. Columnist David Broder wrote last week in The Washington Post that Republicans were following Mr. Bush “off a cliff” for supporting the White House veto of the SCHIP bill. Other published accounts described the situation for the GOP as “politically perilous” with some of the president’s stalwart allies and most Republicans in swing districts abandoning him.

This assessment, however, deserves a dose of perspective. First, whatever happened to Republicans learning a lesson from the 2006 election about excessive spending? They seem trapped in a vortex. After years of castigation by many for “spending like drunken sailors,” now Republicans get no credit for taking a stand on spending. Why is it that when the president and some Republicans propose to extend the current SCHIP program and even spend an additional $5 billion, it’s not only insufficient, but also inconsistent with the aspirations of “the children’s Congress,” as House Speaker Nancy Pelosi described her majority’s legislature last week. Once again, in the liberal welfare-state paradigm, more money is tantamount to caring — cash equals compassion.

Breaking out of this no-win quagmire means changing the model. And that provides the Republicans with an opening. When it comes to health care, polls show Americans care more about reducing costs than expanding access (i.e. universal coverage). In other words, paying for health care worries them more than getting it. A Republican health-care alternative should begin with that basic premise: How can we make health care more affordable? Just engaging in that debate will improve the party’s standing on the issue. If Republican lawmakers start every speech by saying, “I know you’re worried about paying for health care. I understand that. And I have a better way to reduce those costs,” GOP standing on the issue would immediately jump.

And the pieces of a policy to fit this rhetoric already exist, waiting for someone to integrate them. For example, Republicans own the issue of competition in health care. They authored such an approach in the Medicare prescription-drug legislation, now a proven way to save taxpayers’ money. Republicans could also include their long-standing support for medical malpractice reform as more fodder to lower health care prices. Moreover, Republicans recognize the need to provide affordable health care outside of an employer-based context — a form of coverage individuals can own and take with them irrespective of their employment situation. The party could tout its tax credits for health-care coverage here. Finally, the GOP has long championed association health plans, which allow various kinds of member-based groups to pool together and provide a broader array of health care options.

Rather than talking only about expanding existing government programs — as Democrats do — Republicans could emphasize their impatience with the bureaucratic status quo and become the party of change on health care.

Whoever seizes the reform mantle by lowering costs will earn big dividends with voters. Over the years, Republicans have advocated a number of uncoordinated initiatives. These threads of change stand as stark alternatives to Democrats trying to only build on tired, inefficient, government-run programs. It’s time for someone to weave them together into a compelling alternative policy and narrative.