Republicans need to fix health care, education, tax reform and re examine drug policy.
The GOP Debate Over Health-Care Reform
By Michael Tanner
CNSNews.com Commentary
July 30, 2007
The long-simmering battle for the soul of the Republican Party may be
about to erupt, not over immigration or Iraq, but over the unlikeliest
of issues: health care.
As
I wrote about in my book, "Leviathan on the Right," Republicans have
been increasingly split between traditional Reagan-Goldwater
small-government conservatives and a new breed of "big-government
conservatives" who believe in using an activist government to achieve
conservative ends -- even if it means increasing the size, cost and
power of government in the process.
The difference in the two
camps is as clear as the difference between Ronald Reagan saying that
"government is not the solution to our problem; government is the
problem," and George W. Bush saying: "we have a responsibility that
when somebody hurts, government has got to move."
Bush's brand
of big-government conservatism brought us No Child Left Behind, the
Medicare prescription drug benefit and a 23 percent increase in
domestic discretionary spending. It may well have cost Republicans
control of Congress. After all, on election night 2006, 55 percent of
voters said that they thought the Republican Party was the party of big
government.
Now, the Republican primary campaign raises the
question of whether the party will continue down the Bush path or will
return to its Reagan-Goldwater roots. And the coming debate over
health-care reform may clearly expose the split.
Former
Massachusetts Governor Mitt Romney has embraced the big-government
approach. He has joined Democrats in calling for universal health
coverage. The plan he supported in Massachusetts is a variation of
"HillaryCare." It has received most of its attention for its
unprecedented individual mandate, a requirement that every
Massachusetts citizen purchase health insurance or face legal
penalties. This represents the first time that a state has said that a
citizen, simply by virtue of living in a state, must purchase a
specific government designated and designed product.
But even
more significantly, Romney's plan also created a managed
competition-style regulatory authority called the Massachusetts Health
Care Connector. This new regulatory body has already mandated that
every health-care policy sold in the state must cover prescription
drugs and has outlawed policies with deductibles of more than $2,000.
And
Romney has joined Democrats in spending more to subsidize health care
for the poor and middle class. In Massachusetts, he significantly
increased Medicaid eligibility and provided taxpayer-funded subsidies
for families of four earning as much as $62,000 a year, effectively
extending welfare well into the middle class.
It is very hard to reconcile Romney's vision of health-care reform with traditional small-government conservatism.
In
contrast, the traditional conservative approach to health care so far
is being carried by former New York Mayor Rudy Giuliani. Giuliani, who
will release a detailed health-care plan later this summer, believes
that the biggest problem facing American health care is not a lack of
universal coverage, but a lack of consumer choice. "It's your health;
you should own your own insurance," he said in Tuesday's debate. "The
reality is that we need a free market."
Giuliani wants to reduce
the regulation of health insurance and change federal tax law that
pushes people into expensive, all-inclusive plans. He says health
insurance should be more like car insurance, where people pay out of
pocket for minor repairs and maintenance but are protected against
catastrophic costs. In pursuit of this goal, he has called for calling
for expansion of Health Savings Accounts and replacing the current tax
exclusion for employer-provided health care with a standard deduction
for health insurance.
This is not a question of the merits of
either candidate but a fundamental question about the direction of the
Republican Party and the conservative movement in general. Being a
conservative Republican should be about more than abortion policy and
the War on Terror. The candidates should have to tell voters whether
they still believe in traditional principles of limited government,
federalism and individual liberty.
The debate over health care reform may offer voters the first opportunity to ask this question.
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