Columns » Ernest Dumas

Call it Republicare



If leaders of the Republican Party had an appreciation for irony, a grasp of destiny or just a good sense of humor, they would show up uninvited in the Rose Garden when President Obama signs the health-reform bill and declare a historic victory for Republicans.

Why not? It was a Republican president, Theodore Roosevelt, who first articulated the goal of universal insurance, a Republican; Richard Nixon, who before Obama had come the closest to achieving it; and a Republican governor, Mitt Romney, who furnished the immediate blueprint for the plan that should soon become law.

If Nixon were around, he would have the chutzpah to grab credit from the Democrats, and he would have good cause. If he had not died four years ago, Caspar Weinberger, who actually crafted Nixon's Comprehensive Health Insurance Plan in 1974 when he was secretary of health, education and welfare, might express satisfaction that his handiwork had been recognized and made the law of the land. It would be some vindication for the proper old Republican, whose Cabinet service for Nixon and Ronald Reagan ended in undeserved disgrace with the Iran-Contra scandal.

As long as we are fantasizing, imagine a revival of the rivalry between Nixon and Mitt Romney's dad, George Romney, who lost to Nixon in the bitter nomination battle in 1968. They could dispute whose health plan, Mitt's or Dick's, was the closest template for Obamacare, as the Republicans are calling the plans written by Democratic congressional leaders.

Whether he was audacious enough to claim victory, Nixon would at least take some smug satisfaction that on the great issue that most defined his hated enemies, the Kennedys, it was his idea, the Republican idea of that time, not the Kennedys', that was victorious.

That is the triumphal irony of our time.  Universal health insurance, if the flawed bill that emerges in the next couple of weeks ever comes close to that goal, will be a Republican-designed plan. Presuming that the bill that goes to the president will be either the Senate bill or a close facsimile of it, it will meet Nixon and Weinberger's basic design, expanded coverage to everyone through employer-based or individual private insurance with government assistance for the poor. In some ways, the Democratic health reforms will have a weaker federal role than even Nixon intended. Democratic health reform is Nixon Lite.

 But no Republican in the land, unless it is the freshman congressman from New Orleans, will embrace the old Republican plan. Republicans rail about socialism and government takeover of health care, which are nonexistent in the current health plans, but their premise is really much simpler. Health care is a zero sum game. It should be reserved for the strong and the well off. If it is available to the sickly and those who toil for poor wages there might be less of it for the rest of us. It is a theme of the teabaggers, too, recited almost daily in letters to the Democrat-Gazette.

How do the Nixon and Harry Reid plans match up?

Nixon spelled out his plan, drafted by Cap Weinberger, in a special message to Congress Feb. 6, 1974. He had proposed a plan in 1971 to extend coverage to everyone but Sen. Edward M. Kennedy had a plan that, in effect, expanded Medicare to everyone and Democrats had a big majority in both houses. By 1974, Kennedy had indicated he could move closer to Nixon's idea and he had a new and powerful ally, Rep. Wilbur D. Mills of Arkansas, chairman of the Ways and Means Committee.

The Nixon plan would require all employers, large and small, to offer private health plans to their employees, with the employer paying 75 percent of the premiums and employees 25 percent. Employees would be free to turn it down. The government would help small and struggling businesses with the costs for a few years. The government would set minimum standards for the policies. There would have to be an option for health maintenance organizations, which Nixon thought was the key to holding down exploding medical costs. Insurance companies could not refuse to insure someone because of the nature of their illnesses — i.e., pre-existing conditions.

For the unemployed, the disabled and the self-employed, he would have provided something he called Assisted Health Insurance, which was basically an expansion of the fledgling Medicaid program. People would pay what they could and the government would pay the rest. Every person, whether covered by private or public insurance, would pay the first $150 of medical bills each year.

Medicare would be expanded to cover drugs. The private and public coverage would include mental health. Children would get special coverage, including eye, hearing and dental exams.

Those are the basic elements of the plan that passed the Senate at Christmas.

Nixon was like current Republicans in another respect. He didn't propose paying for the extra federal burden with new taxes. Current taxes could handle the few tens of billions in extra costs each year and moreover he expected big economies in health costs to follow. The current bills pay for themselves with slightly higher taxes on the wealthy and by counting part of the premiums of expensive health plans as taxable income (the Republican John McCain's solution 18 months ago).

Still, Nixon's was a stronger plan than either the Senate or House bills today, but Kennedy and Mills thought it too weak. Nixon signaled that he was willing to compromise with the Democrats on the details, but no sooner had Mills begun hearings on health insurance than Nixon resigned to avoid impeachment over Watergate and Mills himself was embroiled in scandal.

President Gerald R. Ford, although he had opposed Medicare as the House minority leader in 1965, called on Congress to pass health care based on the Nixon model.

 Who could have imagined that we would one day yearn for Nixon and Ford? 

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