Matt Miller - The Archives

Republicans to sick people: Tough luck
The Washington Post, May 1, 2013

There was a striking Republican stumble on health care the other day that deserves to be parsed because it reveals so much about the party's current dilemma. I'm talking about the tea party revolt that embarrassed House Majority Leader Eric Cantor (R-Va.) and forced him to withdraw a modest bill to bolster the high-risk insurance pool meant to help sick Americans until Obamacare's insurance exchanges are up and running next year.

A word of warning, however: what follows contains political attitudes so petty and out of touch they may disturb younger readers.

Cantor, you'll recall, has been trying to get his party to embrace some ideas that would show Republicans are not just austerity monomaniacs blind to middle class anxieties. In a speech on "Making Life Work" not long ago, Cantor laid out a handful of initiatives in this vein, like boosting flex time and retraining. One idea was to strengthen the high-risk pool that covers Americans with pre-existing conditions. Obamacare established this program as an interim patch for vulnerable Americans until the law's community rating kicks in, at which point everyone can buy coverage regardless of health status. But this national high-risk pool is so poorly funded (as has been the case with similar state pools for years) that only a few of the country's uninsurables have availed themselves of the protection.

Now, to put what happened next in context, you need to understand that Republicans who resist universal coverage but who resent being labeled "heartless" have always been quick to say that they're as concerned as the next guy about people with predictably high health expenses. The answer, they say, rather than some broad "socialist" risk pooling, is to set up publicly subsidized high risk insurance programs. That way these unlucky souls get help while leaving private health plans to cover the rest of us in ways that don't force higher premiums on everyone.

Note that in either scenario our sense of decency requires the cost of predictably high health expenses to be spread beyond the individual—either through slightly higher premiums for everyone in a pooled system, or via public subsidies to the relative handful of sicker Americans in the high risk pool. (Every large company that offers health benefits, by the way, has taken the "socialist" path—an irony no one ever mentions.)

In theory, then, the high-risk pool approach can work—though in practice, since sick Americans lack political clout, these pools tend to be treated like stepchildren in the budget process.

Hence Cantor's "Help Sick Americans Now Act." Let Republicans back an approach they've philosophically endorsed before, Cantor thought, and by funding it a bit more generously than Obama has, show that the GOP can solve a problem that haunts (and often bankrupts) luckless families.

That was the idea. Then—boom!—conservatives revolted. L. Brent Bozell III cried "Cantorcare." The Club for Growth warned that a vote for the measure would be tantamount to supporting Obamacare on their coveted conservative score card. "We often say we don't need this Democrat big-government program [but then say] we need this Republican big-government program," harrumphed Rep. Trey Radel of Florida. Rep. Tim Huelskamp of Kansas urged the party to skip this sideshow and get back to the real issues: the debt ceiling and spending cuts.

Wow. It almost makes you feel sorry for Cantor.

But here's the bigger point. It's not as if Cantor was foisting some sweeping plan on his colleagues to restore upward mobility, equal opportunity and economic security in the United States. Republican politicians won't go near ideas truly aimed at these goals; even Republican policy intellectuals out to save the party are barely inching in this direction.

No, in asking his colleagues to do this small thing for the sickest of the sick, Cantor was taking a parody of a baby step. Cantor's overall agenda was already minimalist. And within this minimalism, to use a painterly analogy, Cantor was pushing something positively pointillist—a few tiny dots meant symbolically to suggest that the GOP "cared" and could "solve a problem."

But this little spec of an idea proved to be too much for today's House Republican caucus and the political ecosystem that sustains it. And if that's the case, how can Republicans ever get remotely serious about big time woes in education, health costs, retirement security, college access and other pressing concerns of the middle class?

The funny thing (and the opportunity for the GOP) is that Democrats don't have good answers on this stuff, either. They have good intentions. Republicans have trouble mustering even that. At least we know what we're dealing with.