The previous congressional majority managed to jam Obamacare down the throats of an increasingly resistant nation. Now the fight against Obamacare may have delivered a shock to the system that goes beyond the battle cry of “repeal and replace.” Serious health care reformers, however, still face some unpleasant realities.
Public-opinion polls consistently reveal an extremely poorly informed public with no coherent commitment to reducing the role of Big Government in health care. To some degree, this remains true. The average citizen is happy to delude himself into thinking that the United States can balance the budget by cutting foreign aid even though it is a trivial part of spending. The politician who challenges the real cost drivers of the federal budget — especially Social Security or Medicare — faces the prospect of a short career.
As William Voegli of the Claremont Institute recently reminded us, conservatism has “clear, categorical arguments against permitting American government to take up any task it did not perform during Jefferson’s presidency.” However, “In 1936 and 1964, the Republicans’ presidential candidates, after repeatedly expressing their commitment to these principles, won 36.5 percent and 38.5 percent of the popular vote, respectively.”
This undoubtedly explains why the current Republican caucus on Capitol Hill is so reticent about introducing real reform to these entitlements. I can’t blame them. It is pretty easy to get the seniors onboard the anti-Obamacare Express by simply attacking the president for cutting half a trillion dollars from Medicare to finance Obamacare. Furthermore, except for the martyrdom of Alf Landon in 1936 and Barry Goldwater in 1964, Republican “founding mythology” does not provide strong grounds for rolling back the entitlement state.
A full 81 of 102 Republican representatives and 16 of 25 Senators voted in favor of the Social Security Act in 1935. As for Medicare and Medicaid, a narrow majority of Republicans in the House voted in favor of the 1965 Social Security amendments, as did almost half of those in the Senate. When Ronald Reagan had to deal with Medicare, he accepted an increase in payroll taxes and imposed centrally fixed prices for medical procedures, laying ground for today’s ridiculous, never-ending sequence of “doc fixes.” Let’s not get started on the Medicare Part D drug benefit, a solely Republican expansion of Medicare passed in 2003.
But the ground may be shifting. The latest Pew Research Center survey of voters’ budget-cutting priorities shows that Americans are far less enamored of surrendering control of their access to medical care to the federal government than they once were. Yes, 40 percent want to increase Medicare spending, versus only 12 percent who want to cut it. But this is a reduction of one-quarter from the 53 percent who wanted to increase spending in 2009. With respect to health care in general, 41 percent want to increase spending, versus 24 percent who want it cut. This represents a one-third reduction from 2009, however, when 61 percent wanted the federal government to increase health spending.
I have little doubt that the population, already on the attack against Obamacare, is beginning to find a target-rich environment in other government health programs, especially Medicare and Medicaid. This is supported by the fact that the shift of opinion on education spending was far smaller: 62 percent of respondents wanted to increase federal education spending, versus 67 percent in 2009.
I suspect the time is coming when politicians in general and Republicans in particular will take more risk on health reform. An ambitious conservative politician, for example, could propose replacing employer-monopoly benefits with individual tax credits, voucherizing Medicare and Medicaid, or eliminating entirely the federal role in regulating private health insurance. Such a politician might discover – with surprise – that he is pushing against an increasingly open door.
(This was also published as an article in PRI's Capital Ideas series.)