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At today’s Blair House confab, Sen. Lamar Alexander, R.-Tenn., was designated by the grumpier and less telegenic Minority Leader Mitch McConnell, R.-Ky., to make the GOP’s opening statement. In doing so, he laid down the Senate Republicans’ strategy in opposing health care reform and not offering a comprehensive bill of its own. House Minority Leader John Boehner, R.-Ohio, introduced a comprehensive health reform bill (text, summary), but McConnell has not, and Alexander indicated he isn’t about to now.
Why not? Not because health care doesn’t need reforming but, rather, because comprehensive bills don’t work. “We’ve come to the conclusion,” Alexander said, “that we don’t do ‘comprehensive’ well.” That was the problem with cap and trade, Alexander said; it was the problem with immigration reform (taken up under President George W. Bush); and it’s the problem with health care reform. None of these bills has cleared Congress. Such bills “fall of their own weight,” Alexander explained. “Our country is too big, too complicated, too decentralized” for comprehensive legislation. Then (in a dig at Obama’s former employment as a law professor), Alexander said, “That sort of thing works well in a classroom” but not in the real world. So while Republicans will support certain incremental reforms (malpractice reform, selling health insurance across state lines, expanding health savings accounts, and so on), they won’t support comprehensive health reform of any kind. Not in the Senate, anyway.
This is a little hard to take from a political party that during the past decade cranked up its war against al-Qaida into a war against terrorism itself (under a president who came into office performing a similar Uriah Heep act). But Alexander was internally consistent, because he was willing to say that extending health care to more Americans wasn’t a good idea. “As much as we want to expand access,” he said, “we shouldn’t expand a system that’s this expensive.” Give up on expanding access, and you can forget about the “three-legged stool” of health reform. No prohibition against insurers turning customers away based on pre-existing conditions; no individual mandate requiring everyone to purchase health insurance; and no subsidies to help lower-income people purchase health insurance. Republicans come off as more humble. They also come off as having little interest in helping the 45 million people who lack health insurance. Let ‘em wait.
President Obama didn’t respond (at least not initially; as I write we’re only about one hour into the summit) to Alexander’s criticism of comprehensive legislation. He said he doesn’t want to talk about process; he wants to “talk about the substance.” That doesn’t necessarily mean Obama is ready to chuck a comprehensive approach. Probably it means that Obama doesn’t want to lose a humility-off with Alexander, and that he wants to stick to a strategy of forcing Republicans to specify what they’ll support and what they won’t. So far, every time a Republican has said in this meeting that he wants this or that reform, Obama has said, in effect, “Great! Let’s put it in the bill!” or (more often), “Dude! That’s already in the bill.” Roll all these GOP reforms into a bill and what have you got? A comprehensive bill.