In 1993, at the height of President Bill Clinton's health care reform initiative, Sen. John Chafee, R-R.I., along with 19 other Republicans and two Democrats, put forth a bill which was considered the major GOP proposal. One of the co-sponsors was then-Sen. Dave Durenberger, R-Minn. The bill, just like the Democratic version, never passed. But in a sense, it's been revived this year.
In fact, the key provisions in the Chafee bill may seem familiar, as they bear a strong resemblance to those in the current Democratic Senate bill, and now in President Barack Obama's proposal. A mandate that individuals buy insurance, subsidies for the poor to buy insurance and the requirement that insurers offer a standard benefits package and refrain from discriminating based on pre-existing conditions were all in the 1993 GOP bill.
Durenberger says the reason many of these ideas have been shunned by today's Republicans, even called unconstitutional by some, is that political times have changed. “The main thing that’s changed is the definition of a Republican,” he said.
KHN’s Maggie Mertens spoke with Durenberger about the contrast. Here are edited excerpts:
Q: Why do you think that Republicans in Congress today have come out against certain provisions they supported in 1993?
A: There are no more efforts at bipartisanship in health care. There certainly weren’t in 2003 - when President Bush did his prescription drug changes, he got a couple of Democratic senators on that by changing the wage index in Medicare, but other than that it was a Republican bill.
Republicans today want to go back to where they were in the first part of this decade with consumer-driven health care. They talk about families and doctors. In other words, they like it just the way it is today. They think that if everybody owned an individual indemnity insurance plan the doctors wouldn’t have to sweat and the consumers of insurance would be just fine, of course they don’t tell you that their deductibles would go up and they’d lose coverage, etcetera.
Q: Do you think that there’s hope for bipartisanship during Thursday's health care summit?
A: Well, I’m an optimist, I always am an optimist, and I’ve been hopeful all along that, somehow or another, this bill was going to pass and it was going to represent the kind of work that the Senate Finance Committee has been doing. I refer to the work that its Chairman Max Baucus, a Democrat, and its ranking member Chuck Grassley, a Republican, have been doing for the last three, four and five years: working principally on payment changes, payment reforms, Medicare, Medicaid, tax policy, paying for performance and quality, dealing with safety issues, and doing a lot of that in a bipartisan way.
And then they abandoned that somewhere last summer, and without that basic Senate bill, it seems to be difficult to imagine the success of whatever passes.
I can’t say the Democrats can’t pass a bill, but I can say they’re not going to have Republican votes with which to pass it unless the president can perform some kind of miracle in four hours with 50 people in the Blair House that’s never been done in the history of this country. And I doubt it’s going to happen on Thursday.
Q: Do you think that there’s anything for this Congress to learn from your experience?
I think a lot of people would agree that the process of getting a bill passed is probably what did this thing in, not just the content of that bill. That’s really the lesson that all of us involved in '93-'94 did learn, and it’s the lesson that everyone should learn from this experience in 2009-2010.
Q: Going into this summit, how should Congress be dealing with the debate now?
The hope lies in trying to find the common ground. I’ve looked at the president’s new proposal and, boy, I tell you, even summarized, it is 11 pages, [in the] weeds. Most Republicans and most Democrats who haven’t been involved in all this negotiation - and don’t have staffers that have been involved in this stuff for the last two years - they’re going to look at this and they’re going to choke. They're going say “I’m used to talking in sound bites, there’s no way I can discuss this sort of stuff and come off sounding intelligent.”
Yes, it takes something from the Senate bill, it takes something from the House bill, it puts in more money, it improves on this and improves on that, but I’ve got to tell you there’s probably about a dozen people who understand that out of 306 million Americans.
I will be eagerly looking for the points of agreement. But I can tell you in advance: the major agreement would be on getting national rules by which major insurance companies will be forced to compete at the local level. Already that’s been characterized as "buying over state lines" by Republicans, and now being characterized as some kind of a "national health insurance rate authority" by the Democrats.
After you get past that kind of agreement, it gets much more difficult because the Republicans really do believe that all of us Americans could reduce the costs and improve the quality of the health care system simply by making our own decisions with our own money. [I believe] that there is half of America out there that doesn’t have the financial resources to make these kind of decisions. And 99 and 44/100 percent of Americans who don’t understand how to deal with a cancer, how to deal with a heart attack, or how to deal with whatever diagnosticians come up with on their MRIs - there’s no way we’re going to price shop. That’s a conflict that won’t go away easily in a four-hour session.
Q: Do you think that an individual mandate is still the way to go?
Yes, if you are going to go to universal coverage and going to get the insurance companies, particularly the private insurance companies, to compete with each other on the basis of how much risk they’re willing to assume and to reduce and thus get their prices down. Yes, if that’s the theory of health insurance, which it should be. But you’ve got to set the rules across this country in order to make it work. That’s something that has not been related well.
Q: You obviously believed in the importance of passing health care reform in 1993, how important is it now?
I think it’s four times more important now than it was then because the costs are four times as bad and they’re escalating more quickly and the entrenched behavior of the medical industry is so bad today compared to what it was then.
If we can’t move toward universal coverage, if we can’t do anything to bring everybody in America into the system, we’re going to discover that the costs are unbearable three or four years from now.
Doing national policy reform is as complex as the system itself, and leadership in getting it done is critical. So the president, having chosen to take this on, has taken a huge step forward, and he can’t step backward.
Even if this bill doesn’t pass, it’s on his desk. The problem stays on his desk. And for the next three years, or the next seven years, whatever Obama may have, this is the problem that brings all Americans together, rather than divides them the way we’ve seen it happen this year. He’s going to have to figure out a way to keep them together and get this problem solved.
David Durenberger was the senior Senator from Minnesota from November 1978 to January 1995. He is a Senior Health Policy Fellow at the University of St. Thomas in St. Paul and chairs the
National Institute of Health Policy
(NIHP). According to NIHP, he has also served on the Medicare Payment Advisory Commission and currently serves on the Board of the National Commission on Quality Assurance (NCQA) and the
Kaiser Commission on Medicaid and the Uninsured
(KHN is an editorially independent program of the Kaiser Family Foundation.)