New England Journal of Medicine: Do Health Care Reform Opposite To How Hillary Did It (But Not Like McCain Would)

Thinking back to the primary battle in the Democratic Party I love how this article starts in last week’s issue of The New England Journal of Medicine:

The Clinton administration’s ill-fated 1993 Health Security Act has at last become a model for health care reform — though not in the way its architects envisioned. The Obama administration and congressional reformers are using the Clinton plan as a blueprint for how not to pass health care legislation. In 2009, reformers are pursuing a strategy that, in key respects, does exactly the opposite of what the Clinton administration tried in 1993 and 1994.

Doing everything the opposite of how Hillary did it does sound like a good model.

Incidentally, I noticed that all the articles related to health care reform are free to non-subscribers (while most of the issue is only available to subscribers). As I subscribe I don’t generally pay attention to what is free and what is for subscribers, but if last week’s issue is typical, those interested in health care reform want to check out the free articles there.

This week’s issue, not yet available on line, includes an article on market-oriented health care which considers the idea generally promoted by Republicans that placing more responsibility on consumers to control health care costs does not work. This includes reasons such as that consumers are not in a good position to make such decisions and that “increased consumer cost sharing causes unintended reductions in the use of services which are important for better health.”

The moral of these two articles is that we should do everything the opposite of Hillary, but now how McCain and other Republicans recommend.

Some Republicans Question Club For Growth

Yesterday I noted how some conservative writers are breaking from  Republican orthodoxy on economics. Hard line Republican economic views and ideological purity are often enforced by the Club For Growth, which often targets Republicans who vary from the party line. The Wall Street Journal reports today that the Club for Growth Wears on Some Republicans.

Pennsylvania Sen. Arlen Specter’s switch to the Democratic Party underscores the clout of Club For Growth, a conservative group that targets Republicans it brands insufficiently committed to low taxes and small government.

The move also has inflamed a debate within the party: Are the group’s tactics good or bad for Republicans?

Mr. Specter fingered Club For Growth as the key factor behind his decision, saying he would have lost the Republican primary to a Club-backed rival. His decision has prompted some Republicans to turn on the organization, saying it backs those who are so conservative that they then lose to Democrats.

“If their goal is to increase the Democrats’ numbers in Congress, they’re doing a very good job,” said Rep. Steven LaTourette (R., Ohio), a moderate who won his seat in 1994. “Do they want a permanent minority of 140 people as pure as Caesar’s wife, or a Republican majority that can get them 70% of the issues that are important to them?” (Republicans hold 178 of the 435 House seats and 40 of 100 Senate seats.)

Some Republicans defended the organization but the article did return to further criticism:

Other Republicans say the Democrats have the right idea with their approach toward the past two elections of fielding candidates even though they deviated from some elements of party orthodoxy such as abortion rights and gun control.

“I’m not looking to be a member of a club,” Sen. Lindsey Graham (R., S.C.) told reporters the day of Mr. Specter’s defection. “The difference between being a club and a national party is being able to play outside your traditional areas.”

Critics of the group say there are several elections in which the Club defeated or weakened a Republican candidate. Republican Reps. Joe Schwarz of Michigan and Wayne Gilchrest of Maryland lost primary bids in 2006 and 2008, respectively. Both districts are now represented by Democrats.

“It brings a smile to our face when we see the Club For Growth going in, because in some instances it improves the prospects for our candidates,” said Rep. Chris Van Hollen (D., Md.), who spearheads the Democrats’ House campaigns.

There was more defense for the organization with the article concluding with LaTourette repeating his criticism:

But Mr. LaTourette, the Ohio representative, said an overemphasis on ideological purity could make the GOP a permanent minority. “If the Democrats said everyone had to look like a Democrat from Massachusetts, they would not be the majority party,” he said.

Ultimately it comes down to whether they want ideological purity or a party which can win national elections. You cannot do both in a two party system.