How Reagan would fix Obamacare

The internal GOP debate on how to replace Obamacare is essentially one of priorities. What is more important, saving money or saving lives? Senate and House Republicans may be surprised to learn that for their idol, Ronald Reagan, this was never a question at all. Throughout his life, Reagan always cared more about saving lives than saving money.

Conservatives might find this shocking and argue that Reagan would never have approved of federal subsidies-such as those contained in Obamacare. But, to paraphrase Reagan himself, it’s not so much that our conservative friends are ignorant, it’s that so much of what they know just isn’t so. In fact, throughout his career, Reagan expressed strong support for government-subsidized medical care for people who couldn’t otherwise afford it.

In researching my book on Reagan’s political philosophy, I came across his speeches and letters from the days before he became famous in 1964 for endorsing Barry Goldwater in a nationally televised address. There was then no Medicare or Medicaid, but there were plenty of proposals to create a federally run or funded program to provide health insurance to all Americans. Reagan opposed those ideas, to no one’s surprise, but the surprise is why he did and what he wanted to do instead.

Reagan did not oppose national health-care plans out of a belief they violated the Constitution, were improper roles for government to play or cost too much. Rather, he opposed them because they weren’t necessary to solve the legitimate humanitarian concerns that evoked Americans’ compassion.

Reagan’s principle was simple: As he told the Conservative League of Minneapolis in 1961, “as one conservative let me say any person in the United States who requires medical attention and cannot provide it for himself should have it provided for him.” To that end, he enthusiastically supported a recently enacted bill called the Kerr-Mills Act. That bill provided federal funds to states to set up programs to pay for medical care for poor senior citizens. This targeted intervention allowed government to meet the true need without creating what he called a compulsory, one-size-fits-all model that “forc[es] all citizens, regardless of need,” into a single program.

Cost was not a concern for him. He wrote a longtime friend, Loraine Wagner, in July 1961 to elaborate on his view. “Very simply,” he wrote, “I’m in favor of helping those who need help.” After describing KerrMills, he wrote, “Now I’m in favor of this bill - and if the money isn’t enough I think we should put up more.” Saving lives was always more important than saving money to Reagan.

And he did not retreat from this stance when he became governor or president. Despite inheriting a terrible budget crisis upon taking office, Reagan refused to push to repeal California’s recently enacted participation in Medicaid. He called it “help” for people who otherwise could not afford their medical bills, and raised taxes by a then-record amount rather than slash the program. He reiterated his support for the principle of governmentfinanced health insurance for those who needed it in letter after letter, including one he wrote in mid-1979.

Applying these principles to the current debate, it’s clear that Reagan would ensure that no one with genuine need would lose his or her ability to get needed medical care regardless of the cost. The newly released Senate bill does a much better job of fulfilling his ideals than does the House bill. It slows the phaseout of federal support for the Medicaid expansion and retains Obamacare’s income-based subsidies for people on the federal exchange, while the House bill’s age-based subsidies would probably have led to many people dropping coverage. In each case, the Senate approach places life over cost. Senators who came out against the plan Friday on grounds that it doesn’t fully repeal Obamacare may think of themselves as conservative, but on this issue they aren’t acting as Reagan conservatives.

Reagan would not have ignored cost concerns. As he told the nation in 1981, “we can be compassionate about human needs without being complacent about budget extravagance.” It’s just that meeting human needs always came first for the Gipper. If he were convinced, as Senate bill critics argue, that this bill’s Medicaid changes will keep people from getting the care they need, Reagan would surely have worked to find a solution.

Republicans have long suffered from the self-inflicted wound of misunderstanding Ronald Reagan. By adopting the liberal caricature of him as an anti-government zealot, they have hurt their ability to win elections and hindered their ability to govern when they did. The current debacle over health-care reform is simply the latest example of this threedecade trend. The GOP should use the coming debate over an Obamacare replacement to finally rid themselves of this false idol and follow the real Reagan into the promised land.