My strong sense is that neither Democrats nor Republicans really want to resolve either issue before the election — they would rather have the issues to take to the election. Actually passing a bill would mean compromise and that would mean diffusing the issue with no chance to leverage it. Neither side sees a gain in such a compromise.
By compromising, Democrats would eliminate important components of the healthcare issue from the election year debate. If they compromise with Republicans on patient rights or prescription drugs, they are in effect saying that the Republicans weren’t so bad on the issue after all. Politically, many Democrats believe they are better off if they can hammer the Republican-controlled Congress for not passing an acceptable bill.
By compromising, Republicans are afraid they will get what conservatives have criticized them for doing before: going too far in doing a deal with the Democrats. The 1995/1996 Medicare budget changes, KidCare and Kennedy/Kassebaum are all examples of what many Republicans consider sellouts to the Democrats that later reinforced the voters’ perception that the Democrats are the ones to be trusted on the healthcare issue.
Republicans believe they have saleable positions on patient rights and prescription drugs and are just as eager to take those ideas to the voters in the hope that they will have a Republican Congress and a Republican president in less than a year.
But both sides are going to spend the spring posturing on patient rights and generic drugs. How else to get the political leverage out of them?
Patient Rights
Like the Republican presidential candidates who have supported the patient’s right to sue, we are beginning to see members of the Republican congressional leadership also change their tune on patient rights. First, standing firmly against any bill that included such a provision, we are now hearing likes of Republican House Majority Leader Dick Armey saying that we could well have a right-to-sue bill pass Congress this year.
However, the devil is in the details. A right-to-sue provision only after all appeals have been exhausted and part of a bill loaded down with Republican proposals to reach more of the uninsured with such things as expanding medical savings accounts and creating small business buying coalitions, called HealthMarts, could well pass both Republican houses of Congress but could also be veto bait for Clinton. Clinton has already said that he would not let such a bill become law.
Look for the Republican congressional leadership to do exactly what their candidates are doing: Voice strong support for patient rights (now including the right for a patient to sue his or her HMO), as well as expanding the prescription drug options for seniors. We will likely see the Republican-controlled House and Senate pass a patient rights conference bill written by conferees the Republican leadership hand picked.
But a distinctly Republican patient rights conference bill will not become law so long as President Clinton and the Democratic leadership believe vetoing it will help their chances in November.