Universal health care's most surprising advocate.

The gathering took place in late May, at a conference center some 80 miles north of Salt Lake City. To the casual observer, it would have seemed like a rather ordinary businessmen's meeting. Inside a windowless room with handsome wood paneling, about 300 people sat at round tables, sipping juice and finishing off eggs from the hot breakfast buffet. Up on the stage, a tall, gangly figure worked his way through a rudimentary PowerPoint presentation. He spoke crisply but in a relative monotone; with the lights dimmed, a few audience members nodded off. But those who stayed awake saw a remarkable speech- -and, potentially, an important one. That's because the man at the podium was Bob Bennett, the Republican senator from Utah. And he was there to champion his new favorite cause: universal health insurance.Step by step, he made the same statistical case for action that Democrats have been making for years. More and more people were losing their health insurance; even those who had it were struggling to pay their bills. Employers who gave their workers coverage were in trouble, too. Bennett assured the audience, a typically conservative slice of Utah's small-business community, that he shared their disdain for the familiar liberal solution of having government insure everybody through a so-called single-payer system. But, he explained, there was an alternative based on free-market principles. It was a bill proposed by one of his Democratic colleagues, Senator Ron Wyden of Oregon. Everybody would have insurance, but, Bennett promised, it would be private coverage rather than a new government program. Competition, not government edicts, would hold down costs. The Wyden bill wasn't perfect, Bennett said, but it was an awfully good start--so much so that, just a few weeks before, he had agreed to co-sponsor the measure. The audience responded positively to Bennett's message, just as two of his Republican Senate colleagues-- Lamar Alexander of Tennessee and Judd Gregg of New Hampshire--have done in the last month. And, while that's a total of just three co-sponsors out of a Republican delegation numbering 49, it's a significant development all the same. For most of recent memory, Republican lawmakers in Washington have followed a dictum first issued by Bill Kristol during the 1994 Clintoncare fight: Oppose universal health insurance "sight unseen." But now the right's political outlook seems to be changing. The rising cost of health insurance has rattled some Republican-leaning interest groups, mainly large employers seeking relief from skyrocketing employee health premiums. Two prominent Republican governors, Mitt Romney in Massachusetts and Arnold Schwarzenegger in California, have embraced universal coverage schemes for their states. Given Bennett's standing in the party--he's widely respected and known to be close to Senate Minority Leader Mitch McConnell--it seems likely he'll win more converts soon. But then what? Bennett's stated reservations about elements of the Wyden proposal aren't exactly surprising, given that Wyden is one of the Senate's most liberal members and Bennett is a bona fide conservative. And those objections seem mild when compared to what the other co-sponsors have said. When Gregg announced his support for the bill, known formally as the "Healthy Americans Act," he issued so many caveats that it was fair to wonder what, exactly, he had agreed to endorse. In 1994, Republican support for compromise health care reforms eventually proved hollow; then-Senate Minority Leader Robert Dole ended up disavowing not one but two universal coverage bills he had previously co-sponsored. Bennett's enthusiasm is encouraging, to be sure, but is there reason to think that he--or his party--will act differently this time? Bennett's own history on health care traces back to the battle over the Clinton plan, when--as a junior senator in his second year--he served as one of several Republican henchmen charged with blocking the initiative. As Bennett explained to me during an interview, the Senate GOP leadership set up a working group with about a half-dozen senators, assigning each one part of the Clinton plan--with orders to research it and develop convincing arguments against it. They met twice daily and, eventually, honed an effective strategy for derailing reform: seize on a controversial provision, develop a stinging critique, and then take that message to the public. By summer, when then-Majority Leader George Mitchell had ditched the politically unviable Clinton plan and substituted his own alternative, the work became easy--since, according to Bennett, the hastily drafted scheme was full of ill-conceived provisions. "Whichever senator got today's clunker would go after Mitchell--and then [Mitchell] would have to admit that this was really bad, have an amendment to take it out, and then the next day it would come down," Bennett recalls. "Eventually, he had to pull the whole bill down." Today, Bennett says he watched the demise of Clintoncare with more sadness than anger. And, as a former businessman who recalls his own frustrations dealing with employee health insurance, he says he hoped to revisit the issue in 1995, once Republicans took over Congress. Dole agreed to let Bennett lead the Republican task force on health care--a group that the late Rhode Island Senator John Chafee had led during the Clintoncare fight and that had nearly devised a successful compromise plan. But Bennett says the "moment of exhilaration ... lasted until the first meeting," once it became apparent that a lowly task force would have no power now that Republicans controlled their own committees. And, while those committees would enact some modest health care reform measures, like the State Children's Health Insurance Program, universal coverage vanished from the congressional agenda. That's how things remained until the past fall, when Democrats won back Congress and, seizing the opportunity, Wyden first introduced the Healthy Americans Act. Although Wyden had not been a pivotal player on health care like, say, Ted Kennedy or Jay Rockefeller, his plan was noteworthy for its ambition. Eschewing the incremental approach of recent years, Wyden wanted to insure every single American. At the same time, Wyden knew that passing a bill meant overcoming the inevitable filibuster from opponents, which meant getting 60 votes, which in turn meant winning over at least some Republicans. So, rather than call for creating a new government insurance program or expanding existing ones--non-starters on the right--Wyden proposed creating a marketplace through which everybody could buy private insurance. The insurance would have to have generous benefits, which meant offering something like what members of Congress get; it would have to be affordable, which meant providing lower-income Americans with subsidies; and it would have to be available to everybody, which meant forcing the insurance companies to sell to all comers, regardless of pre- existing medical conditions. But it would still be private insurance. And, since people would be shopping around for coverage, insurance companies would theoretically have to compete for their business based on price and quality-- unleashing the kind of market forces in which conservatives have faith. As Wyden went door to door, making his pitch, Republican colleagues were friendly but skeptical--Bennett among them. "I said the standard thing any senator says: 'Well, I'll have a look at it,'" Bennett remembers. "That's as firm a 'no' as you're going to get." But, when he dispatched a staffer to review the Wyden plan, the response surprised him: There seemed to be a lot of common ground. Like many conservatives, Bennett had come to believe the fundamental problem with health insurance was the fact that most working people get coverage through their employers, who select the type of coverage and pay a large share of the premiums directly--thereby taking away employees' choice and insulating them from the real cost of their medical care. The Healthy Americans Act essentially eliminated the employer system altogether. Bennett, like many of his GOP colleagues, had also become very concerned about the unhealthy lifestyles of many Americans--and the way those habits contributed to rising health care costs. Wyden's bill proposed to address this problem, too, by offering financial incentives for enrolling in wellness programs. After checking with McConnell to make sure he wouldn't run afoul of the party leadership, Bennett agreed to hold formal conversations with Wyden. (Wyden sought, and received, the same blessing from Senate Majority Leader Harry Reid. ) Eventually, he signed on, with the caveat that he was endorsing the general approach but not every specific feature. How big a deal was this? Under the Healthy Americans Act, the federal government would discourage insurance companies from competing to avoid medically risky beneficiaries--the way they do now--by prohibiting insurers from discriminating based on pre-existing conditions. That's a whole lot of regulation. People with high incomes and generous health benefits would end up losing some of their existing tax breaks--which is to say, they would pay (slightly) higher taxes. Some conservatives are sure to attack that. And, of course, it would achieve universal coverage--the traditional Republican bugaboo. But Bennett has signed on to these features and, on more than one occasion, defended them. At a recent event co-sponsored by the Heritage Foundation and the New America Foundation, a questioner asked Bennett what he would tell a critic who called the plan a tax hike. Bennett retorted that such a critic is "incapable of reading a piece of legislation," since the plan simply makes explicit--and redistributes more equitably--the hidden payments people already make for the nation's health care bill. Still, there are sticking points. Early on, Bennett objected to Wyden's promise that all Americans would have insurance "as good as" the coverage members of Congress get. Bennett thought that promised too much; the federal employee system (through which members get their coverage) offers a menu of choices, with higher prices for more generous plans, and he saw no reason to promise the high-end plans for which most members of Congress presumably opt. And, while that issue was easy to finesse--Bennett just talks about giving all Americans the "same choices" that members have--it's fair to wonder how many other Republicans would go as far as Bennett has. Among the "serious concerns" Judd Gregg enumerated in his endorsement was "the imposition of mandates." But it's the mandates--on individuals to buy insurance, on businesses to help pay for it, and on insurers to provide it in a fair and equitable way--that make the plan work. Without them, the Healthy Americans Act would quite literally fall apart. Not that Gregg's reticence is surprising. All the mandates and regulation in the Healthy Americans Act really are pretty antithetical to modern conservatism- -more, perhaps, than Bennett wants to admit. It may not be government-run insurance, but it's still more government-- a lot more, as a matter of fact. At one point during our interview, I noted that new state agencies would get heavily involved in the business of buying and selling health insurance-- screening private insurance companies to enforce standards for pricing and benefits and acting as a conduit through which people would actually select their coverage. In effect, they would become giant purchasing cooperatives-- which, as it happens, is more or less what the dreaded Clinton plan would have done. Bennett denied the similarity, but his explanation wasn't particularly convincing--and it was fair to wonder whether he, or other potential GOP supporters, might change their minds once Congress takes up the issue seriously. Moreover, will bipartisanship still sound appealing if it means passing a bill for which Democrats will, undoubtedly, get most of the credit? Bennett thinks there is plenty of political credit to go around--and warns that a strategy of pure obstruction could simply build momentum for a single- payer system. (This is one of many reasons why it's so important to keep single- payer part of the conversation; it scares opponents.) And at least one veteran of the Clinton effort--New America economist Len Nichols, who helped craft the Healthy Americans Act--is equally optimistic: "Is there enough common ground to build a real reform? Absolutely." Even my own skepticism waned a little after speaking to Bill Johnson of Vernal, Utah, who attended Bennett's speech back in May. About ten years ago, Johnson told me, he had to sell his small mobile home construction company and take a job with a bank, in good part because his wife had developed several chronic conditions, rendering her uninsurable in the individual market. "I think she takes about twenty-five different drugs," Johnson said, "and if we had to pay for them out of pocket, we'd go bankrupt in a pretty short amount of time." Johnson called himself "a pretty staunch right-wing type of person ... pretty typical for us out in Utah." As such, universal health insurance was not an idea he had entertained seriously--until he saw Bennett's presentation. "I'm not going to say we should implement this thing tomorrow, but let's take a closer look at it," he said. Given the history of conservative thinking on health care, that's progress.