Conservatives bridge the gap on health care

July 16, 1998|By David M. Shribman

WASHINGTON -- The revolt against HMOs has produced a Democratic health care plan, a Republican health care plan, and a juicy campaign issue that came along just in time to resuscitate some of the dullest midterm congressional elections in years.

But hidden amid the sound (bites) and the fury (to appeal to voters' fears) may be something more enduring for the nation's politics: a way of bringing together the two warring wings of the Republican Party.

The social conservatives and the economic conservatives have as many skirmishes and cease-fires as the factions in Kosovo, and often for reasons just as inscrutable. But they've finally found common ground -- and are making common cause -- on an obscure corner of the health care debate that both sides agree should be at the center of the Republicans' response to the health care furor.

Just the other day a remarkable group of conservatism's high priests gathered in a small room to join forces in support of what they believe will become the populist issue of the future: medical savings accounts (MSAs), which would be easier to sell if they were easier to explain. They combine high-deductible health insurance policies (at low premiums to subscribers) with savings accounts (to pay those deductibles).

The only thing more complicated than an MSA is the health insurance plan you already have, but its political significance is simple, and is symbolized by the principals at that session: There, 13 floors above the bustle of the capital, was Randy Tate, the one-time House member from Puget Sound who now heads the Christian Coalition. He's the chief social conservative politico now that Ralph Reed is a private consultant.

There was Karen Kerrigan, president of the Small Business Survival Committee. She's a cutting-edge economic conservative and a symbol of the anger of the small-business revolt that helped sweep Newt Gingrich into power.

Bridge to the future

And presiding over it all was Steve Forbes, the magazine publisher and 1996 presidential candidate. He once planted himself firmly in the ground of the economic conservatives, but now may be the only person on Earth with one foot in both camps. Mr. Forbes wants to be the bridge to the Republicans' 21st century; GOP insiders actually use that phrase, borrowed from President Clinton himself.

Ordinarily the word "straddle" is a political pejorative, suggesting a hedge, or the refusal -- or, worse yet, the inability -- to choose one side or another. In the modern GOP, the word may be a virtue.

There sure is a lot to straddle. Just this week the two camps are sparring -- again -- about most-favored-nation trading status for China, which the business wing desperately wants and which the religious conservatives are increasingly skeptical about. The two sides, moreover, take a perverse joy in this fight.

That's why the medical savings account is so significant. It offers economic conservatives the market-oriented approach that is their fondest desire. (Ms. Kerrigan calls it "an escape hatch from HMOs.") It offers religious conservatives a boon for the family. (Mr. Tate says that three-quarters of the market for MSAs will be families, adding: "That's what we do. Families 'R' Us.") It has the additional advantage of permitting each side to do what it does naturally, which is attack Sen. Edward M. Kennedy, the Massachusetts Democrat who is a convenient target for both.

Kennedy style

"The GOP majority cannot needlessly upset and demoralize its traditional base by passing a big-government, Kennedy-style solution" to the latest health care problem, says Ms. Kerrigan.

And Mr. Forbes, an avid MSA advocate who offers the accounts to his magazine empire employees, reaps the benefit of bringing the two GOP factions together on this issue. It may be an uneasy -- and temporary -- peace, but at least he has the ear and perhaps the respect of the two wings that make the GOP fly.

"This is a piece of the puzzle," Mr. Tate says of MSAs. "The key ingredient for winning the Republican nomination is to unite religious conservatives and economic conservatives. That's the true Reagan coalition, and it's the route to success for Republicans."

It's a start. But in presidential politics as well as in the midsummer health debate, the Republicans face an enormous challenge. A recent CNN/Time poll shows the public overwhelmingly agrees (92 percent) that some or a great deal of health care reform is necessary. But, according to the poll, a majority trust Mr. Clinton and the Democrats more than congressional Republicans to do it.

On health care, at least, the Republicans may have found a way out of the classic GOP conundrum of the late 1990s: being in a real fight, but mostly with themselves. And they seem to have realized that flatter taxes alone won't fix everything.

David Shribman is Washington bureau chief of the Boston Globe.

Pub Date: 7/16/98

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