Obamacare A Wake-Up Call For Republicans, Time To Start Governing

Last week's Supreme Court decision on Obamacare was a wake-up call for Republicans to get going and get governing. The Republican benign-neglect approach to health care reform during the past decade was an unwitting contributor to the situation we find ourselves in today. The question is: Will Republicans be able to come together to craft a replacement for Obamacare?

A June 28 Wall Street Journal editorial contained a summary of sound ideas for improving how America pays for health care. No surprises here, it's about fixing the tax code, block-granting Medicaid, allowing people to purchase high-deductible catastrophic insurance across state lines, etc.

If these ideas are so good, why didn't the Republicans enact them when they had control? Why did it take Obamacare to make Republicans realize that inaction was not the answer?

Back in the last decade, the conservative message seemed to be that there wasn't a health care crisis and that health care was not a right. Or to put it another way, nothing to see here, keep moving.

Let me be clear, I agree a crisis in health care doesn't exist or is a right. But as we've seen, the American health system has serious problems. There are two paths to a solution: market-based or statist. The missed chances of the past decade have dumped the statist solution in our laps, courtesy of President Barack Obama, Minority leader Nancy Pelosi and Senator Harry Reid.

For an alternative, look back nine years ago to George W. Bush's prescription drug plan for seniors. Remember those busloads of seniors from border states going to Canada to buy prescription drugs? Remember how then-Gov. Rod Blagojevich was going to save $91 million annually by having Illinois state employees buy their drugs from Canada?

Ten years ago, the Democrats' solution to drug prices for seniors was to simply replicate Canada's state-mandated price control system, first by encouraging imports from Canada and then enacting a U.S. version of the controls. If Bush had not gotten his Medicare prescription drug plan passed in 2003, you can bet that drug price controls would be front-and-center of the Obamacare law today.

You may recall that Bush's Medicare Part D plan involved having seniors purchase subsidized prescription drug coverage in the private market. The idea was that market competition would keep premium prices and subsidy amounts down. And that's exactly how things have worked out.

But certain purists on the right were unhappy about Part D being enacted at all -- and they're still not happy. During this presidential primary cycle, they boxed in Rick Santorum, forcing him to describe his 2003 Senate vote for Part D as a mistake.

That was unfortunate, because Santorum could have defended his vote for Bush's Part D plan as a reasonable approach to an issue that was going to have to be dealt with sooner or later. Further, he could have made the case that a market-based solution was better than doing nothing and being at risk of having a price control system imposed later when the Democrats would (inevitably) get their turn at running things. That's governing, folks.

The lesson for Mitt Romney and John Boehner is that while those purists on the right haven't gone away, they shouldn't distract them from taking action. In 2003, Bush managed to keep the purists at bay, he proved it could be done. Ten years later, in 2013, a (hopefully) President Romney will face a brief window of opportunity to get our nation's health care system on the right track. He must be able to take on the difficult task of governing in order to replace Obamacare with market-based solutions.

Some conservatives are donning sackcloth and ashes over the SCOTUS decision. I prefer to look to The Producers' Max Bialystock for inspiration. I can imagine him asking Romney on the campaign trail: Mr. Romney, isn't govern part of your title? And this response: It's much more than that; it's my duty to America.

Joanne Butler is a graduate of the Kennedy School of Government at Harvard University and a former professional Republican staff member at the U.S. House of Representatives Ways and Means Committee.