For years, Republicans have attacked advocates of universal health insurance as "socialists." But what are they going to call Arnold Schwarzenegger? Last Monday, the Republican governor announced that he wants to bring universal coverage to California—just as another Republican governor, Mitt Romney, recently did for Massachusetts. This would be the same Schwarzenegger who, in his 2004 prime-time address to the Republican National Convention, decried European-style socialism, pledged his "faith in free enterprise," and called Democrats "economic girlie-men" for harping on the financial insecurity of their fellow citizens. Apparently, this was before he realized that millions of Californians were struggling with medical bills—and that only government could solve the crisis. Who's the girlie-man now?
Of course, Schwarzenegger and Romney aren't the only elected officials talking about universal health care these days. Two Democratic senators, Ron Wyden and Ted Kennedy, are touting plans of their own. More plans should be forthcoming from their party's presidential candidates. Still, it's Schwarzenegger, like Romney before him, getting all the attention. And with good reason. When prominent Republicans start embracing universal coverage, it's a sign that the next great debate about health care has begun.
But how will it end? A lot depends on how liberals react to proposals like Schwarzenegger's. On the one hand, his plan represents a clear departure from the previous decade, when even Democrats limited themselves to incrementalism. It would give coverage to virtually every California citizen and would break some important political taboos along the way. The plan features extensive regulations of the insurance industry, so that it cannot exclude people with prior medical conditions. It also has higher taxes and requirements that employers contribute toward health insurance. There is even bigger government, in the form of expanded Medicaid.
Still, the plan has some serious drawbacks. For one thing, its minimum-benefits package seems meager, which could encourage employers who now offer more generous coverage to cut back. For another, its financing scheme makes some heroic assumptions about the savings that reform will produce.
But perhaps the biggest problem with Schwarzenegger's plan is the danger that it could stall momentum for more sweeping changes—both in California and beyond. His proposal arrives on the heels of a measure he vetoed last year that would have created a single-payer system—the most comprehensive type of reform, in that it seeks to blow up the entire health care system and have government insure citizens directly. Yet even people who support single-payer may be tempted to rally around schemes like Schwarzenegger's, which have more limited ambitions, because they might fear their preferred plans couldn't pass.
It's a reasonable instinct. Reformers with long memories know that the United States probably came closest to creating universal coverage in 1974, when Richard Nixon (hey, another Republican!) embraced the idea, only to have Democrats reject it because they believed they could pass a better plan.
But it's not self-evident that moderate plans are so politically viable, either. Consider what happened to Bill Clinton, who tried desperately to blunt the opposition of special interest groups and get past Americans' well-known skepticism of government. The result was a plan so complicated that it failed to capture the public's imagination. Meanwhile, even interest groups that stood to benefit ceded the political field to organizations that opposed change.
At the very least, it's premature for would-be reformers to "settle" on a plan that, like Schwarzenegger's, has some major flaws. If this plan defines the outer limits of political acceptability, then whatever compromise it finally produces will likely have even greater deficiencies.
Yes, champions of universal coverage should welcome the likes of Schwarzenegger to their cause. But these common areas of belief should be the beginning of discussion, not the end. There is a time for compromise, and that time will come soon enough. But, right now, advocates of universal health care should speak openly and unabashedly about what they actually believe is right, even if that means proclaiming ambitions that defy conventional notions of the politically possible. That is how you stretch the boundaries of debate. And that is how reform, eventually, will happen.