When it comes to his role in health care issues, most Americans probably associate former Kansas Senator Bob Dole with Viagra. Yet this week, the 1996 GOP presidential candidate stood up (so to speak) for the cause of health care reform, issuing a joint statement with Democrat Tom Daschle urging "the joint leadership to get together for America's sake." But while Dole castigated his own Republican Party for "putting up a 'no' sign and saying, 'we're not open for business,'" 15 years ago he did exactly that in blocking Bill Clinton's reform effort.
As it turns out, Bob Dole's story isn't merely that of health care hatchet man turned born again reformer, but perhaps instead that of a now-reflective political opportunist come full circle. As Jon Meacham detailed in the Washington Monthly in the fall of 1994:
Long before Clinton, Dole had been talking about a crisis in health care: "Mr. President, yesterday, President Nixon sent to Congress a comprehensive health message," Dole said on the floor of the Senate on February 19, 1971. "This message recognizes the present health care crisis in our nation." On June 6, 1991, he did it again: "Mr. President, yesterday the Majority Leader, joined by four of his colleagues, announced their solution to certain aspects of the health care crisis confronting this nation. They are to be commended for helping to begin and shape a long overdue debate on access to health care."
Sadly, that was before the election of Bill Clinton and the Republican scorched-earth strategy to deny him a victory on health care at all costs in order to forestall an enduring Democratic majority.
In December 1993, the former Quayle chief of staff and former New York Times columnist Bill Kristol galvanized Congressional Republicans with a private memo titled, "Defeating President Clinton's Health Care Proposal." As the American Prospect recalled in January, Kristol's war plan:
Darkly warned that a Democratic victory would save Clinton's political career, revive the politics of the welfare state, and ensure Democratic majorities far into the future. "Any Republican urge to negotiate a 'least bad' compromise with the Democrats, and thereby gain momentary public credit for helping the president 'do something' about health care, should be resisted," wrote Kristol. Republican pollster Bill McInturff advised Congressional Republicans that success in the 1994 midterm elections required "not having health care pass."
Kristol's central strategy in obstructing Clinton's success in resolving the health care crisis was simply to deny its existence. Not content to offer a "simple, green-eyeshade criticism of the president's health care plan," Kristol insisted the GOP must "kill it outright." While advocating many of the same free-market reforms later peddled by George W. Bush and John McCain (tax credits, medical savings accounts, etc.), Kristol implored his allies that "passage of the Clinton health care plan in any form would be disastrous." His prescription:
"To repeat: The president's plan would have a seriously detrimental effect on the quality of medical health care. And the president's plan is unnecessary: There is no health care crisis, and the reforms suggested above show how real problems can be directly addressed."
"Our country has health care problems, but no health care crisis."
Walking away from his work with John Chafee (R-RI) to create voluntary insurance purchasing alliances, by January '94 Dole had almost completely backtracked. As the New York Times summed up his partisan posturing:
Mr. Dole proposed an approach that would be less generous than any of them [Republican proposals]. His argument was that steps like barring insurance exclusion of pre-existing conditions or allowing self-employed individuals to deduct all of their premiums from their taxes could be done quickly because everyone wants them and that the tougher issues could be left for later.
In language eerily reminiscent of today's Republican stonewalling, Senator Dole was soon parroting the standard GOP talking points from the Kristol crib sheet:
That prefigured what Dole - the 20-year-old "crisis" he once worried about long forgotten as the Clinton plan sunk in the polls - said at the July 19 meeting of the National Governors Association in Boston, where the president (briefly) abandoned his universal coverage pledge. "The health care system may not be perfect but it is the best in the world," said Dole, parroting Kristol's memos. "It needs repair but I'm not certain it needs a complete and total overhaul and certainly not a complete and total takeover by the federal government." Helpfully, the senator added, "I think the seeds of a bipartisan agreement still exist - if the administration is willing to come our way."
Bob Dole's descent into bitter partisanship on health care didn't end there. As his fellow Kansan Republican Nancy Kassebaum and Democrat Ted Kennedy were finalizing their bill providing health insurance portability for American workers in 1996, Dole threw a last minute monkey wrench into the process. As the New York Times recounted, Republican politics - and free market ideology - got in the way:
Mr. Dole, the majority leader and apparent Republican Presidential nominee, has frequently insisted that he wants the bill passed before he resigns from the Senate on Tuesday, and his desire to exit on a note of triumph has been counted on to help it. Mr. Dole himself told reporters on Thursday, "I'm afraid if I leave and it's not done, it might not happen."
This afternoon Senator Edward M. Kennedy, the Massachusetts Democrat who co-sponsored the bill with Senator Nancy Landon Kassebaum, Mr. Dole's fellow Kansas Republican, told the Senate that by keeping a broad provision or medical savings accounts in the bill, "Dr. Dole is prescribing a poison pill for this consensus legislation," which the Senate passed 100 to 0 on April 23.
The Kennedy-Kassebaum bill ultimately became law in August 1996 after Dole's departure from the Senate, but not before a provision was added in conference for 750,000 families to enroll in medical savings accounts.
Fast forward to 2009 and Bob Dole has experienced a change of heart. While he still opposes the public option, Dole in Kansas City this week argued:
"This is one of the most important measures members of Congress will vote on in their lifetimes. "If we don't do it this year I don't know when we're gonna do it."
As the Kansas City Star noted, the 86-year old Dole reflected on the failure of past efforts to reform the American health care system and his crucial role in them:
He blamed himself -- and Hillary Clinton -- and finally politics.
"Politics took over," he said. "And you lost."
On that last point, Bob Dole is exactly right. Thanks to the obstructionist politics of Dole and his Republican allies, the U.S. health care system is in critical condition.
And that can't be treated with a little blue pill.