Health-care historian: GOP opposing ideas it long espoused

In the past, most opposition to changing health care came from health-care interest groups: doctors, insurance companies, drug companies.

This time, it's different. There has been considerable grumbling from the medical establishment, but the approach Democrats are taking "doesn't really threaten any of those groups," said Paul Starr, a Princeton University professor who won a Pulitzer Prize for his book on the history of health care: The Social Transformation of American Medicine. He later was involved in the creation of the Clinton health plan.

Starr spoke yesterday to about 70 lawyers and Widener University professors and law students at the Union League. He later spoke at Widener.

This time, "one group remains unmollified, and that is the Republican Party," he said. The battle "has become a test of the ability of the Democrats to govern."

While Starr said the country, which has been talking about improving health care for many decades, was "closer than we ever have been to reform," he would not guess whether Congress would pass a bill this time. "It all depends on a few senators," he said. "There's no way anybody can predict what they will do."

There was a time when many of the changes included in the House and Senate health bills would have been considered Republican or at least bipartisan ideas, Starr said. In the days of Harry S. Truman, he said, Democrats favored a single-payer system. The current approach is closer to what President Nixon proposed before Watergate sidelined his plans. He called for universal coverage through a combination of government and employer-based insurance.

Starr said he had only begun to read the 2,074-page Senate bill. He was impressed that it calls for Congress to buy insurance, along with individuals and small-business employees, through the new insurance exchanges.

His biggest concern is with the timetables of the two bills. Most of the House version does not go into effect until 2013. In a move meant to reduce costs, the Senate bill waits until 2014.

"To me, this is a huge mistake," Starr said.

While some important provisions that would affect coverage for young adults and people who cannot buy insurance because of health problems take effect earlier, "most of the uninsured will not get coverage from the Senate bill for more than four years."

That leaves Democrats with a political problem - few results to show voters during 2010 congressional elections and the 2012 presidential election.

"That's asking for a lot of patience from voters," Starr said. The consequence could be lost elections and even a repeal of the bill.

He thinks the bill should take effect by Jan. 1, 2012.