The last time health care was repealed

The drive to “repeal and replace” the newly enacted health care-reform law has already bumped into a bit of Beltway conventional wisdom: Entitlements are never repealed. Even if Republicans somehow summoned the political will to try, they would first need to win the presidency and a filibuster-proof majority in the U.S. Senate.

That would be a tall order, to be sure. And no one should underestimate the difficulty of reversing what Washington has wrought—in a welfare state, the ratchet effect usually works only one way. But those who say it has never been done before are forgetting about the Medicare Catastrophic Coverage Act of 1988.

Unlike President Obama’s recent health care handiwork, the 1988 law was a genuinely bipartisan achievement passed by lopsided margins. It was signed into law by a Republican president, Ronald Reagan. It offered all kinds of new benefits, including expanded coverage of hospital stays, at-home care, and prescription drugs (the act was in some respects of a forerunner of Medicare Part D).

The Medicare Catastrophic Coverage Act was nevertheless repealed a year later. No change in partisan control of Washington was necessary—the repeal was passed by a Democratic Congress and signed into law by another Republican president, George H.W. Bush. The repeal turned out to be most popular with the elderly voters who had demanded the new benefits in the first place.

Why? In addition to creating new benefits, the reform also imposed staggering new costs. Those costs fell most heavily on the senior citizens who were supposed to be the program’s biggest constituency. But, congressional Democrats were astonished to learn, many of these seniors were happy with their existing coverage and resented having to pay a new tax to fund this expansion of government—costs which kicked in before many of the benefits.

Sound familiar? The similarities don’t end there. Members of Congress also had to hear from angry mobs opposed to the legislation, otherwise known as their constituents. The most memorable such incident occurred on Aug. 17, 1989, when House Ways and Means Chairman Dan Rostenkowski (D-Ill.) held a meeting in his district to sell seniors on the benefits of the catastrophic coverage act.

Instead of being won over by their powerful congressman, the angry seniors waved protest signs and ran him out of the room. As Rostenkowski fled, they shouted “coward,” “recall,” and “impeach.” One elderly woman wearing heart-shaped glasses even threw herself on the hood of Rostenkowski’s car to keep him from leaving.

Rostenkowski got out of the car and tried to escape on foot. The crowd chased him for about a block before his driver came to whisk him away. Imagine what would be said if the Tea Party movement did something like that. Instead the protest was organized by one Jan Schakowsky, then director of the Illinois State Council of Senior Citizens, now a Democratic congresswoman and chief deputy whip for House Speaker Nancy Pelosi.

The protest made the national news and graced the front pages of newspapers. It also had its desired affect—the catastrophic coverage act was repealed within three months. Not everyone who opposed Medicare expansion was particularly principled or even well informed. Health care scholar David Hyman quoted a reporter as saying at the time, “the elderly are not against the new benefits—unlimited hospital care, new at-home benefits, prescription drug coverage; they just don’t want to pay for them.”