Here is the ultimate paradox of the Great Health Care Showdown: Congress will divide along partisan lines to pass a Republican version of health care reform, and Republicans will vote against it.

Yes, Democrats have rallied behind a bill that Republicans — or at least large numbers of them — should love. It is built on a series of principles that Republicans espoused for years.

Republicans have said that they do not want to destroy the private insurance market. This bill not only preserves that market but strengthens it by bringing in millions of new customers. The plan before Congress does not call for a government “takeover” of health care. It provides subsidies so more people can buy private insurance.

Republicans always say they are against “socialized medicine.” Not only is this bill nothing like a “single-payer” health system along Canadian or British lines. It doesn’t even include the “public option” that would have allowed people voluntarily to buy their insurance from the government. The single-payer idea fell by the wayside long ago, and supporters of the public option — sadly, from my point of view — lost out last December.

They’ll be back, of course. The newly pragmatic Rep. Dennis Kucinich was right to say that this is just the first step in a long process. We will see if this market-based system works. If it doesn’t, single-payer plans and public options will look more attractive.

Republican reform advocates have long called for a better insurance market. Our current system provides individuals with little market power in the purchase of health insurance. As a result, they typically pay exorbitant premiums. The new insurance exchanges will pool individuals together and give them a fighting chance at a fair shake.

Republicans now say they hate the mandate that requires everyone to buy insurance. But an individual mandate was hailed as a form of “personal responsibility” by no less a conservative Republican than Mitt Romney. He was proud of the mandate, and also proud of the insurance exchange idea, known in Massachusetts as “The Health Connector” (the idea itself came from the conservative Heritage Foundation). Romney had a right to be proud. As governor of Massachusetts in 2006, he signed a bill that is the closest thing there is to a model for what the Democrats are proposing.

Don’t believe me on this? On The Wall Street Journal’s opinion page earlier this week, Grace-Marie Turner — criticizing Romney from the right, it should be said — noted the startling similarities between the plan he approved and the one President Obama is fighting for.

“Both have an individual mandate requiring most residents to have health insurance or pay a penalty,” she wrote. “Most businesses are required to participate or pay a fine. Both rely on government-designed purchasing exchanges that also provide a platform to control private health insurance. Many of the uninsured are covered through Medicaid expansion and others receive subsidies for highly prescriptive policies. And the apparatus requires a plethora of new government boards and agencies.”

She added: “While it’s true that the liberal Massachusetts Legislature did turn Mr. Romney’s plan to the left, his claims that his plan is ‘entirely different’ will not stand up to the intense scrutiny of a presidential campaign, especially a primary challenge.”

What does it tell us that Republicans are now opposing a bill rooted in so many of their own principles? Why has it fallen to Democrats to push the thing through?

The obvious lesson is that the balance of opinion in the Republican Party has swung far to the right of where it used to be. Republicans once believed in market-based government solutions. Now they are suspicious of government solutions altogether. That’s true even in an area such as health care where government, through Medicare and Medicaid, already plays a necessarily large role.

As for the Democrats, they have been both pragmatic and moderate, despite all the claims that this plan is “left wing” or “socialist.” It is neither.

You could argue that Democrats have learned from Republicans. Some might say that Democrats have been less than true to their principles.

But there is a simpler conclusion: Democrats, including President Obama, are so anxious to get everyone health insurance that they are more than willing to try a market-based system and hope it works. It’s a shame the Republicans can no longer take “yes” for an answer.

E.J. Dionne’s e-mail address is ejdionne(at)

© 2010, Washington Post Writers Group

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