What began as a civil discussion of health care reform last spring among Republicans, Democrats, industry and consumer groups has deteriorated into a loud and fractious national argument. Today the issue is deeply dividing Americans, largely along partisan lines, with Republicans relentlessly attacking Democratic reform bills now in Congress, and Democrats defending the proposals.

The attacks have made it easy to see what reforms Republicans don’t like and won’t support.

They don’t want a government-run insurance option to help cover uninsured Americans. Many don’t like the idea of making employers offer health insurance or else pay a penalty. And they don’t like a provision that would require Medicare to pay doctors for the time they spent with their patients who wanted to talk through end-of-life decisions like living wills.

What then do Republicans like and want?

Democrats control the White House and hold big majorities in both the House and Senate, so not much attention has been paid to Republican health care reform proposals. In fact, GOP lawmakers haven’t pushed hard for their own legislation—though several have introduced reform bills. And they haven’t spoken with a unified voice or clearly articulated their vision of an improved American health care system.

But many do agree on some ingredients of reform— including tax breaks to encourage people to buy health coverage and the need to rein in medical malpractice suits.

“We’ve lacked the megaphone because there’s this perception health care belongs to one party,” says Dennis G. Smith, senior fellow in health care reform at the conservative think tank the Heritage Foundation. “There are a lot of conservatives who have lots of good ideas about health care.”

Many Republicans and conservatives agree that the reforms proposed by congressional Democrats and President Obama just aren’t necessary. House Democrats have backed the idea of a government-run insurance option that they say would compete with private insurers and help bring down premiums for consumers. Republicans see the public option as a government takeover of the private health insurance system, and contend that a government-run plan would eventually drive private insurance firms of business.

Unity is missing

While Republicans appear united against the public plan, that unanimity doesn’t extend to what should be done to cover people with no insurance or to slow skyrocketing health care costs for consumers, business and government.

Phil Kerpen, policy director for the free-market think tank Americans for Prosperity, says Republican solidarity is hampered because the GOP is now the minority party in Congress. “Part of being out of power,” he says, “is you don’t really speak with one voice because you don’t have the burden of legislating. Each congressman goes with what he feels is best.”

True, Republicans have introduced various reform bills in both Houses. And the Republican National Committee on Monday issued what it called a “Seniors’ Health Care Bill of Rights.”

But many Democrats accuse the GOP of playing politics, pure and simple.

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