WASHINGTON – There are 18 states, as columnist Mark Shields recently pointed out to me, that have gone Democratic in each of the last five presidential elections. Of the 36 senators who represent those states, only two are Republicans. Both are from Maine, one of the last, storm-lashed, surf-pounded footholds of the Yankee GOP. So it is hardly shocking that the lone Republican supporter of Democratic health reform on the Senate Finance Committee should be Maine’s Olympia Snowe.

Snowe has taken a beating in the conservative media as part of the “turncoat caucus” and for being a RINO – Republican in Name Only. But such criticism fails to take a syllogism into account. The GOP can’t be a national party without winning in the Northeast; Republicans can’t win in the Northeast without ideological heretics; therefore, the GOP will not be a national party without ideological heretics.

As heretics go, Snowe is a serious and principled one. Gaining her vote in committee was a genuine achievement for the administration. But recall that President Bill Clinton got three Republican votes on the Senate Finance Committee for his health reform bill in 1994 – little good that it did him. And some Democrats rightly fear the central role that Snowe has taken. If the bill she supported in committee is modified to secure liberal support among Senate Democrats, it is possible that Snowe will make a damaging vote against the final bill. “Getting her vote and then losing it later,” argues Noam Scheiber of The New Republic, “is pretty much the only way health reform dies this year.”

Snowe’s vote applies a thin veneer of bipartisanship on health reform, but it does not indicate broader Republican momentum. She did not bring any Republican colleagues along with her, and her main argument – that the bill is flawed, but better than nothing – is not likely to begin a rush. Non-Maine Republicans object to the Senate Finance bill for three substantive reasons that will be difficult to address without fundamentally changing the direction of reform.

First, it will make the average insurance plan more expensive. This cost will be offset for many Americans by government subsidies. But subsidies don’t cover everyone, and they don’t come from the subsidy godmother. They are funded mainly by taxes and future cuts in Medicare. Many in the middle class will see the total cost of their health coverage increase.

Second, while Democratic reform does expand health care access, it does little to address the issue of cost inflation – one of the main justifications for reform in the first place. The Congressional Budget Office estimates that health costs under this new entitlement program will grow at about 8 percent a year – higher than the growth of the economy or of government revenues.

Third, the Medicare cuts assumed by the Finance Committee are dishonest. A future Congress is required to display remarkable, politically suicidal heroism – to impose a 25 percent cut in Medicare reimbursements to doctors in 2011 – which everyone, literally everyone, knows will not happen. Senate Majority Leader Harry Reid admitted as much last week by proposing to pour $240 billion into Medicare to protect doctors from massive cuts – new spending simply added to the deficit. It was a confession that health reform, when facts are faced on Medicaid, will actually cost more than a trillion dollars and add to the deficit that President Obama has already tripled.

Critics of all things Republican insist that these objections are merely a cover for politics – that the GOP has decided to defeat Obama, no matter what the content of his health reforms. But concerns about America adopting the fiscal practices of a banana republic are not merely an excuse, they are a wave. And it is not cynical for Republicans to recognize the ideological stakes that Obama has raised. The passage of a massive health entitlement would change the relationship of Americans to their government.

On the evidence of nations such as England, a national health system places a conservative party at a permanent ideological disadvantage. Every proposal for tax reductions is attacked as undermining the eternally hungry public health system. Every failure of that system becomes an excuse for greater spending and government involvement. The tide of government grows, and the ebb weakens, until no one can fight the flood.

This is the main explanation for Republican resistance to Democratic health reform – and the reason that Sen. Snowe is likely to remain a lonely heretic.

© 2009, Washington Post Writers Group