Peter Suderman on Why the GOP Can't Win on Health Care
In anticipation of the Supreme Court's big health care ruling in King v. Burwell, I've got a piece in Politico Magazine today looking at the GOP's history of being about to have an Obamacare replacement plan already…but never quite having one ready. Here's a bit from the middle of the piece that goes all the way back to the 1990s:
The GOP's failure to engage proactively with health policy has become more apparent in the Obama era, as the Affordable Care Act has taken hold, but it goes back long before that. Its modern incarnation arguably starts with the collapse of the Clinton health care plan in the early 90s.
What Republicans learned from the defeat of the Clinton plan was that they could win health care debates by refusing to provide an alternative. An enormously influential 1993 memo from Bill Kristol cautioned Republicans to avoid the temptation to "[help] the president 'do something'" on health care, which would only lend credence to the Democratic idea that the system was broken. Instead, Kristol advised Republicans to question reforms that would upset a system with which a majority of the middle class was already satisfied, and to concentrate on tweaking the system as it already existed.
The result was that many Republicans in Congress walked away under the impression that the American health care system was largely fine, and that doing something to significantly redirect it would only serve the other party's interests. And so in the decade and a half after the collapse of the Clinton plan, Republicans, on the whole, were largely content to ignore health policy.
Democrats, in contrast, used the time between the demise of the Clinton plan and the election of Barack Obama to regroup and rebuild, with a focus on overcoming the specific challenges that doomed the 1993 effort. The Congressional Budget Office (CBO) scored the Clinton plan as an increase in the near-term deficit, with health premiums counted as government spending, so Democrats, starting with Sen. Ron Wyden, worked with the CBO to craft legislation that the CBO could score as deficit neutral, and premiums kept off the government tabs. The Clinton plan was widely criticized for causing people to lose their doctors and health care plans, so Democrats worked out legislation that President Obama could plausibly—if not, it turns out, accurately—promise would allow anyone who wanted to keep their current plan to do so. The Clinton plan was assailed by a mountain of industry funded ads opposing the proposal, so one of the first orders of business in crafting Obamacare was to negotiate support from doctors, hospitals and health insurers.
Planning for what would eventually become the Affordable Care Act begun not only prior to President Obama taking office but before he even won the nomination. As John McDonough, an influential health policy adviser to former Democratic Sen. Edward Kennedy, notes in his 2011 book Inside National Health Reform, the effort began in earnest in April, 2008, when a group of forty-some veteran health wonks, most of whom had worked on the Clinton health plan in the early 1990s, met in Saint Paul, Minnesota to discuss the prospects for overhauling the health care system. Not everyone was sure that it would succeed, but, importantly, all three Democratic presidential candidates had "produced similar reform plans." The party had settled on a unified vision, and had even managed a general agreement about the particulars.
Obamacare, in other words, was ClintonCare's second act—the culmination of more than 15 years of work and consensus building. To put it another way: Republicans never started working on health policy; Democrats never stopped.
