Arguments that the ACA is fundamentally a “Republican” proposal have three potential ways to go. One is to argue that the ACA was based on the Heritage plan for health care reform. This plan does quite accurately reflect Republican priorities on health care, which makes the argument self-refuting given the massive dissimilarities between the Heritage Plan and the ACA. The second avenue is to conflate the Heritage plan with the plan passed by massive supermajorities of liberal Massachusetts Democrats over Mitt Romney’s multiple vetoes, which has the advantage of discussing a plan that’s fairly similar to the ACA but the disadvantage that it’s not a “Republican plan” in any meaningful sense.
The third avenue, which has come up a lot in various online fora since I didn’t explicitly discuss it in my recent TAP piece, is John Chafee’s 1993 proposal, which briefly became the Potemkin Republican health care “plan” until the failure of Clinton’s proposal relieved congressional Republicans of having to pretend to care about the uninsured. The plan, while dissimilar from the ACA in crucial ways, is at least more similar to the ACA than the Heritage Plan. But to call it a “Republican plan” is to be completely blind to the historical context of its proposal. As I said yesterday, it’s as much a “Republican” proposal as Chafee’s proposed federal handgun ban.
First, on the substantive point, it won’t fly to just yadda-yadda the lack of a Medicaid expansion in the Chafee proposal, particularly if your point in bringing up the Potemkin conter-offer is that Obama could have obtained a far better bill if he wasn’t blinded by his love of free markets. Not only did the ACA greatly increase federal intervention into the private health insurance market, it contained a historic expansion of the single-payer system that covers America’s most vulnerable citizens. This isn’t some minor difference of detail; it reflects the major differences between Democrats and even moderate Republicans.
This crucial substantive difference makes it all the more remarkable that Chafee’s plan had, for all intents and purposes, no Republican support in 1993. It’s true that, nominally, the proposal had the co-sponsorship of the Senate minority leader and a couple actual conservatives (most notably, Bennett and Hatch.) But, as everyone should know by now, these co-sponsorships did not indicate any substantive support of the bill. This isn’t speculation; we know as a fact that Dole’s “support” of the bill was part of a conscious strategy to stop any reform from happening. Some Republicans pretended to support the proposal because it’s a lot easier to justify obstructionism if you have a nominal alternative you can sadly declare Clinton wouldn’t embrace, so the co-sponsorships do not reflect any substantive support for the proposal. As the behavior of actually existing congressional Republicans from 1995-2006 makes particularly clear, Chafee’s proposal had no real Republican support. No powerful faction of Republicans made the slightest effort to pass it. Nothing like it was ever on George W. Bush’s agenda. To portray the cynical ploy as a “Republican proposal” at this late date would suggest that your information is very valuable to telemarketers. Cons don’t get much more straightforward.
Now, it may well be true that Chafee himself sincerely supported his proposal on the merits. But since Chafee would, even in 1993, not have been particularly conservative for a Democratic senator, it’s beyond ludicrous to suggest that his views define the “Republican” position on health care reform. To do so would be akin to citing John Paul Stevens or David Souter as defining “Republican” principles of constitutional law. To attack Democratic-appointed judges because they joined a Stevens opinion would be absurd, and even leaving aside the fact that the ACA is considerably more progressive than Chafee’s proposal it’s no less absurd to attack the ACA as a sellout because a Republican who was a massive outlier in his conference even two decades ago favored what could be a called a (substantially more conservative) version of it.
While the Republican Party has gotten even worse, the idea that the Republican Party of 1993 was a responsible player that was committed to health care reform (if a vision somewhat more conservative than the ACA) is the purest Broderite nonsense. I’ve said it before and I’ll probably be compelled to say it again: the Republican offer to the uninsured in 1993 is exactly the same as the one in 2010 — nothing. The ACA was not based on a “Republican proposal” that had the support of a non-trivial number of Republicans. Can we please stop pretending otherwise?