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No, Bob Dole and Newt Gingrich Didn’t Support Any Kind of Health Care Reform

[ 113 ] January 8, 2014 |

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?

Comments (113)

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  1. mpowell says:

    I don’t know how effective your efforts will be Scott, but I think you’re doing important work here.

    • The Tragically Flip says:

      +1

      • Dilan Esper says:

        I honestly don’t understand what the “efforts” or the “important work” here is.

        Obamacare is law. The Republicans do not have the votes to repeal it. It is going to be given a chance to work. (Indeed, if I were advising the Republicans, I would very sincerely tell them to knock off the knee-jerk opposition. Unless the thing fails on a national level (which, if it is going to happen, will happen no matter what the Republicans do, and if it won’t happen, won’t happen no matter what they do too), it is going to be the baseline for American health care policy and they are going to need to start thinking about what changes they would want to make to it.

        And the history of Obamacare is both complicated and basically irrelevant.

        There will be a bunch of fights down the road when Republicans want to seriously amend this thing, and also when liberals and the left decide they want to push it in other directions. At that point, Scott can decide what side he wants to be on.

        But 500 posts on how the Republicans really never had a thing to do with Obamacare? He doth protest too much, and for no reason at all. He’s the Ahab of health care reform.

        • Scott Lemieux says:

          Yes, I doth protest too much.

        • Bijan Parsia says:

          And your 500 comments on these posts?

          Seriously, I don’t understand what implications we’re supposed to draw from volume, but it’s hard to see how they aren’t equally applicable.

          (For the record, I comment on these when 1) I feel prompted to learn something new or 2) I react or 3) I find it entertaining to do so. 3 is often interacting with 2.)

        • Self-Parody Awards, 2013 says:

          But 500 posts on how the Republicans really never had a thing to do with Obamacare? He doth protest too much, and for no reason at all.

          This comment is funny, because Dilan not only never objected to any of the twelve million “Obamacare is the Heritage Plan” posts across the internet over the past four years, but has devoted probably hundreds of hours of his life over that time period making that argument.

    • jim, some guy in iowa says:

      it’s kind of sad, though, that he has to spend so much time doing ‘whack-a-mole’ posts. just seems like people ought to accept that what they thought could happen didn’t, and move on. we have lots of things to worry about

      • jim, some guy in iowa says:

        or, in the words of a certain Canadian band, “you can’t be fond of living in the past, ’cause if you are there’s no way that you’re gonna last”

    • James E. Powell says:

      Once you are done with this, can you apply the same clear-minded effort to the question of whether Clinton banned Casey from speaking at the 1992 convention because he was pro-life?

      All this makes for interesting reading for wonks, but who among the great mass of American voters cares where Obamacare, aka the end of America as we know it, came from?

      • Hogan says:

        Once you are done with this, can you apply the same clear-minded effort to the question of whether Clinton banned Casey from speaking at the 1992 convention because he was pro-life?

        Is that still a thing?

        • Scott Lemieux says:

          I used to be a Democrat, but when someone who wanted to give a speech repudiating a fundamental part of the Democratic Party platform wasn’t permitted to speak at the Democratic convention, I became a Republican, where speakers routinely speak in defense of upper-class tax increases.

        • IM says:

          five years ago or so it still popped up regularly in the Wapo.

  2. joe from Lowell says:

    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.

    This really does overstate things. Romney didn’t veto the whole thing, even once. He was centrally involved in the negotiations that created the overall structure, and vetoed elements that ranged from peripheral to significant but not central.

    Mittens really does deserve significant credit for the Massachusetts health care plan. He put together the process that produced it, negotiated in good faith to actually make it happen, and – and this last part is why my observations don’t refute Scott’s core thesis – was sufficiently reality-based to accede to what was a fundamentally Democratic plan (albeit one that represented a compromise solution).

  3. The Tragically Flip says:

    You could add that in 2002-2006, for the first time since 1928, Republicans controlled the House, the Senate and the Presidency.

    The only health reform they did was Medicare Part D. That took a massive uplift lift by the leadership to keep the rank and file in line so Bush could keep his “compassionate conservative” election promise to a very important voting bloc.

    After the 2004 election, returned with solid majorities, the GOP priority was….privatizing Social Security.

    Not to mention the dozens of States which have had Republican trifectas at some point since 1993 have had opportunities to do some kind of health reform.

    Republicans have had their chance to solve the mass uninsured problem and done nothing about it. I agree, they have no plan and any plan any Republican or Conservative ever proposed was only a disingenuous foil to justify rejecting any real proposal with any chance of passing.

    • cpinva says:

      “The only health reform they did was Medicare Part D. That took a massive uplift lift by the leadership to keep the rank and file in line so Bush could keep his “compassionate conservative” election promise to a very important voting bloc.”

      and they conveniently, as part of that “compassionate conservatism”, allocated no funds to pay for it, and denied medicare the ability to negotiate prices with big pharma, based on their huge segment of the market.

    • Theophrastus Bombastus von Hoenhenheim den Sidste says:

      As a small coda, just this afternoon I came across a Republican squealing that GOVERNMENT SPENDING ON PART D COSTS THE TAXPAYER A TRILLION DOLLARS A YEAR!!!!!

      Which is of course absurd but it does illustrate the point that no good deed goes unpunished.

  4. Denverite says:

    it contained a historic expansion of the single-payer system that covers America’s most vulnerable citizens

    This point can’t be emphasized enough. And it’s not just that it made a bigger number of people eligible, it changed the fundamental nature of the program. Prior to the ACA, in most states, Medcaid was a categorical eligibility program — meaning that in order to be eligible, you had to fall in a group deemed to be especially vulnerable. This usually meant that Medicaid was limited to the elderly, blind, disabled, and children (and in many states, their families). If you hear someone in the Medicaid field say “EBD” or “EBD plus kids,” that’s what they’re referring to. If you weren’t in one of those groups, you were out of luck, no matter how poor you were.

    The ACA changed that. Now, in the states who didn’t opt out of expansion (and I think that eventually almost all states will expand — there’s just so much federal money involved, and the provider industry has a very powerful lobby), the poor and near poor are eligible just by virtue of their socioeconomic status. That’s enormous.

    • Pat says:

      Absolutely. I know people in red states who can apply for Medicaid now, because before, owning a house disqualified them from applying. Now, it’s strictly based on your income level. Before, if you owned anything worth more than $1000, no Medicaid. So you couldn’t have a house, a decent car, or a job. You had to be fundamentally destitute before the state would consider helping you.

    • RS22 says:

      Yep. I had a legal aid client who had contingent eligibility based on the Medicaid “spend down” regulations (if your medical bills reduce your income to below the eligibility threshold, you can get some assistance). She was an incredibly patient woman, but it was an administrative nightmare trying to work through the rules. Based on the changes in the law, I expect that she is now fully eligible for Medicaid. It’s a big deal and it matters quite a bit to some of our most vulnerable — Being poor sucks, and being sick sucks. Being both is awful.

      Generally speaking, there is a lot of ignorance about how eligibility for means-tested programs operate. People have described Medicaid and TANF as programs “for the poor,” when they were only for some of the poor. If you’re a childless, you’re pretty much on your own.

    • +1

      Precisely what I’ve been arguing for three plus years.

    • wengler says:

      (and I think that eventually almost all states will expand — there’s just so much federal money involved, and the provider industry has a very powerful lobby)

      No they won’t. The Republicans don’t care about the people that will be covered by the Medicaid expansion. They won’t opt in. They want Obamacare to fail worse than anything in human history. If it means their hospitals will close, so be it. The ones in the rich areas will stay open.

      • Pat says:

        At some point, we have to expect that the business lobby’s patience will become exhausted with the Republican jihadists. The business lobby is spending hundreds of millions of dollars and achieving nothing. The Republican jihadists won’t stop doing what they’re doing, but business guys have got to make a living.

        The question is when, not if, the business guys either join up with Democrats or have the jihadists “out of the picture”. If hospitals close there will be hell to pay.

      • Denverite says:

        Eh. Republicans may always oppose the ACA on principle, but at some point it’s going to fade away as their biggest concern. Then they’re going to realize that almost all of the huge pile of federal money sitting out there is going to end up in providers’ pockets if they expand.

        I know for a fact that a lot of health care lobbying groups are salivating at the huge pool of potential Medicaid recipients in the opt out states (keep in mind that Medicaid rates have been jacked up to entice providers to participate). They don’t feel like they can be effective now because the issue is so toxic among Republicans, but think that it will be much less of a hot button issue in 2015 or 2016.

  5. joe from Lowell says:

    The proposal some Republicans pretended to support 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.

    I think Dole, though not Gingrich, would have been willing to not just waive around the Chaffee bill, but actually pass it if the alternative was the passage of Hillarycare. In the same sense that I’d be willing to give a robber my wallet if he’s holding a gun on me.

    That still doesn’t get us anywhere near actual support for the plan, though.

  6. efgoldman says:

    Shorter Scott: Enough is enough! I have had it with all these mthrfcking green lanterns on this mthrfcking blog!

    [agree 100%]

  7. Pat says:

    Let’s also point out that Chafee is now an Indie, having no place anymore in his father’s Republican party…..

  8. Naught says:

    Another potential candidate for the fabled GOP precursor to the ACA:

    The Steinmo and Watts paper linked in the TAP article makes clear that Nixon and Ford both were quite eager, post-Watergate, to support a universal health insurance bill. I gather their proposals were basically employer mandate systems. However, it’s clear that they would have passed them with mainly Democratic support. And it’s not as though either ran on health care reform.

    • rea says:

      makes clear that Nixon and Ford both were quite eager, post-Watergate, to support a universal health insurance bill.

      Permit me to doubt, given that they didn’t support any such bill.

      • Scott Lemieux says:

        Right. This disconnect comes up in comments every once in a while. Allegedly, 1)Nixon was to Obama’s left, 2)this was a golden age in which the Democratic Party was far better than today’s, but 3)oddly, no health care reform ever passed. Strange when everybody favored it!

    • David W. says:

      Well, duh:

      Like the rest of the world, the US is an ageing society (Table 1). Between 2000 and 2050, the number of older people is projected to increase by 135%. Moreover, the population aged 85 and over, which is the group most likely to need health and long-term care services, is projected to increase by 350%. Over this time period, the proportion of the population that is over the age of 65 will increase from 12.7% in 2000 to 20.3% in 2050; the proportion of the population that is age 85 and older will increase from 1.6% in 2000 to 4.8% in 2050.

      • gman says:

        A demographic trend that has been obvious for decades is hardly good explanation of a 125% run up in an industry in the last 5 years.

        Both the Right and Scott are trying to make this plan out to be some altruistic Social Democratic nirvana..the share prices are acting like it is just another corporate give away!

        Some crumbs are thrown to the masses but lets not say this is as good a “socialized medicine” would be.

    • Greg says:

      Reducing the stock prices of health care companies is not a goal of health care policy.

    • Hogan says:

      It doesn’t occur to you that the week in which the premiums for all the new PPACA enrollments are collected and none of the new claims have been paid out might not be representative of the entire year? Please join my weekly poker game. First beer is on me.

  9. JazzBumpa says:

    Can we please stop pretending otherwise? </blockquote

    While there is no doubt some pretending going on, many of us believed the ACA to Heritage near equivalence in all honest ignorance.

    I, for one, was quite surprised to learn otherwise.

    And, since this horse is far from dead, it might be necessary to continue the beatings.

  10. steve says:

    I think it is more that the old heritage plan had a mandate and the mandate was the thing the conservatives opportunistically jumped on and rode to Supreme Court failure.

    It seems fine to say, “Well, even the Heritage plan had a mandate so it is a bit odd that you object to that mechanism in particular but are publically in support of keeping with all the other things, i.e. the more leftwing additions you’d presumably object to on an idological level but are immensely popular. It’s almost like you are trying to opportunistically kill the ACA while appearing to support thing people like.”

  11. mds says:

    Some Republicans pretended to support the proposal because it’s a lot easier to justify obstructionism if you have a nominal alternative

    Emphasis added for purposes of forthcoming pedantry. I would suggest that the tense should be “it was.” The present-day Congressional GOP apparently find it effortless to justify obstructionism for virtually everything without offering alternatives, and I’ve yet to see any sign that they’ll pay a significant political price for it.

  12. wengler says:

    The problem with Obamacare is that those that aren’t covered by so-called ‘universal’ healthcare are probably in a worse-off position than before. The vast majority of these will be in Republican opt-out states, where their governors have decided that thousands of state residents should die because the GOP hates Obama.

    If your whole point is that Obamacare is different than the GOP healthcare option then point taken. The Republicans haven’t had a healthcare policy other than ‘fuck off and die and don’t make me pay for it’ for the past two decades.

    • Pat says:

      There are most certainly problems with Obamacare. Another real issue deals with people who are offered insurance for their families through their work, but are not paid sufficient wages to be able to afford it. Those people aren’t eligible for any subsidies.

      If the whole of the government was interested in improving the law to benefit more people, then these issues would be brought up and dealt with accordingly. But things are kind of dysfunctional right now.

    • NonyNony says:

      And of course the original ACA legislation included the ability for states to opt-out as part of its passage, which is another way that Democrats sold us all out.

      Oh wait – no it didn’t. The opt-out part of the ACA came about because of an unprecedented SCOTUS ruling that wasn’t part of the original formulation of the law at all. Had anyone suspected that the SCOUTS would undermine the Medicaid expansion in the way they did, I suspect that the legislation would have been crafted to mitigate against them.

      • Mike says:

        “Had anyone suspected that the SCOTUS would undermine the Medicaid expansion in the way they did, I suspect that the legislation would have been crafted to mitigate against them.”

        That’s kinda hard to believe, given that the president was a professor of constitutional law and that his administration is entirely run by very experienced lawyers. The more likely explanation is that Obama and his buddies knew perfectly well what the Supreme Court would do, and were quite happy with it. I would go so far as to bet that they deliberately crafted the bill in such a way that they knew the court would do that, and that that was their intention all along. Never underestimate the mendacity of a lawyer, much less a whole cabal of them.

        • Bijan Parsia says:

          That’s kinda hard to believe

          Only for someone who is conspiracy minded, hates Obama irrationally, and was completely unaware of the history of the case.

        • Ralph Wiggum says:

          You appear to be under the illusion that the Roberts Court’s decisions have any kind of consistency or respect for precedent.

        • Scott Lemieux says:

          I would go so far as to bet that they deliberately crafted the bill in such a way that they knew the court would do that

          How exactly could the Supreme Court decision have been avoided? Not do the Medicaid expansion at all?

        • rea says:

          Yeah, very obviously an adjunct con law instructor (Obama was never a professor) ought to have anticipated that the Supreme Court would do something completely contrary to all relevant precedent.

        • joe from Lowell says:

          The more likely explanation is that Obama and his buddies knew perfectly well what the Supreme Court would do, and were quite happy with it.

          Given the radical departure from precedent that the ruling represented, no not really.

          Don’t you remember the Supreme Court case at all? Everyone thought they were going to strike down the individual mandate, while the ruling against the Medicaid expansion came out of left field.

  13. Weldon Berger says:

    Republicans have been touting market-based solutions to health care access woes since at least Nixon’s time. This has meant making insurance companies central to any expansion of access. That’s what Nixon’s plan called for, that’s what Chafee’s 1993 plan called for, and that’s what Obamacare does. You’re arguing that because Chafee adopted a Republican approach, and Chafee was much less conservative than most Republicans, then the Republican approach can no longer be considered Republican because it is contaminated with liberal Chafee cooties. But it would be a Republican approach even if Gus Hall had proposed it.

    Both the Chafee and Obamacare plans included provision for marketplaces where insurers would compete for customers — again, a staple of the Republican market-based approach — and both included the individual mandate. Being as this is in fact not Switzerland or Germany, it is quite reasonable to call the individual mandate in the US a Republican proposal; it was introduced here by Republicans and rejected by most then-contemporary Democrats.

    So you have three core elements of the program — expanding and subsidizing the central role of private insurers, creating regional marketplaces for the insurers and requiring the purchase of their products — in both plans, and all are Republican in origin. That the poles have flipped and most professional Republicans now reject the principles and many professional Democrats embrace them doesn’t change the origins.

    Medicaid has been increasingly privatized since the 1980s. That too is a Republican initiative, one that began under Reagan, continued during the Clinton years and accelerated under the most recent Bush administration. At least 28 states are now using Medicaid funds to pay for-profit managed care organizations to run their Medicaid systems in whole or part.

    Obamacare does nothing to discourage this. In fact, the administration recently granted Arkansas a waiver to steer newly eligible Medicaid recipients into subsidized private insurance plans offered on the exchange there, thereby treating them exactly as the Nixon and Chafee plans proposed to do. One can expect that the states which rejected the expansion will be looking to the Arkansas model when they finally accept it, and that some states which accepted the expansion will follow suit as well.

    You can argue, then, that the Medicaid expansion is more progressive than the Republican plan of simply subsidizing private insurance for low-income people ineligible for Medicaid — as Arkansas is now doing with Medicaid funds courtesy of that waiver from the administration — but you can’t seriously argue that it is a great leap forward in single-payer. Or at least you can’t expect to be taken seriously when you do argue it.

    You’re right in saying that these Republican market-based plans were proposed to forestall the adoption of actual progressive plans. Obamacare is a market-based plan that imposes more progressive regulations upon the insurance industry than previous market-based proposals. That doesn’t make it a progressive plan; just less conservative than the Republican market-based proposals upon which it is based.

    (Your wording on the eight Romney vetoes really is deceptive. It suggests that he was opposed to the legislation overall and vetoed the entire package eight times, when these were line-item vetoes of measures that weren’t central to the bill. One of the vetoes would have stripped out dental benefits for adult Medicaid recipients, something Obamacare doesn’t mandate and most states don’t offer. Another would have killed the employer mandate, which the Obama administration has itself delayed for a year.)

    • Malaclypse says:

      these were line-item vetoes of measures that weren’t central to the bill.

      The employer mandate wasn’t central?

    • Scott Lemieux says:

      The central problem with your argument is that it defines any politically viable health care reform — i.e. one that does not involve the nationalization of the insurance industry and/or of health care providers — as inherently “conservative.” But in the actual context of American politics, that doesn’t make any sense, and the Swiss and German systems show there’s nothing inherently conservative by American standards about the idea either.

      The Heritage Foundation proposal was a genuinely conservative one, which is why the dissimilarity between it and the ACA is so instructive, and why you have to fall back on a plan proposed by a liberal Republican that both had no Republican support and was much less progressive than the ACA, and a plan passed by huge supermajorities of Massachusetts Democrats (although, yes, after some attempts to make the bill worse a Republican governor did sign it when it was put on his desk.)

      Whether or not the ACA is progressive in some absolute sense, in the context of American politics it obviously is. And by your standards, progressive change has almost never happened in American politics. Certainly, the New Deal doesn’t count, unless you think substantive compromises with white supremacists are less immoral than compromises with pharmaceutical companies.

      Obamacare is a market-based plan that imposes more progressive regulations upon the insurance industry than previous market-based proposals. That doesn’t make it a progressive plan

      This logic — that a statute that substantially tightens regulations on business without eliminating them is inherently conservative irrespective of the relationship between the regulations and the status quo ante — is simply bizarre. Is the Civil Rights Act “conservative” because it merely regulated employment discrimination rather than outlawing private labor contracts and nationalizing the means of production? The Clean Air Act — mere regulation and signed by a Republican! — is even more conservative than the ACA!

      You’re right in saying that these Republican market-based plans were proposed to forestall the adoption of actual progressive plans.

      I don’t agree that Clinton’s proposal was all that more progressive than the ACA. And by your standards, it was clearly a conservative proposal.

      • Weldon Berger says:

        Political viability is fluid, obviously.

        Yes, I think plans to which for-profit insurers are central, subsidized and mandated are all conservative to one degree or another. Certainly not progressive, not only because of the profit-taking but because of the disparities in access, quality and cost that are baked in. And that does in fact make sense in the context of American politics. You’re just hamstrung by your pointless desire to define Obamacare as progressive.

        Forgive me if you already know this stuff, but German residents don’t have access to products from for-profit insurers in Germany, never mind being compelled to buy from one, unless they make more than about 250% of the median income. (Maybe 20% of the eligible population does so, because for various reasons it’s sort of risky.) Swiss insurers are prohibited from taking a profit on the mandated basic insurance package. Even with that, the German and Swiss systems don’t compare particularly well with the more comprehensive and cost-effective single payer systems in Europe. Much better than ours, of course, and simpler for people to navigate than ours, but not great.

        By my standards, progressive change is relatively common in America. Certainly the New Deal counts, transformative as it was to the relationship between the federal government and the citizenry it is meant to serve. So do a number of the Great Society programs. Medicare, Medicaid, Head Start, the National Environmental Policy Act, the various civil rights initiatives … all progressive, although Medicaid in particular is being steadily subverted, as I mentioned.

        You come up with some weird analogies. Cutting deals with the pharmaceutical industry has little bearing on the degree to which Obamacare is progressive; it’s just one among a host of cost-control issues that will undermine the program. No doubt you’re talking about Social Security in connection with white supremacists, but you’re largely wrong about that as well. If you’re interested in disabusing yourself, you can google “Larry DeWitt” and “Social Security” to start.

        • Scott Lemieux says:

          Political viability is fluid, obviously.

          Indeed, but this is non-responsive. What’s your basis for the belief that it was possible for a single-payer or nationalized health care system to be enacted by Congress in 2010?

          Yes, I think plans to which for-profit insurers are central, subsidized and mandated are all conservative to one degree or another. Certainly not progressive, not only because of the profit-taking but because of the disparities in access, quality and cost that are baked in.

          So any regulatory regime that maintains a market relationship is inherently conservative, even if the baseline alternative is less or no regulation? And even if no actually existing conservatives support it? That’s absolutely bizarre.

          And that does in fact make sense in the context of American politics.

          How? With the exception-that-proves-the-rule of abolishing slavery, what would be the precedent for nationalized heath care? Progressive social policy in the United States has virtually always required accommodating and buying off vested interests.

          I concede that the German program is more progressive than the American one — that’s not in any dispute.


          Certainly the New Deal counts, transformative as it was to the relationship between the federal government and the citizenry it is meant to serve. So do a number of the Great Society programs. Medicare, Medicaid, Head Start, the National Environmental Policy Act, the various civil rights initiatives … all progressive, although Medicaid in particular is being steadily subverted, as I mentioned.

          The fact that you see the creation of Medicaid to be progressive but see an expansion that makes it far broader and more generous as conservative underscores the tendentiousness of your argument. Nor can environmental policy be progressive by your standards, since it consists of mere regulation and not nationalization. (Plus, again, the Clean Air Act was signed by a Republican and hence is doubly conservative.)

          No doubt you’re talking about Social Security in connection with white supremacists, but you’re largely wrong about that as well.

          How? The most salient facts about Social Security in this context are that 1)it was supported by conservative southern Democrats ex ante, and 2)was egregiously racially discriminatory. Now, since I believe in evaluating public policy based on its relationship to the status quo ante and on what’s plausibly viable in a given institutional context, I have no problem seeing Social Security as a major progressive achievement despite this. Since you apparently believe that the relevant standard is European welfare states, you must believe Social Security was a conservative policy.

          • Weldon Berger says:

            Gesundheit!

            Did I say that a single-payer plan could have been passed in 2010? Why no, I don’t believe I did. I have said that in order to have an opportunity to pass it, Democrats would have to press the issue with the same single-mindedness that Republicans press tax cuts and spending cuts. Hammer on something nonstop for a few decades and lo! it becomes part of the conversation. My takeaway is that most institutional Democrats and their fellow travelers don’t care about it.

            Programs can be conservative even when other options are more conservative or reactionary or completely absent, yes. That seems obvious, doesn’t it? Conservative programs can also be improved upon and still be conservative, if less so. You seem to regard “making progress” and “progressive” as interchangeable. You also seem to confuse the nature of a policy with the nature of whoever espouses it at a given moment.

            Precedent for nationalized health care: Medicare, the VA health care system, the active-duty military health care system and Medicaid — although, again, Medicaid suffers from the increasing encroachment of the pirates. At present something like 150 million Americans are covered by our various single-payer programs.

            I explained why the Medicaid expansion overall is not nearly so progressive as you wish it were, and in one instance to date is identical to the Nixon and Chafee proposals. There are other problems with Medicaid as well. I expect you’re as superficially familiar with the actual experience of the program as you were with the Swiss and German models when you cited them in your TAP piece.

            Okay, don’t disabuse yourself about Social Security. That follows.

            In order to believe that I consider nationalization the only measure of “progressive” in every circumstance, you have to believe that I think every issue is identical to health care. Is that what you believe?

            • joe from Lowell says:

              Weldon’s convinced me that food stamps are not a progressive program at all, relying as they do on a market mechanism for the delivery of food.

              A truly progressive program would have nationalized the supermarkets and their suppliers.

              • Scott Lemieux says:

                Also, since food stamps mean more revenue and profts for Wal-Mart, the Republican policy is more progressive. After all, the first-order progressive goal is punishing corporations, not providing important things to the poor. Better millions of people go without health care than an insurance company in Arkansas skim some rents!

                • Weldon Berger says:

                  Dishonesty ins service to your cause is one thing; this is actually outright stupid. Food stamps deliver cash to people to buy food. The Obamacare equivalent would be to deliver cash to people who then have to give it to a broker who takes a cut and tells the participant where to get food and what food he can get.

                • Scott Lemieux says:

                  This is a very convincing rebuttal to the zero people who have argued that food stamps and the ACA are identical in every respect.

                • Brien Jackson says:

                  Um, Food Stamps does not give you cash, they give you a card that can only be used where and for what products administrators say it can be used for.

                  I can’t say I’m terribly surprised you don’t know the damn basics of what Food Stamps actually are.

            • rea says:

              There are, roughly, 800,000 people employed in the health insurance industry. Apparently rendering them all umemployed is “progressive.”

            • Scott Lemieux says:

              Did I say that a single-payer plan could have been passed in 2010? Why no, I don’t believe I did.

              You didn’t say it explicitly, of course. But the only way to see the ACA is “conservative” if it that’s the baseline you’re comparing it to.

              Democrats would have to press the issue with the same single-mindedness that Republicans press tax cuts and spending cuts.

              1)Blaming the “Democratic Party” is at least more technically accurate than blaming Obama, but unless you have a plan for getting social democrats elected in Nebraska, Arkansas, North Dakota, and various other red states whose senators will each have a veto over health care policy, it’s equally useless.

              2)Are you seriously equating upper-class tax cuts and nationalized health insurance as if American political institutions similarly constrain both?

              You also seem to confuse the nature of a policy with the nature of whoever espouses it at a given moment.

              This is much more your focus than mine. Anyway, it seems to me that when deciding whether a policy is progressive, the most important factors (in order) are 1)whether a policy substantially advances progressive goals compared to the status quo, 2)whether the a more progressive policy was plausibly viable, and 3)Who supports it. It is weird that you consider a policy that virtually no American conservative supported either before or after the fact “conservative,” but the ACA isn’t “conservative” on the more important criteria either.

              Precedent for nationalized health care: Medicare, the VA health care system, the active-duty military health care system and Medicaid

              These policies are not, in fact, useful precedents. These policies did not eliminate the American health insurance industry, and provided care for the least profitable potential customers. Medicare for those 65 and over is far, far, far easier lift than Medicare for all, which is why LBJ went in that direction. And, again, I note that you consider Medicaid progressive but greatly expanding it conservative, which would seem to indicate that your primary criterion for determining whether a policy is conservative is whether Barack Obama signed it.

              I explained why the Medicaid expansion overall is not nearly so progressive as you wish it were, and in one instance to date is identical to the Nixon and Chafee proposals.

              I understand your argument that vastly expanding access to Medicaid isn’t progressive because in a single state the expanded access is being accomplished less efficiently than it could be; I just think it’s silly. Also, my TAP piece never said that the ACA was identical to the Swiss and German systems. And, by the way, if the way Arkansas has implemented Medicaid is enough to make the entire expansion conservative (even though it wasn’t caused by the expansion,) what about the fact that under the original, Medicaid could be denied to low-income people who own cars or didn’t have children? That seems rather more important in determining whether a policy is progressive.

              Okay, don’t disabuse yourself about Social Security.

              Sorry, but you’re going to have to do better than that. Are you denying that large numbers of workers, disproportionately African-American, were excluded? Are you denying that Southern Democrats, with that condition, supported it?

              • Weldon Berger says:

                You didn’t say it explicitly, of course. But the only way to see the ACA is “conservative” if it that’s the baseline you’re comparing it to.

                Doesn’t it itch after a while when you keep pulling straw men out your ass?

                Are you seriously equating upper-class tax cuts and nationalized health insurance as if American political institutions similarly constrain both?

                No. Not even unseriously. Not at all. I am saying what I said, which is that Democrats “have to press the issue with the same single-mindedness that Republicans press tax cuts and spending cuts” in order to succeed. Bring it up every year, talk it up, explain the benefits, familiarize people with the concept. This is such a basic political process that you have to be wilfully blind not to recognize the need for it. Even you won’t deny that it hasn’t been done.

                These policies are not, in fact, useful precedents.

                Of course they are. They’re working examples of large scale single-payer systems, some of which are quite popular, which together serve almost half the people in the country. You’re simply being obtuse.

                I note that you consider Medicaid progressive but greatly expanding it conservative …

                You don’t note that; you just made it up, liked the sound of it and keep repeating it. I said that it’s not the progressive triumph you think it is, and I explained why. The issue with the Arkansas waiver is — again — that it transmogrifies the Medicaid expansion into exactly the policy in the Chafee plan that you regard as laughably inferior to the Medicaid expansion.

                Also, my TAP piece never said that the ACA was identical to the Swiss and German systems.

                And neither did I ever say or imply that you said the Swiss and German systems were identical to ACA; just that you were only superficially familiar with them, which I’m sure you’ll agree is true.

                I’ve been addressing your remarks directly, while you’re being increasingly dishonest in your characterizations of what I said and in attributing things to me that I didn’t say. It’s to the point now where you’re conducting both sides of the discussion.

                Sorry, but you’re going to have to do better than that.

                Why no, I’m not.

                • Scott Lemieux says:

                  They’re working examples of large scale single-payer systems, some of which are quite popular, which together serve almost half the people in the country. You’re simply being obtuse.

                  You think programs that minimized opposition by cherry-picking particularly unprofitable classes of customers provide a precedent for the complete nationalization of the health insurance industry, and I’m being obtuse?

                  You don’t note that; you just made it up, liked the sound of it and keep repeating it.

                  You’ve said that the ACA was “conservative.” The massive Medicaid expansion was, in fact, part of the ACA. So I stand by my characterization. Also, correct me if I’m wrong, but in my understanding under the Chafee plan the state would not have been required to cover everyone within 138% of the FPL, regardless of other assets. The Chafee plan did not impose any new coverage requirements — the ACA, even in this worst-case scenario, is much better.

                  And, most importantly, the modified Arkansas Medicaid program was not a result of the design created by the ACA. The funding mechanism created by the ACA would have compelled Arkansas, like the other states, to do a full expansion unless they wanted to forego Medicaid funding entirely. That mechanism, however, was thrown out by the Supreme Court. How this is the fault of the ACA is far from clear.


                  Why no, I’m not.

                  So you’re not willing to even say which of my (uncontroversial) claims about Social Security is wrong, let alone why. A wise choice, since as far as I can tell DeWitt’s account does not conflict with Katznelson’s except by omission.

  14. Incontinentia Buttocks says:

    The Republican offer to the uninsured is to do everything in the GOP’s power to make sure that the uninsured are protected from the scourge of “dependency,” i.e. having insurance,

  15. cpinva says:

    in fairness, it was a republican proposal, simply one with no substance. had it ever actually been called, the entire GOP would have run away, screaming and pulling out their hair.

    • Scott Lemieux says:

      Evidently, it it trivially true that it was a “Republican proposal” in the sense that it was proposed by a nominal Republican. In the context of claims that the ACA sucks because it’s inherently a conservative and Republican proposal, the fact that no conservative Republicans supported it is the more relevant point.

  16. witless chum says:

    It was a Republican proposal, just like “Here Charlie Brown, kick this football” was a Lucy proposal.

  17. LittleDan says:

    Mentioned up-thread, but not really addressed (IMHO): The wording of “passed by massive supermajorities of liberal Massachusetts Democrats over Mitt Romney’s multiple vetoes” still weakens the whole presentation to me. I promise, I am not concern trolling!

    When I read a post or article which attempts to set the record straight on something, and I encounter a statement which really surprises me, and then I do some research and decide that the statement is misleading, it makes me doubt the rest of the post/article. And I really fell that this statement is misleading. And I am not sure why it is being phrased this way, when it could be powerful and informative without being misleading.

    And I want to be clear that I think it is very important to set the record straight here, because I was once in the camp of “Obamacare is based on Republican plan, why are the Republican so against it!”. So I thank Scott for hammering on this topic, and getting me to understand the topic better. But that phrase glosses over the fact that these were line-item vetoes and that Romney did play a significant part in the legislation (for better or worse).

    Can I humbly suggest something more like “passed by massive supermajorities of liberal Massachusetts Democrats. And Romney line-item vetoed some of the most important/progressive/whatever parts of the final legislation, but those vetoes were overridden.”? OK, maybe not so elegant, but hews closer to describing what happened.

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