Home / General / But the ACA REALLY WAS the Heritage Plan, Amirite? (SPOILER: No.)

But the ACA REALLY WAS the Heritage Plan, Amirite? (SPOILER: No.)



Not pictured: the many Republican supporters of the ACA, Mrs. Eisenhower

A commenter believes that he has a GOTCHA!

The other day, Obama was touting the successes of Ocare and needling the Rs for not accepting a healthcare reform plan (the ACA) that was basically their (the Rs) proposal as put forth by Heritage.

I’ve been waiting with bated breath Lemieux’s excoriation of the President. Apparently, dumb ol’ Obama thinks his health reform was the conservative approach. What a moron, amirite?

The assertion about Obama’s rhetoric is, as far as it goes, accurate-ish:

I mean, we have been promised a lot of things these past five years that didn’t turn out to be the case: death panels, doom. (Laughter.) A serious alternative from Republicans in Congress. (Laughter.)

The budget they introduced last week would literally double the number of the uninsured in America. And in their defense, there are two reasons why coming up with their own alternative has proven to be difficult.

First, it’s because the Affordable Care Act pretty much was their plan before I adopted it — (laughter) — based on conservative, market-based principles developed by the Heritage Foundation and supported by Republicans in Congress, and deployed by a guy named Mitt Romney in Massachusetts to great effect. If they want to take credit for this law, they can. I’m happy to share it. (Laughter.)

And second, it’s because health reform is really hard and the people here who are in the trenches know that. Good people from both parties have tried and failed to get it done for 100 years, because every public policy has some trade-offs, especially when it affects one-sixth of the American economy and applies to the very personal needs of every individual American.

And we’ve made our share of mistakes since we passed this law. But we also know beyond a shred of a doubt that the policy has worked. Coverage is up. Cost growth is at a historic low. Deficits have been slashed. Lives have been saved. So if anybody wants to join us in the spirit of the people who have put aside differences to come here today and help make the law work even better, come on board.

The context here is important. His invocation of the Heritage Plan is preceded by a description of the actually existing contemporary Republican alternative — i.e. a policy framework substantially worse than the status quo ante that would double the number of uninsured. To call the ACA a “Republican plan” in these circumstances would be pretty dumb. Still and all, Obama did indeed use the “ACA was a Republican plan” line. The question remains: what, precisely, is this supposed to prove?

The most important question here is an empirical one — does the ACA resemble the Heritage Plan? The answer to this question is unambiguous: the plans are radically dissimilar. Nothing Obama says can change this basic fact.

Obama gets around this in part with the familiar technique of conflating the Heritage “mandate to buy nearly unregulated catastrophic insurance while destroying Medicare and Medicaid” plan with the Massachusetts health care reform plan. This argument has the advantage that the Massachusetts plan does bear a real resemblance to the ACA. But it has the fatal disadvantage that what laws a Republican governor will sign (significant parts of) when facing veto-proof supermajorities of Massachusetts Democrats is about as relevant to national Republican health care policy as the views of Thaddeus Stevens and John Bingham are to Republican civil rights policy in 2015.

So, on this issue what Obama is saying is wrong. But his Heritage Plan comments should be seen as having a strategic, not descriptive, purpose. The point of the argument — which is abundantly clear in context — is to preempt Republican assertions that the ACA a radical threat to freedom itself while also painting the GOP as obstructionist and intransigent. It would be silly to take the comments at face value as some kind of wonky policy analysis, and for that reason it would also be silly to “excoriate” Obama as an ignoramus (or, alternatively, to cite his comments as evidence that the ACA really was the Heritage Plan, which seems to be the thrust of the comment.)

This is not to defend the rhetorical strategy, which I continue to think is deeply misguided, particularly with the constitutionality of the individual mandate no longer being a live issue. As Shelley Levene observed, if you’re gonna make something up, make sure that it helps. At this late date, it’s pretty clear that the preemption strategy is a failure, and I think a more accurate description of Republican health care policy — their offer to the uninsured is nothing to more people and their offer to many of the insured is to make things worse — is also the better rhetorical approach. But since only a tiny minority of people were paying attention to Obama’s comments and 0% of that group are persuadable on health care policy, I also don’t think that it particularly matters.

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