The ACA Consists of Things National Republicans Have Always Hated
By 
There was a very good Frontline documentary about the passage of the ACA I show in American Government surveys sometimes. One drawback is that it features Howard Dean making ridiculous claims about how the statute didn’t accomplish anything. Via Chait, these comments were representative of his views at the time:
“This is a bigger bailout for the insurance industry than AIG,” former Democratic National Committee chairman and medical doctor Howard Dean told “Good Morning America’s” George Stephanopoulos today. “A very small number of people are going to get any insurance at all, until 2014, if the bill works.
“This is an insurance company’s dream, this bill,” Dean continued. “This is the Washington scramble, and I think it’s ill-advised.”
Dean sent shockwaves when he said Tuesday in an interview with Vermont Public Radio that the removal of the Medicare buy-in means Democrats should just kill the health care bill and start over.
“This is essentially the collapse of health care reform in the United States Senate,” Dean said. “Honestly, the best thing to do right now is kill the Senate bill, go back to the House, start the reconciliation process, where you only need 51 votes and it would be a much simpler bill.”
[…]
He said he also doesn’t see cost-control measures but, rather “a whole bunch of bureaucracies and a lot of promises.”
There are some good elements in the current health care bill, Dean said, but “at this point, the bill does more harm than good.”
I was very pleased by the solidarity with which the left, loosely defined, defended the ACA from Ryan and McConnell. From DSA to Joe Manchin, almost everybody recognized the urgent necessity of killing the repeal bills, and countless people observed that repeal would inflict large amounts of preventable death, suffering, and financial ruin. But what’s amazing at the time is that a non-trivial number of the people making Dean’s 2017 argument that repealing the ACA would be a “disaster” spent years arguing for Dean’s 2010 view that the ACA was a BAILOUT of insurance interests that accomplished little or nothing or maybe even worse than nothing. This was the view, for example, of Adolph Reed’s widely praised Harper’s cover story, and is the implicit claim of arguments that Obama governed in Reagan’s paradigm rather than FDR’s. As Chait says, “It is logically impossible for the repeal of an insignificant reform to be catastrophic. If it is a big deal to uninsure 24 million Americans and cut taxes on the rich, then it must be a big deal to insure 24 million and raise taxes on the rich.” I’m glad that the threat of repeal concentrated people’s minds, but it’s important not to keep making the analytical mistakes that led to the initial mischaracterization of the ACA.
The transparently false claim that the ACA was not an incredibly hard-fought reform that is one of the most important achievements of the New Deal tradition of Democratic governance but a minor or perhaps even counterproductive reform was based on using the wrong baseline, comparing the ACA not to the status quo ante but to European systems. The passage of an ACA-like model by veto-proof supermajorities of Massachusetts Democrats but signed by a Republican governor encouraged the belief that something like the ACA was just the consensus position of both parties, and the only question was whether Obama, Pelosi, and Reid could do better. This idea is transparently speciois, completely misunderstanding the basic ideological divisions between the two parties that started with the New Deal and have only gotten sharper.
We can see this in a couple of our recent discussions. In yesterday’s McConnell thread, for example, multiple people said that actually McConnell is incompetent because if he knew what he was doing rather than pursuing a long-odds battle to inflict major damage to the ACA, he should have just passed a bipartisan bill to stabilize the exchanges or something and called it a day. The obvious problem with this argument is that McConnell and the vast majority of the Republican conference in both houses don’t want that. They wanted to inflict real damage on the ACA and make it fail because it represents everything they hate. I mean, did you watch the vote and McConnell’s subsequent speech? If McConnell was presiding over a kabuki he strongly wanted to fail, they should cancel the Best Actor Oscar and just give it to McConnell in perpetuity. And you don’t make even marginal senators up for re-election in 2018 vote for an empty gesture you want to fail. Saying McConnell should have just worked with Democrats to pass a bipartisan bill to help the exchanges work is like saying that Reid and Pelosi were incompetent because instead of trying to pass cap-and-trade they should have just passed a bipartisan bill subsidizing the Keystone pipeline and increasing defense spending.
And the even better example is the remarkably persistent falsehood, still put forward by very smart people who would never make similar arguments about the parties in any other context, that the ACA was really a “Republican Plan.” This is the false premise of Jim Newell’s otherwise good piece — that the Republican Party secretly likes the ACA. “The ACA was like the Heritage Plan” argument is based on a similar false premise — maybe this Republican Party doesn’t like the ACA, but it logically should like the ACA, because after all old-timey reasonable Republicans we like to imagine existed liked it. Lots of people still defend Obama for being suprised by how much Republicans hated his signature initiative. But this is all ridiculous.
The ACA essentially consisted of:
- A historic expansion of the public insurance program for the poor
- Increased taxes on the wealthy
- Substantially increased regulation of the insurance industry
- Subsidies to allow the non-affluent to purchase comprehensive insurance
The core elements of the ACA that Republicans should logically like are “none of them.” The Republican Party has for time out of mind been organized in opposition exactly to this kind of reform. Its coalition has become more homogeneous and its opposition to spending for the poor and tax increases on the rich more intense, but it’s a difference of degree. Republicans inflicted a lot of damage on themselves desperately trying to repeal the ACA because they hate everything the ACA stands for and always have. It’s really not complicated. It’s hard for them to repeal the ACA because their ideas have no mass constituency and it’s hard even for popular major legislation to make it through James Madison’s sausage factory. But Republican public officials despise the ACA for perfectly logical reasons.
And what kills me is that the Heritage Plan, which is so often cited as evidence that Republicans should logically loves them some Obamacare, is explicit evidence of this! It’s a plan to destroy Medicaid, Medicare, and comprehensive employer-provided insurance and replace them with a system in which insurance covers almost nothing, and most healthcare expenses are provided out of pocket, with a bunch of hand-waving where the answers to the question of how people aren’t rich should pay for healthcare should be. It would be a considerably more radical repeal plan than AHCA and BCRA were. Republican healthcare policy preferences aren’t a secret, and are perfectly consistent with their general worldview. The mystery is why so many smart people adamantly refuse to listen to them.