Uwe Reinhardt does a great job running through the health care proposals over that last two decades that supposedly had Republican support. He points out how many of these plans were remarkably similar to the Affordable Care Act. If you take these proposals at face value, it would then seem the GOP has ideologically abandoned their past positions with their total opposition to Obamacare or “come across as nomadic tribe lost in the intellectual desert on this issue.”
Taking politicians at their word though is too naive a way to judge them. What matters in Washington is action, not words. If you want to judge a politician or a party you should only look at the actual concrete steps they take.
Looking at promises, proposals or ideas can be misleading because often they are used just for posturing, with zero intention to see them carried out. Posturing for the base, posturing for the media, posturing for donors, or posturing to drive a wedge with the other party.
By looking through this more cynical lens it is clear the GOP hasn’t abandoned their past health care reform plans because they never really held them. Past proposals were mere tools for dividing supporters of reform or pushing Democrats further to the right, they weren’t actual plans. Since 1990 the Republican Party had at least a half a dozen real opportunities to pass Republican universal health care, but Republicans never even attempted to make it reality.
Republicans didn’t try to exploit the failure of Hillarycare to get Bill Clinton to back a Republican proposal. When George W. Bush took office Republicans could have forced through a Republican health care plan like they did Medicare Part D, but chose not to. When Democrats won Congress in 2006, Bush could have offered to work on a bipartisan health care reform package, but no real attempt was made. If a large group of Republicans put forward a real alternative while Barack Obama was struggling to pass the Affordable Care Act, they probably could have forced Obama to back it.
If Republicans want the United States to have a Republican universal health care system they easily could have put one in place. The fact they didn’t says more than all the think tank white papers.
Ultimately, expanding coverage requires either dramatically reducing profits at big health corporations, raising taxes or exploding the deficit, all things Republicans care more about than the uninsured. Old proposals were merely useful weapons, not deeply held principles.
Top Democrats, health care policies experts, columnists, lobbyists, and even a few moderate Republicans wasted time trying to thread what turned out to be a non-existent needle. This basic analysis is not very popular, but seems the most accurate in retrospect.
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