Peter Suderman of Reason magazine has an excellent article in Politico on just how bad the Congressional Republicans have been at coming up with an alternative to ObamaCare. I won't recite all of his points because that would amount to repeating almost the whole article. But here's one nugget that conveys the flavor of the piece:
In March, Rep. Paul Ryan (R-Wisc.), the Republican Chairman of the House Ways and Means Committee, promised that he would have a bill ready and scored by the Congressional Budget Office by late June when the decision arrived. "We have to be prepared, by the time the ruling comes, to have something. Not months later," he said. Yet when Ryan finally unveiled the outlines of a plan last Wednesday, he provided few details, and no legislation or CBO score.
The Democrats, by contrast, regrouped after the failure of HillaryCare. Here's an excerpt on that:
Democrats, in contrast, used the time between the demise of the Clinton plan and the election of Barack Obama to regroup and rebuild, with a focus on overcoming the specific challenges that doomed the 1993 effort. The Congressional Budget Office (CBO) scored the Clinton plan as an increase in the near-term deficit, with health premiums counted as government spending, so Democrats, starting with Sen. Ron Wyden, worked with the CBO to craft legislation that the CBO could score as deficit neutral, and premiums kept off the government tabs. The Clinton plan was widely criticized for causing people to lose their doctors and health care plans, so Democrats worked out legislation that President Obama could plausibly--if not, it turns out, accurately--promise would allow anyone who wanted to keep their current plan to do so. The Clinton plan was assailed by a mountain of industry funded ads opposing the proposal, so one of the first orders of business in crafting Obamacare was to negotiate support from doctors, hospitals and health insurers.
There is one issue, though, on which I think Suderman is off-target: his view on a famous 1993 memo by William Kristol that set in motion the Republican steps to kill HillaryCare. Suderman is both too uncharitable and not critical enough.
What Republicans learned from the defeat of the Clinton plan was that they could win health care debates by refusing to provide an alternative. An enormously influential 1993 memo from Bill Kristol cautioned Republicans to avoid the temptation to "[help] the president 'do something'" on health care, which would only lend credence to the Democratic idea that the system was broken. Instead, Kristol advised Republicans to question reforms that would upset a system with which a majority of the middle class was already satisfied, and to concentrate on tweaking the system as it already existed.
That's accurate, but my take at the time, given the way Americans were feeling about health care, is that Kristol chose the right strategy. If you kill a bad idea for almost 20 years, you've done a lot. Suderman is right that the Republicans "learned" what he says they learned and that that was ultimately wrong. I'm not sure Kristol is to blame, though. The Republicans, once they won the majority in both the House and Senate in the November 1994 elections, should have undertaken health care reform by free-market principles. They didn't. That's bad for them--and, more important, bad for us. But Suderman does not confront what might be the truth: that Kristol made the best out of a bad situation.
And how is Suderman insufficiently critical of Kristol? By referring to his proposed reforms as "tweaks." Some of them were tweaks. One of them likely was not. In the 1993 memo, Kristol wrote:
Relatively simple changes to insurance regulation, for example, can eliminate the barriers to health insurance for people with pre-existing medical conditions.
It's not clear what kinds of "relatively simply changes to insurance regulation" Kristol had in mind. But if, as I think, he meant prohibiting insurance companies from pricing for risk, that's not a tweak: that destroys insurance as insurance.