Seven years and three days ago, the House of Representatives grumblingly voted to approve the Senate’s version of the Affordable Care Act. Democrats in the House were displeased by many of the changes introduced by Senate Democrats. But in the interval after Senate passage, the Republicans had gained a 41st seat in the Senate. Any further tinkering with the law could trigger a Republican filibuster. Rather than lose the whole thing, the House swallowed hard and accepted a bill that liberals regarded as a giveaway to insurance companies and other interest groups. The finished law proceeded to President Obama for signature on March 23, 2010.
A few minutes after the House vote, I wrote a short blog post for the website I edited in those days. The site had been founded early in 2009 to argue for a more modern and more moderate form of Republicanism. The timing could not have been worse. At precisely the moment we were urging the GOP to march in one direction, the great mass of conservatives and Republicans had turned on the double in the other, toward an ever more wild and even paranoid extremism. Those were the days of Glenn Beck’s 5 o’clock Fox News conspiracy rants, of Sarah Palin’s “death panels,” of Orly Taitz and her fellow Birthers, of Tea Party rallies at which men openly brandished assault rifles.
The conservative establishment in Washington caught the same fever that then raged among conservatives across the country. At that time, I worked at the American Enterprise Institute, the most high-toned of Washington’s conservative think tanks. In later years, AEI would provide a home for the emerging “reform conservative” tendency. Its president, Arthur Brooks, would speak eloquently of the need for conservatives to show concern for the poor and the hard-pressed working class. But all that lay ahead in 2010. The mood then was that supporters and opponents of the Obama administration were engaged in a furious battle over whether the United States would remain a capitalist economy at all.
“We must choose,” Brooks wrote in his highly influential book titled, precisely, The Battle, whether “America will continue to be a unique and exceptional nation organized around the principle of free enterprise” or whether “America will move toward European-style statism grounded in expanding bureaucracies, increasing income redistribution, and government-controlled corporations. These competing visions are not reconcilable.”
It was no moment for advocates of compromise—indeed, it was precisely because I appreciated its unwelcomeness where I worked that I had launched an independent blog in the first place. There, to the increasing irritation of my colleagues and employers, I fruitlessly argued through 2009 and 2010 that Republicans should do business with President Obama on health-care reform.
It seemed to me that Obama’s adoption of ideas developed at the Heritage Foundation in the early 1990s—and then enacted into state law in Massachusetts by Governor Mitt Romney—offered the best near-term hope to control the federal health-care spending that would otherwise devour the defense budget and force taxes upward. I suggested that universal coverage was a worthy goal, and one that would hugely relieve the anxieties of working-class and middle-class Americans who had suffered so much in the Great Recession. And I predicted that the Democrats remembered the catastrophe that befell them in 1994 when they promised health-care reform and failed to deliver. They had the votes this time to pass something. They surely would do so—and so the practical question facing Republicans was whether it would not be better to negotiate to shape that “something” in ways that would be less expensive, less regulatory, and less redistributive.
As I said: fruitless.
From a personal point of view, in fact, my efforts were worse than fruitless. Old friends grew suspicious and drifted away. At second and third hand, I heard echoes of unpleasant explanations for my deviation from the ever-radicalizing main line of Washington conservatism. Increasingly isolated and frustrated, I watched with dismay as people I’d known for years and decades incited each other to jump together over the same cliff.
So, when the Democrats indeed did pass the law without Republican input, just as I’d warned they would, a fury overcame me. Eighteen months of being called a “sellout” will do that to a man, I suppose. I opened my computer and in less than half an hour pounded out the blogpost that would function, more or less, as my suicide note in the organized conservative world.
The post was called “Waterloo.” (The title played off a promise by then-senator and now Heritage Foundation president Jim DeMint that the Affordable Care Act would become Obama’s Waterloo, a career-finishing defeat.)
We followed the most radical voices in the party and the movement, and they led us to abject and irreversible defeat.
There were leaders who knew better, who would have liked to deal. But they were trapped. Conservative talkers on Fox and talk radio had whipped the Republican voting base into such a frenzy that deal-making was rendered impossible. How do you negotiate with somebody who wants to murder your grandmother? Or—more exactly—with somebody whom your voters have been persuaded to believe wants to murder their grandmother?
I’ve been on a soapbox for months now about the harm that our overheated talk is doing to us. Yes it mobilizes supporters—but by mobilizing them with hysterical accusations and pseudo-information, overheated talk has made it impossible for representatives to represent and elected leaders to lead. The real leaders are on TV and radio, and they have very different imperatives from people in government. Talk radio thrives on confrontation and recrimination. When Rush Limbaugh said that he wanted President Obama to fail, he was intelligently explaining his own interests. What he omitted to say—but what is equally true—is that he also wants Republicans to fail. If Republicans succeed—if they govern successfully in office and negotiate attractive compromises out of office—Rush’s listeners get less angry. And if they are less angry, they listen to the radio less, and hear fewer ads for Sleepnumber beds.
So today’s defeat for free-market economics and Republican values is a huge win for the conservative entertainment industry. Their listeners and viewers will now be even more enraged, even more frustrated, even more disappointed in everybody except the responsibility-free talkers on television and radio. For them, it’s mission accomplished. For the cause they purport to represent, it’s Waterloo all right: ours.
Even more provocatively to Republicans already fixed on a promise to repeal the Obamacare abomination, I urged: "No illusions please: This bill will not be repealed."
To that point, it was a big day on my website if we reached 25,000 unique visitors. The Waterloo post passed a million clicks before our servers crashed. But it had remained available long enough for the editors of The Wall Street Journal to slam me by name in an editorial that same evening. The next morning came a phone call inviting me to talk things over with AEI’s president. By Thursday, I was an ex-think-tank staffer.
In retrospect, I have to confess to considerable sympathy for my employers’ point of view. A think tank is not a university, a haven for disinterested thought. It exists to advocate, and I had contradicted my institution’s advocacy on the most sensitive point at the most sensitive time. Being right was no excuse. If anything, being right aggravated my offense.
The demand for message discipline reached its zenith in the conservative world in the months before and after ACA passage, and I was by no means the only person to fall afoul of it. From the libertarian Cato Institute, from the National Center for Policy Analysis, from Heritage—about half-a-dozen people were and would be forced to leave for expressly ideological reasons before and after me. And why not? If during the Obama presidency we did indeed—to borrow the mighty phrase of Theodore Roosevelt’s— “stand at Armageddon to battle for the Lord!” there could be no room in such a host for warriors who questioned the merits of the cause or the prudence of the generals.
Over the next seven years, Republicans would vote again and again to repeal the Affordable Care Act. Total and permanent opposition to the law would become the absolute touchstone of Republican loyalty. Even Donald Trump, who dissented from so much of the old orthodoxy, retained this piece of the doxology. On the strength of their vow to eliminate the ACA, Republicans would win election after election, culminating in the stunning capture of all the elected branches of government in November 2016. From time to time, some old veteran would recall my 2010 prediction that the law would endure and smilingly wonder if I wished to reconsider.
I never did, for the reasons that the whole world has witnessed in real time over this week of Obamacare’s 7th anniversary.
Some of the conservatives who voted “no” to the House leadership’s version of repeal may yet imagine that they will have some other opportunity to void the law. They are again deluding themselves. If the Republican Party tripped over its own feet walking across this empty ballroom, it will face only more fearsome difficulties in the months ahead, as mid-term elections draw closer. Too many people benefit from the law—and the Republican alternatives thus far offer too little to compensate for the loss of those benefits.
In that third week in March in 2010, America committed itself for the first time to the principle of universal (or near universal) health-care coverage. That principle has had seven years to work its way into American life and into the public sense of right and wrong. It’s not yet unanimously accepted. But it’s accepted by enough voters—and especially by enough Republican voters—to render impossible the seven-year Republican vision of removing that coverage from those who have gained it under the Affordable Care Act. Paul Ryan still upholds the right of Americans to “choose” to go uninsured if they cannot afford to pay the cost of their insurance on their own. His country no longer agrees.
What happens now? What happens now is that—a few bitter-enders aside—Republican politicians, especially in the states, begin the slow and belated process of entering the next era of health-care politics. Contrary to Paul Ryan’s bleak vision of a political “tipping point” after which the nation declines into “dependency and passivity,” Americans will continue to find plenty to argue about—and possibly more than ever.
How generous should health coverage be? What should be done to control costs? Who should pay, and on what terms? To what extent should citizens be free to impose the cost of their unhealthy choices upon others? Conservative-minded people will converge on one set of intuitions; progressives on another. It’s possible to imagine a Republican health-care politics that rejects the ultra-redistributionary approach of the ACA and instead argues that since all benefit from health coverage, all must contribute to its costs via some kind of broad-based tax. It’s possible to imagine a Republican health-care politics that emphasizes cost control over benefit provision. It’s possible to imagine a Republican health-care politics that incentivizes providers and insurers to achieve better outcomes at lower prices. It’s possible to imagine a Republican health-care politics that resists socializing the burden of addiction, obesity, and other unhealthy behaviors. It’s possible to imagine a Republican Party that cares about the details of health policy and is not satisfied with poorly informed hand waves toward outworn party shibboleths. It won’t happen soon, perhaps—but the sooner the better.
Conservatives have a crucial role to play in shaping the future American health-care system to enhance and support enterprise, innovation, individual responsibility—to resist open-ended spending, state planning, and the risk that social insurance will penalize effort and success. It’s past time to accept reality, quit promising the impossible, and do the work that a democracy that seeks both equity and efficiency should expect from its more conservative-minded thinkers and politicians.
Whatever else the 2016 election has done, it has emancipated Republicans from one of their own worst self-inflicted blind spots. Health care may not be a human right, but the lack of universal health coverage in a wealthy democracy is a severe, unjustifiable, and unnecessary human wrong. As Americans lift this worry from their fellow citizens, they’ll discover that they have addressed some other important problems too. They’ll find that they have removed one of the most important barriers to entrepreneurship, because people with bright ideas will fear less to quit the jobs through which they get their health care. They’ll find they have improved the troubled lives of the white working class succumbing at earlier ages from preventable deaths of despair. They’ll find that they have equalized the life chances of Americans of different races. They’ll find that they have discouraged workplace discrimination against women, older Americans, the disabled, and other employees with higher expected health-care costs. They’ll find that their people become less alienated from a country that has overcome at last one of the least attractive manifestations of American exceptionalism—and joined the rest of the civilized world in ameliorating and alleviating our common human vulnerability to illness and pain.
I take no pride or pleasure in saying “I told you so.” We’ve all been wrong about enough things to teach us humility about our rare bursts of foresight. What I would urge is that those conservatives and Republicans who were wrong about the evolution of this debate please consider why they were wrong: Consider the destructive effect of ideological conformity, of ignorance of the experience of comparable countries, and of a conservative political culture that incentivizes intransigence, radicalism, and anger over prudence, moderation, and compassion.