A column by Hugh Hewitt in the Washington Examiner earlier this month reveals a likely Republican talking point as the next presidential election approaches: "Hillary is Obamacare's grandmother. Put another way: Obamacare is Hillary's grandchild." Mr. Hewitt's goal, of course, is to pin the disastrous rollout of the Affordable Care Act (ACA) on a likely Democratic candidate for the White House in 2016.
While it's true that Ms. Clinton endorsed the individual mandate during her 2008 presidential campaign, the ACA's pedigree isn't Democratic at all. It's Republican—which raises questions not only about GOP accusations like the one from Mr. Hewitt, but also about progressive support for President Obama's health-care reform legislation and abandonment of universal health care, i.e. a Single-Payer national health care plan (or "Medicare For All").
The individual mandate is the foundation and most controversial part of the ACA, requiring all of us to purchase health coverage from private insurance companies. It was introduced in 1989 by the Heritage Foundation, a rightwing pro-business think tank allied with the GOP.
Mr. Hewitt wishes to associate the individual mandate with the managed-care proposal that was crafted by the Jackson Hole Summit convened by Ms. Clinton and offered by President Clinton in 1993. In reality, the individual mandate was the basis for two GOP alternatives to the Clinton plan: the Health Equity and Access Reform Today Act ("HEART Act"), sponsored by 20 Republican Senators, and the Consumer Choice Health Security Act sponsored by Sen. Don Nickles (R-Okla.) and Rep. Cliff Stearns (R-Fla.).
The half-dozen largest insurance companies favored the Clinton plan, which they helped write (consumer advocates were excluded), while smaller firms represented by the Health Insurance Association of America (HIAA) favored GOP proposals. HIAA ran the famous "Harry and Louise" ads against the Clinton plan.
Gov. Mitt Romney signed the individual mandate into law in Massachusetts in 2006, drawing praise from Senators Jim DeMint and Orrin Hatch and other Republican leaders because of the mandate's boost for private business. It was even part of a bipartisan bill co-written by Senators Bob Bennett (R-Ut.) and Ron Wyden (D-Oreg.) in 2007.
Some Republicans and the Cato Institute opposed it, but there's no doubt that the individual mandate was a Republican scheme until Democrats grabbed hold of it in 2009. After that, Republicans denounced the mandate and called it socialism.
Insurance companies, whose representatives attended the health-care reform panels hosted by Democrat leaders in 2009 and helped draft the ACA, knew that the new legislation was designed to provide them a massive windfall. Whether the ACA was passed or defeated in Congress, they'd be the real winners. The ACA debate was rigged from the beginning by insurance and other corporate lobbies whose profits and high overhead, burdening the US with the highest medical costs of any nation on earth, would be maintained.
In the real world, no genuine socialist would ever jump on board a bill that imposes a direct public subsidy for the financial sector. Neither can the ACA be compared with Social Security or Medicare, which are administered efficiently by government agencies with minimal overhead costs.
The ACA is far more comparable to the Medicare Prescription Drug, Improvement, and Modernization Act ("Medicare Modernization Act"), a Republican "reform" bill signed by President Bush in 2003. This legislation turned Medicare into a corporate cash cow and imposed a complex semi-privatized Medicare system that funnels over $500 billion to Big Pharma and Big Insurance.
The Medicare Modernization Act accomplishes this giveaway through increased payments to Medicare Advantage plans, which converts Medicare funds into insurance company profits, and through Part D, which provides drug benefits for seniors. Part D is only available under a private drug plan provided by (what else?) an insurance company.
Partisan Loyalty vs. Substance
If Obamacare is the rejected grandchild of the Heritage Foundation and betrayed love child of the pre-2009 GOP, then we should also ask: Why did so many progressives, unions, and liberal advocacy groups suddenly endorse legislation that they had recognized earlier as a handout to the insurance industry?
Why did progressives abandon the demand for Single-Payer and the idea that the right to enjoy good medical care should trump the right of private insurance firms to make a profit? (Not all progressives went along with the ACA. Physicians for a National Health Program, the California Nurses Association, the Green Party, and some other groups criticized Obamacare and continued to insist on Single-Payer.)
The obvious answer is post-inauguration loyalty to President Obama. By electing a new Democratic (and first black) president and Democratic Congress, we took back our country from the Bush-Cheney Gang. The health care crisis and other problems would be solved by 'Change We Can Believe In.'
The Supreme Court upheld the individual mandate (National Federation of Independent Business v. Sebelius, 2012), but I can't help wondering how the liberal justices would have ruled on it if the new health care law had been promoted and signed by a Republican president, a plausible scenario given the mandate's history. Would progressive Democrats in Congress, all of whom voted for the ACA, have voted yea on a Republican bill with the same planks?
Such loyalty implicates progressive apologists for the ACA in the rollout mess, including the web-site fiasco, the broken promise that everyone can keep their existing insurance plans, the sorely inadequate and prohibitively expensive policies offered in the insurance exchanges that will leave millions of Americans vulnerable to financial ruin if they face a medical emergency, the looming penalty for those who fail to purchase coverage that they can't afford, and the estimated 31 million who'll still lack insurance.
The history of the individual mandate should lead us to two conclusions:
(1) The debates over health care and other big issues are very often less about substance and more about partisan allegiances. The main criterion for judging any policy or piece of legislation is which side of the aisle introduced it. The Iraq and Afghanistan wars and other military ventures, answered with vociferous protest when George W. Bush occupied the White House, provoked little outrage after Barack Obama moved in, even after the expansion of civilian-slaughtering drone warfare.
(2) While the GOP wallows in extremism and partisan obstruction, Democrats are embracing traditional Republican agenda.
Like the individual mandate, most of the Obama Administration's major proposals and accomplishments would have been recognized as Republican ten years ago: the plan to slash Social Security, the Wall Street bailouts, refusal to prosecute bankster crimes that triggered the economic crisis, the Trans-Pacific Partnership trade agreement, school privatization, the NSA's massive surveillance dragnet, unprovoked military attacks on other countries, "clean coal," permission for continued mountaintop removal mining and fracking, even greenhouse-gas emissions trading (introduced by the George H.W. Bush Administration and supported by Newt Gingrich and John McCain before the 2008 presidential race).
This tendency was already at work in the two Clinton terms. Bill Clinton's legacy would make any Republican president proud: NAFTA, the Welfare Reform Act, "Don't Ask, Don't Tell" and the antigay Defense of Marriage Act, consolidation of media ownership under the Telecommunications Act, the Antiterrorism and Effective Death Penalty Act, expansion of the private prison-industrial complex and war on drugs, training of civilian police in military tactics, the Commodity Futures Modernization Act, repeal of the Glass-Steagall Act. (The last two set the stage for the Subprime Mortgage Crisis and 2008 economic meltdown.)
A pattern emerges: Democrats enact Republican policies that Republicans can't enact by themselves. This doesn't mean there's no difference between the two, but it demonstrates that the parties are in a symbiotic dance that's drifting steadily to the right, with the Democrats few steps behind the Republicans. Sometimes they simply flip-flop, as in the case of the mandate, but the bipartisan game keeps profit-driven health insurance—too expensive, low-quality, and inaccessible for millions of Americans—firmly in place.
Thus Democrats in Congress fell into line behind the ACA, which offers some limited positive reforms but maintains the insurance industry's bureaucratic control over medical care, imposing modest regulations that are offset by the individual mandate's profit pipeline. The ACA isn't a government takeover of health care, it's a financial-sector takeover of government.
Single-Payer doesn't sustain the private insurance industry, so Democrats declared it "off the table." It doesn't have to stay off the table. The current mood of consternation and frustration with the rollout gives us a perfect opportunity to campaign vigorously for Single-Payer as the solution to Obamacare.