“Compromise” and the Affordable Care Act

One of the strangest narratives in the current shut down debate is the idea that Democrats won’t compromise. This narrative is funny to me because the Affordable Care Act itself seems like one of the biggest examples of compromise in modern politics. Yes, the final act passed with no Republican votes, but the bill itself was the product of decades of compromise dating back to the failed 1990s health care reforms. Brad DeLong (among others) has been writing about this issue since the ACA was enacted, e.g. The Curious Triumph of Romneycare:

It has been a long slog, since those days in the early 1990s when right-wing policy analysts proposed an individual mandate to purchase health coverage as a respectable, market-oriented, responsibility-based alternative to either government-provided health care (the nanny state) or mandated employer-provided health care (the boss state). In November, 2004, Republican Governor Mitt Romney of Massachusetts followed through on that conservative proposal, and in April, 2006 he signed into Massachusetts law a health reform plan based on it.

Having conquered Massachusetts, RomneyCare is now the law of the land. But how did Republican RomneyCare become Democratic ObamaCare?

In addition to the obvious structural parallels between Romney’s health reform, the 1990s conservative proposals, and the ACA, a group of political scientists have identified even more Republican ideas in the final text of the ACA. Here’s the Economist’s coverage:

On the surface, it looks totally partisan. Not a single Republican voted for the Patient Protection and Affordable Care Act, aka “Obamacare”. But the law is filled with concessions to them. A new computer analysis counts the GOP policy ideas that overlap with other bills that made it into the law: 3% from the House and 8% from the Senate. In fact, when “markup” bills are excluded—basically, amendments and legislative re-writes—11% and 28% of policy ideas from Congressional and Senate Republicans, respectively, align.

The underlying paper is here. Long story short: The ACA was already a massive compromise at every level.

But Republicans since 2008 have not been interested in compromising, no matter how hard the Democrats tried to bring in their ideas. Instead, Republicans have single-mindedly focused on torpedoing Obama’s presidency. “Let’s just say it, the Republicans are the problem.” And the media have enabled this strategy. As Al Jazeera puts it, “Shutdown coverage fails Americans”:

So, no, the shutdown is not generalized dysfunction or gridlock or stalemate. It is aberrational behavior by a political party that is willing to take extreme and potentially damaging action to get its way. And by not calling it what it is, the political press is enabling it.

The culture of false equivalence enables extremists to look less extreme, and masks the extensive compromises Democrats made in the vain attempt to secure any Republican support for ACA from the very beginning.

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  1. Max

     /  October 4, 2013

    I’ll admit that I don’t read a ton of mainstream press these days, but I feel like the shutdown, uniquely, hasn’t been covered as an ‘on the one hand/on the other hand’ issue. Starting sometime last weekend, there was a shift from that kind of coverage to coverage more clearly blaming the Republicans as acting with incredible irresponsibility (my favorite example is here: http://www.economist.com/blogs/democracyinamerica/2013/09/debt-ceiling).
    I have nothing to point you to here except my own perception, but my perception has been that the shutdown jolted a number of media outlets out of their usual ‘opinions differ’ coverage.
    Occasionally you see an article where someone analyzes the language used in newspaper articles to draw conclusions about things, I’d be interested in seeing one of those studies focused on the past week or so vs. prior ‘government negotiation’ coverage.

    • I agree it’s been less pointedly “balanced” than usual, which is refreshing, though my sample of outlets is also pretty skewed. What I haven’t seen is the discussion above so much – people keep referring to Obamacare as President Obama’s signature legislative achievement, and saying how ridiculous it is to try to force the Democrats to abandon it. That’s true, but it’s worth reminding ourselves that “Obama’s signature legislative achievement” was born as the conservative response to our broken health insurance system. So, you could also call it “the Heritage Foundation’s signature legislative achievement”, but then it looks sillier for the Republicans to shutdown the government to stop it.

  2. carly

     /  October 8, 2013

    There’s an added factor that we have to consider here, which is the Blue Dog Democrat contingent. Many of the compromises were made directly in response to that group. One would expect, consequently, that this contingent would come out vocally in favor of the reform and defend it on at least somewhat conservative grounds — but that hasn’t been the case. In fact, you have folks like Max Baucus saying the ACA is a ‘train wreck’.

    And I’d agree with Max above, that the Republicans have been pretty effectively called out in the mainstream media. BUT, that doesn’t actually matter to the far right part of the Republican party, who simply have to show their home constituencies that they ‘stood up to Obamacare’. It’s the same exact logic as the repeated failed repeal attempts or Ted Cruz’s non-filibuster filibuster. I’m not sure anyone genuinely believes it will achieve anything. Instead, it’s very expensive political theater.

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