Kristol: We Can't Return to 2009 Health Care

Ezra Klein reports on Bill Kristol's surprising views on the Affordable Care Act on vox.com.

Today's GOP lawmakers wouldn't need a memo to know that working with President Obama to pass a massive new entitlement doesn't dovetail with their electoral or ideological interests. Where Republican strategists once had to work to prevent cooperation, today obstruction has become the norm, and it's compromise that requires an extraordinary effort.

But 22 years later, it's not just the politics that have changed; it's the policy, too. Democrats did pass a massive health-care reform bill — and they passed it over the kind of lockstep opposition from Republicans that Kristol proposed in 1993. So we can now look back at Kristol's memo and try to ask what he got right and what he got wrong.

Kristol freely admits he was trying to shock the Republican Party into a political strategy many of its members would have been too genteel to mention, much less follow. "I was trolling before anyone knew what trolling was," he laughs. But trolling, he argues, was what Clinton's bill called for. "When I wrote that memo, there was a real prospect of it getting bipartisan support."

In retrospect, Kristol thinks his memo was misinterpreted as more Machiavellian than it actually was. "I wasn’t scared of [Clinton's bill] because it was good policy, but because bad policy can become institutionalized," he says. "When these things get passed it’s hard to unwind them."

Obamacare, he continues, proves the point. Already, congressional Republicans are falling all over themselves to show that if the Supreme Court repeals the law's subsidies, Republicans will somehow fix the resulting mess. A party that can't even permit the Supreme Court to destroy Obamacare is never going to be able to do it alone.

Now that Obamacare is delivering health insurance to millions of people, Kristol says, it can be replaced, but it can't simply be eliminated. "You need a credible alternative. You can't just return to the health system of 2009."

Kristol's perspective on this will be of some comfort to liberals. "I was never convinced that single-payer wouldn’t be more attractive than Obamacare," he says. "I think there was some truth to the left-wing critique of Obamacare. You’re building this giant contraption, making people worried about disruption, but you’re helping a rather limited number of people. In a funny way, if you’re doing a middle-class entitlement, you should do a big middle-class entitlement."

Instead, Obamacare's legacy will be its substance: it has permanently reshaped the social contract in America. It is now the federal government's role to make heath insurance affordable and available to all its citizens, and any Republican president who seriously wants to repeal or reform Obamacare will need to propose a replacement that fulfills that basic bargain.