That’s what Bruce Bartlett says, in an essay on The American Conservative website, specifying that Barack Obama is “the heir to Richard Nixon, not Saul Alinsky.” Bartlett, pour mémoire, is a former GOP leading light who has become disillusioned with the party (which, on Twitter, he refers to as “the wanker party”). He explains
In my opinion, Obama has governed as a moderate conservative—essentially as what used to be called a liberal Republican before all such people disappeared from the GOP. He has been conservative to exactly the same degree that Richard Nixon basically governed as a moderate liberal, something no conservative would deny today. (Ultra-leftist Noam Chomsky recently called Nixon “the last liberal president.”)
Bartlett then sets out to prove his argument. Here’s what he has to say on the subject of health care reform
Contrary to rants that Obama’s 2010 health reform, the Patient Protection and Affordable Care Act (ACA), is the most socialistic legislation in American history, the reality is that it is virtually textbook Republican health policy, with a pedigree from the Heritage Foundation and Massachusetts Gov. Mitt Romney, among others.
It’s important to remember that historically the left-Democratic approach to healthcare reform was always based on a fully government-run system such as Medicare or Medicaid. During debate on health reform in 2009, this approach was called “single payer,” with the government being the single payer. One benefit of this approach is cost control: the government could use its monopsony buying power to force down prices just as Walmart does with its suppliers.
Conservatives wanted to avoid too much government control and were adamantly opposed to single-payer. But they recognized that certain problems required more than a pure free-market solution. One problem in particular is covering people with pre-existing conditions, one of the most popular provisions in ACA. The difficulty is that people may wait until they get sick before buying insurance and then expect full coverage for their conditions. Obviously, this free-rider problem would bankrupt the health-insurance system unless there was a fix.
The conservative solution was the individual mandate—forcing people to buy private health insurance, with subsidies for the poor. This approach was first put forward by Heritage Foundation economist Stuart Butler in a 1989 paper, “A Framework for Reform,” published in a Heritage Foundation book, A National Health System for America. In it, Butler said the number one element of a conservative health system was this: “Every resident of the U.S. must, by law, be enrolled in an adequate health care plan to cover major health costs.” He went on to say:
Under this arrangement, all households would be required to protect themselves from major medical costs by purchasing health insurance or enrolling in a prepaid health plan. The degree of financial protection can be debated, but the principle of mandatory family protection is central to a universal health care system in America.
In 1991, prominent conservative health economist Mark V. Pauley also endorsed the individual mandate as central to healthcare reform. In an article in the journal Health Affairs, Pauley said:
All citizens should be required to obtain a basic level of health insurance. Not having health insurance imposes a risk of delaying medical care; it also may impose costs on others, because we as a society provide care to the uninsured. … Permitting individuals to remain uninsured results in inefficient use of medical care, inequity in the incidence of costs of uncompensated care, and tax-related distortions.
In 2004, Senate Majority Leader Bill Frist (R-Tenn.) endorsed an individual mandate in a speech to the National Press Club. “I believe higher-income Americans today do have a societal and personal responsibility to cover in some way themselves and their children,” he said. Even libertarian Ron Bailey, writing in Reason, conceded the necessity of a mandate in a November 2004 article titled, “Mandatory Health Insurance Now!” Said Bailey: “Why shouldn’t we require people who now get health care at the expense of the rest of us pay for their coverage themselves? … Mandatory health insurance would not be unlike the laws that require drivers to purchase auto insurance or pay into state-run risk pools.”
Among those enamored with the emerging conservative health reform based on an individual mandate was Mitt Romney, who was elected governor of Massachusetts in 2002. In 2004, he put forward a state health reform plan to which he later added an individual mandate. As Romney explained in June 2005, “No more ‘free riding,’ if you will, where an individual says: ‘I’m not going to pay, even though I can afford it. I’m not going to get insurance, even though I can afford it. I’m instead going to just show up and make the taxpayers pay for me’.”
The following month, Romney emphasized his point: “We can’t have as a nation 40 million people—or, in my state, half a million—saying, ‘I don’t have insurance, and if I get sick, I want someone else to pay’.”
In 2006, Governor Romney signed the Massachusetts health reform into law, including the individual mandate. Defending his legislation in a Wall Street Journal article, he said:
I proposed that everyone must either purchase a product of their choice or demonstrate that they can pay for their own health care. It’s a personal responsibility principle.
Some of my libertarian friends balk at what looks like an individual mandate. But remember, someone has to pay for the health care that must, by law, be provided: Either the individual pays or the taxpayers pay. A free ride on government is not libertarian.
As late as 2008, Robert Moffitt of the Heritage Foundation was still defending the individual mandate as reasonable, non-ideological and nonpartisan in an article for the Harvard Health Policy Review.
So what changed just a year later, when Obama put forward a health-reform plan that was almost a carbon copy of those previously endorsed by the Heritage Foundation, Mitt Romney, and other Republicans? The only thing is that it was now supported by a Democratic president that Republicans vowed to fight on every single issue, according to Robert Draper’s book Do Not Ask What Good We Do.
Senior Obama adviser David Axelrod later admitted that Romney’s Massachusetts plan was the “template” for Obama’s plan. “That work inspired our own health plan,” he said in 2011. But no one in the White House said so back in 2009. I once asked a senior Obama aide why. His answer was that once Republicans refused to negotiate on health reform and Obama had to win only with Democratic votes, it would have been counterproductive, politically, to point out the Obama plan’s Republican roots.
The left wing of the House Democratic caucus was dubious enough about Obama’s plan as it was, preferring a single-payer plan. Thus it was necessary for Obama to portray his plan as more liberal than it really was to get the Democratic votes needed for passage, which of course played right into the Republicans’ hands. But the reality is that ACA remains a very modest reform based on Republican and conservative ideas.
If any Republicans are reading this and disagree with Bartlett on the health care issue, I’d like to hear their objections.