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Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsNo, Obamacare Wasn't a "Republican" Proposal
No, Obamacare Wasn't a "Republican" Proposal
Scott Lemieux
January 3, 2014
Why this oft-repeated and very wrong idea is both unfair to the Affordable Care Act and far too fair to American conservatives.
The filmmaker Michael Moore has, through his fine documentary Sicko and other public arguments, done a great deal to bring attention to the deficiencies of the American health-care system. His New York Times op-ed on the occasion of the first day of the Affordable Care Act's exchanges repeats some of these important points. However, his essay also repeats a pernicious lie: the idea that the Affordable Care Act is essentially a Republican plan based on a Heritage Foundation blueprint. This argument is very wrong. It is both unfair to the ACA and far too fair to American conservatives.
Before explaining why a central premise of Moore's argument is wrong, let me emphasize our points of agreement. It is true that the health-care system established by the ACA remains inequitable and extremely inefficient compared to the health-care systems of every other comparable liberal democracy. Moore, unlike some critics of the ACA from the left, is also careful to note that the ACA is a substantial improvement on the status quo ante: if it's "awful" compared to the French or Canadian or British models, it's a "godsend" for many Americans. Moore also has some sensible suggestions for improving the ACA in the short termmost notably, a public option and state-level experiments in more public health care where it's politically viable.
Where Moore goes wrong is in this paragraph:
The assertion that the ACA was "conceived" at the Heritage Foundation is simply false. I say this with no little humilitysince Republicans at the national level have never actually favored any significant plan for health-care reform, I thought the content of the Heritage Plan was irrelevant, but didn't think to question claims that it was fundamentally similar to the ACA. When I actually took the time to read the Heritage plan, what I found was a proposal that was radically dissimilar to the Affordable Care Act. Had Obama proposed anything like the Heritage Plan, Moore would have been leading daily marches against it in front of the White Houseand I would have been right there with him.
The argument for the similarity between the two plans depends on their one shared attribute: both contained a "mandate" requiring people to carry insurance coverage. But this basic recognition of the free-rider problem does not establish a fundamental similarity between the two plans. Compulsory insurance coverage as a way of preventing a death spiral in the insurance market when regulations compel companies to issue insurance to all applicants is hardly an invention of the Heritage Foundation. Several other countries (including Switzerland, the Netherlands, and Germany) have compulsory insurance requirements without single-payer or socialized systems. Not only are these not "Republican" models of health insurance, given the institutional realities of American politics they represent more politically viable models for future reform than the British or Canadian models.
The presence of a mandate is where the similarities between the ACA and the Heritage Plan end, and the massive remaining differences reveal the disagreement between Democrats and Republicans about the importance of access to health care for the nonaffluent. The ACA substantially tightens regulations on the health-care industry and requires that plans provide medical service while limiting out-of-pocket expenses. The Heritage Plan mandated only catastrophic plans that wouldn't cover basic medical treatment and would still entail huge expenditures for people afflicted by a medical emergency. The Affordable Care Act contained a historic expansion of Medicaid that will extend medical coverage to millions (and would have covered much more were it not for the Supreme Court), while the Heritage Plan would have diminished the federal role in Medicaid. The ACA preserves Medicare; the Heritage Plan, like the Paul Ryan plan favored by House Republicans, would have destroyed Medicare by replacing it with a voucher system.
more...
http://prospect.org/article/no-obamacare-wasnt-republican-proposal#.UsbE7mQQZwo
solarhydrocan
(551 posts)http://en.wikipedia.org/wiki/Heritage_foundation#Policy_influence
"Assuring Affordable Health Care for All Americans"
By Stewart Butler, Heritage Foundation
This mandate is based on two important principles. First, that health care protection is a responsibility of individuals, not businesses. Thus to the extent that anybody should be required to provide coverage to a family, the household mandate assumes that it is t h e family that carries the first responsibility.
Second, it assumes that there is an implicit contract between households and society, based on the notion that health insurance is not like other forms of insurance protection. If a young man wrecks his Porsche and has not had the foresight to obtain insurance, we may commiserate but society feels no obligation to repair his car.
But health care is different. If a man is struck down by a heart attack in the street, Americans will care for him whether or not h e has insurance. If we find that he has spent his money on other things rather than insurance, we may be angry but we will not deny him services - even if that means more prudent citizens end up paying the tab. A mandate on individuals recognizes this implicit contract. Society does feel a moral obligation to insure that its citizens do not suffer from the unavailability of health care. But on the other hand, each household has the obligation, to the extent it is able, to avoid placing demands on society by protecting itself...>more
http://www.heritage.org/research/lecture/assuring-affordable-health-care-for-all-americans
Notice the comparison to auto insurance in the Heritage paper.
"Free Rider" used to be a term used by Republicans. Now it's bi-partisan.
The Obama that ran for President didn't like Obamacare. So it would be great if those that didn't "change their mind" were not called RACISTS.
tritsofme
(17,323 posts)When the actual provisions of the Heritage plan and the ACA are compared, the inclusion of a mandate is about as superficial as both plans including the word "Affordable" in their names.
The idea of a mandate to solve the free-rider problem predates this Heritage paper, and is not particularly unique.
The "free rider problem" is a concept in economics, not a political talking point, I'm sorry you're not more familiar with it.
solarhydrocan
(551 posts)Others may decide differently.
tritsofme
(17,323 posts)The comprehensive insurance offered by the ACA does not resemble catastrophic only coverage in the Heritage plan, it's apples and oranges.
jeff47
(26,549 posts)The fact that Republicans say it with a sneer is about as meaningful as Republicans saying "Liberal" with a sneer.
El_Johns
(1,805 posts)outlining how to take down Social Security:
Achieving a Leninist Strategy".
Tactics being pursued ever since.
joshcryer
(62,265 posts)He ran against mandates for adults and ran the Rovian Harry and Louise ads because he wanted to differentiate himself from Hillary and Edwards (both who supported a mandate) on the subject.
Regardless the Heritage Foundation's mandate was a tax credit.
Obama's is a fine.
These are fundamentally different ways to implement a mandate.
treestar
(82,383 posts)That was on of those "repeat it until it's true" memes.
Cha
(295,915 posts)and Scott Lemieux.
"Lipstick on dog".. my Democratic
ProSense
(116,464 posts)The Heritage plan was the proposal that was going to devastate programs like Medicaid and Medicare.
Since then, Republicans have done everything to undermine Medicare, exploiting the gaps in coverage.
http://www.democraticunderground.com/10024270235#post4
Cha
(295,915 posts)pa28
(6,145 posts)see 0:59
woo me with science
(32,139 posts)Last edited Fri Jan 3, 2014, 09:40 PM - Edit history (1)
The backroom deal to gut the public option and the mandated entrenchment of parasitic middlemen in the system should have been the first clues.
pa28
(6,145 posts)That turned into a public option for people in their 50's. Then no public option at all.
ScottyEss
(54 posts)pa28
(6,145 posts)Oh yeah. None.
ScottyEss
(54 posts)Who starts negotiating from the end, anyway?
pa28
(6,145 posts)ScottyEss
(54 posts)iamthebandfanman
(8,127 posts)and the OPs attempt (along with the original writer) to portray it otherwise is kinda silly...
are the heritage plan and ACA identical? no. are they super similar? nope.
but is the heritage plan the foundation in which it was built on , for the sake of a 'bipartison' bill that would actually pass?
Yes.
the republicans gave their edited version in the house in the 90s..
then a further revamped edited version in Mass...
then yet another revamped edited version for the ACA...
to say they are the same is definitely going more than too far..
but to act as if there was no influence from republican ideology is ... well.. pretty naïve... IMHO.
Little Star
(17,055 posts)it works pretty darn good now. It was a Republican idea and they liked it until it came to be called Obama Care.
eridani
(51,907 posts)Medical bankruptcies are still 50% of all bankruptcies in MA. Of course this only affects the 15% of the population accounting for 85% of health care expenses. And the healthy 85% accounting for 15% of expenses could care less.
RBInMaine
(13,570 posts)tritsofme
(17,323 posts)It was also passed by veto-proof Democratic majorities, more despite Romney than because of him.
They all share a mandate, but in terms of reform and coverage differ greatly.
progressoid
(49,825 posts)former9thward
(31,804 posts)In February 1974, Republican President Richard Nixon proposed, in essence, today's Affordable Care Act. Under Nixon's plan all but the smallest employers would provide insurance to their workers or pay a penalty, an expanded Medicaid-type program would insure the poor, and subsidies would be provided to low-income individuals and small employers. Sound familiar?
Private insurers were delighted with the Nixon plan but Democrats preferred a system based on Social Security and Medicare, and the two sides failed to agree.
Thirty years later a Republican governor, Mitt Romney, made Nixon's plan the law in Massachusetts. Private insurers couldn't have been happier although many Democrats in the state had hoped for a public system.
http://www.huffingtonpost.com/robert-reich/the-democrats-version-of-_b_4166664.html
ProSense
(116,464 posts)"Thirty years later a Republican governor, Mitt Romney, made Nixon's plan the law in Massachusetts. Private insurers couldn't have been happier although many Democrats in the state had hoped for a public system."
...is free to disagree with the facts. Democrats made significant changes to Mitt Romney's proposal. In fact, Romney opposed those changes, and upon signing the bill into law, vetoed them. Romney's vetoes were overturned by the legislature.
On April 12, 2006, Governor Mitt Romney signed the health legislation.[23] Romney vetoed eight sections of the health care legislation, including the controversial employer assessment.[24] Romney also vetoed provisions providing dental benefits to poor residents on the Medicaid program, and providing health coverage to senior and disabled legal immigrants not eligible for federal Medicaid.[25] The legislature promptly overrode six of the eight gubernatorial section vetoes, on May 4, 2006, and by mid-June 2006 had overridden the remaining two.[26]
http://en.wikipedia.org/wiki/Massachusetts_health_care_reform#Legislation
Here's how the veto was reported:
By The Republican Newsroom
This story from The Republicans archive is part of our look back at Republican presidential candidate Mitt Romneys years in Massachusetts politics: as Senate candidate, gubernatorial candidate and governor. It was published on April 26, 2006.
By The Associated Press
BOSTON Sending a sharp rebuke to Gov. W. Mitt Romney, House lawmakers voted overwhelmingly yesterday to overturn his vetoes to the state's landmark health-care law, including the controversial $295 fee on businesses that don't offer insurance.
The predominantly Democratic House broke from debate of the state budget to begin the override process, first voting to restore a portion of the law guaranteeing dental benefits to Medicaid recipients.
The House overrides had been expected, and Senate President Robert Travaglini said yesterday that he expects the Senate will override all eight of Romney's vetoes. The Republican governor's spokesman said the differences were not essential to the larger goal of health care coverage.
- more -
http://www.masslive.com/mitt-romney-archive/index.ssf/2012/04/gov_mitt_romney_health_care_ve.html
former9thward
(31,804 posts)As are you.
I wonder if you will remember that "Reich is free to disagree with the facts" the next time you link to him in one of your posts...
ScottyEss
(54 posts)Single payer was "perfect", public option was good, and ACA is mediocre at best.
But preexisting conditions are gone, and caps are gone, so there's that.
sendero
(28,552 posts)..... the ACA is just good enough to be worth having. Nothing more and nothing less.
And all of the argument about where is came from is moot and stupid. It is what it is, a small improvement over what we had for some people, a small detraction for others. It does help people that need help (pre-existing conditions) and places a minor burden on some who do not.
My beef with it is that it is uncertain and will remain so for a while. Why? Because it is so lame its constituencies of support are not large enough to protect it. And also it is so overly complex that we won't really know the unintended consequences for many years.
SomethingFishy
(4,876 posts)Welcome!
ScottyEss
(54 posts)We take one step every generation. It's rediculous, frankly.
And the Republicans have learned an important lesson. They learned that you keep hammering until you win. They will NEVER, NEVER let up on ACA the way they did with SS back in the 30s, and how they half heartedly did with Medicare in the 60s. The ACA will not last a generation, in my opinion. The Republicans have already succeeded in reversing the contraception mandate and the Medicare Expansion mandate. In 2017 they will not let Vermont obtain the waiver for state level single payer.
TekGryphon
(430 posts)No one, and I mean NO ONE, has said that the Affordable Care Act was based off the Heritage Foundation's plan. What everyone has said from day one is that the payment vehicle, the individual mandate, was based off the Heritage Foundation's plan. This is true, and the author of this crap piece spends a full paragraph acknowledging it.
Everything else beyond the individual mandate is a product of progressive-minded reforms that are universally popular with the public. None of those are a part of the Heritage Foundation's plan and everyone knows this.
Click bait junk journalism trying to event a fantasy position that he can argue against.
brett_jv
(1,245 posts)The point of the article (i.e. the OP) is to refute what SOMEone (i.e. Michael Moore, clearly not a NOONE) has publicly (at least 'arguably appeared to have') said.
Not sure why you're denigrating the article here, I think this is a valuable 'rebuttal' of (or at the least provider of context for) what MM has gone out and said.
IOW I don't get your beef. I think it's great, myself.
Not only that, but if what you're saying is true, then why are there so many good Liberals on this very thread ... supporting what Michael Moore said?
The disturbing thing to ME is that Moore has given rhetorical ammo to the Wingnuts. You see, in a few months, the ACA will begin to become known as a rousing success ... and then the tools at Faux, Rush, etc, in their pathetically dishonest and memory-challenged way ... will begin to look for way to take credit for the success.
I can already hear the dipshits I argue with on FB, 6 months from now "Oh, yeah, of COURSE 'ObamaCare' is working ... that cause it's really Heritage/Nixon/ROMNEYCARE! Just look, your libtard hero Michael Moore even SAID SO (link to the same article quoted in the OP)!!!" ... acting like THEY knew all along it was a good idea ...
TekGryphon
(430 posts)It was clear that he was referring to the individual mandate when he tied the ACA to the Heritage Foundation.
The ACA is the Individual Mandate plus a whole host of reforms. All (or perhaps the vast majority) of those reforms are good and universally popular, and the individual mandate is, while still an improvement over the prior system, substantially less effective than any other payment vehicle we could have used (public option or NHS). Michael Moore did not attempt to claim that those reforms were from the Heritage Foundation, as this author is alluding.
NOVA_Dem
(620 posts)Some people can't admit that this plan is the insurance industry's wet dream.
progressoid
(49,825 posts)Private insurers were delighted with the Nixon plan but Democrats preferred a system based on Social Security and Medicare, and the two sides failed to agree.
Thirty years later a Republican governor, Mitt Romney, made Nixons plan the law in Massachusetts. Private insurers couldnt have been happier although many Democrats in the state had hoped for a public system.
http://www.salon.com/2013/10/29/nixon_proposed_todays_affordable_care_act_partner/
Nixon in his own words:
Early last year, I directed the Secretary of Health, Education, and Welfare to prepare a new and improved plan for comprehensive health insurance. That plan, as I indicated in my State of the Union message, has been developed and I am presenting it to the Congress today. I urge its enactment as soon as possible.
The plan is organized around seven principles:
First, it offers every American an opportunity to obtain a balanced, comprehensive range of health insurance benefits;
Second, it will cost no American more than he can afford to pay;
Third, it builds on the strength and diversity of our existing public and private systems of health financing and harmonizes them into an overall system;
Fourth, it uses public funds only where needed and requires no new Federal taxes;
Fifth, it would maintain freedom of choice by patients and ensure that doctors work for their patient, not for the Federal Government.
Sixth, it encourages more effective use of our health care resources;
And finally, it is organized so that all parties would have a direct stake in making the system work--consumer, provider, insurer, State governments and the Federal Government.
More...
http://www.kaiserhealthnews.org/stories/2009/september/03/nixon-proposal.aspx
JCMach1
(27,544 posts)fight over single-payer proposed by the Clinton's.
Hoyt
(54,770 posts)That's why we have this temporary work around. Thank god something passed that can be improved now that logjam is broken.
MannyGoldstein
(34,589 posts)Applauding and cheering like giddy teenagers. Since Obama claims he basically copied RomneyCare in order to appease Republican... Smells like a heritage plan, no?
Hoyt
(54,770 posts)Another fate like Hillarycare - - two more decades of nothing - - would have been catastrophic.
Even Bernie Sanders acknowledged ACA was about all that could pass, even though - - at a minimum - - a public option would have made it so much better (although expanded Medicaid as originally envisioned was close to a limited public option).
BlueStreak
(8,377 posts)It was the manure they threw on the wall as part of their attempt to stop Hillary in 2992. But they never actually wanted it to become law. It was just a backstop. Just a red herring. Something to confuse the debate.
That being the case, Romney does deserve some credit for going ahead with that in Massachusetts when he SHARED power with Democrats in one of the most liberal states. It wasn't exactly the most courageous, heroic thing, but it was better than any other Republican did. Too bad he had to be such a dick about it later, rather than owning it. But the voters saw through that.
1000words
(7,051 posts)Defending it is no longer necessary. Let's focus on making it better.
last1standing
(11,709 posts)Even Obama admitted this was a republican plan based on the MA model which was based on the Heritage Foundations original plan. All the revisionist history in the world isn't going to change that.
great white snark
(2,646 posts)"Based on" the MA model. Obamacare is different from the Republican plan and the only people who think that's propaganda have already convinced themselves that Obama is Republican.
last1standing
(11,709 posts)Your opinions are not facts, especially when even those you're somehow trying to protect disagree with you.
Cha
(295,915 posts)easy work"! So easy. Scott Lemieux deconstructs how different it is.. if those who are intent are whining about "it's a republicon plan" would bother to read it.
Soundbytes marinated in lies are so easy to repeat without having to actually see how different ACA is than the heritage plan.. and mitt rmoney wanted to veto the Mass Health Care law. Didn't get it, though, did he?
"It's michael moore.. he must be right "
ProSense
(116,464 posts)http://www.democraticunderground.com/10023715400
Obamacare moved health care in the right direction, expanding Medicaid, opening a door to single payer and strengthening the social contract.
by ybruti
In January 1 2014: US health reform's Gettysburg moment, a veteran of decades-long battles over health care policy sees a parallel between the Union Army's victory at Gettysburg in 1863 and today, which he calls
the most transformational day in the history of United States health care policy, ever....the first day of fundamental reform of the business and regulation of health insurance in all 50 states.
In his article, John E. McDonough, a professor at the Harvard School of Public Health and the author of Inside National Health Reform, lists these accomplishments of The Patient Protection and Affordable Care Act (PPACA), which was signed into law by Barack Obama on March 23, 2010:
Banning the practice of "medical underwriting" by which insurance companies rate enrollees based on their health status and medical history,
Banning pre-existing condition exclusions from US health insurance everywhere,
Establishing "guaranteed issue" as the new operating paradigm for individual health insurance,
Completely eliminating lifetime limits on all health insurance, and
Establishing "minimum essential benefits" that must be included in nearly all licensed health insurance policies everywhere.
In addition, McDonough highlights Medicaid coverage beginning today for five million previously uninsured low-income people, "with many more millions to follow"; private health insurance coverage obtained through federal and state exchanges and starting today; and the principle of personal responsibility to obtain health insurance - the individual mandate. Although the July 1, 1966 beginning of Medicare was another historic date in health care policy, McDonough says "the scope and breadth of changes" beginning today are "far more consequential by comparison."
Regarding the Battle of Gettysburg analogy, McDonough compares the Republican 17-day shutdown of the federal government on October 1 to Picketts Charge on July 3, 1863, "the final and failed Confederate assault at Gettysburg." And just as the Civil War did not end for almost two years after Gettysburg, so the Republican war against the ACA will continue but "the ultimate outcome is no longer in doubt."
McDonough concludes:
The overriding importance of 1/1/2014 is the actualization of a new principle of health justice for all Americans, however flawed that principle is in form and in practice under the ACA. That principle now is here to stay.
- more -
http://www.dailykos.com/story/2014/01/01/1266424/--US-health-reform-s-Gettysburg-moment
blue neen
(12,306 posts)In December (and all of last year), our son paid $500 a month for COBRA.
In January, thanks to the ACA, he paid $200. A $300 a month difference...not too shabby. If only the Republicans would understand that he will now have $3600 more of disposable income this year to spend at *voila* small (and large) businesses!
Thank you, President Obama and all members of Congress who voted for it.
ucrdem
(15,512 posts)woo me with reality
joshcryer
(62,265 posts)Bluenorthwest
(45,319 posts)around Hillary's neck and named it evil in every possible setting and medium. That's why the inclusion of the mandate is so striking and the idea for a mandate sure did not come from the left. ACA is a lot like Bob Dole's plan, but that's not what's important, what counts is that it is nothing like the Obama campaign plan which had no individual mandate and a strong public option to help contain costs.
When you toss aside your own rhetoric so fully and swiftly, people will question where the new ideas come from, they will note Romney Care, Dole's alternative plan and the other plans with a mandate and without any form of public option for coverage. To think one can carry on like that and never be asked about it or called on it is too stupid to be called hubris.
bvar22
(39,909 posts)Everybody already KNOWS.
mike_c
(36,214 posts)Lemieux splits hairs until they're unrecognizable, but they're still hairs. After agreeing with most of Moore's criticisms and suggestions for improvement, he disputes the ACA's Heritage Foundation lineage by pointing to the differences between the conservative proposal and the ACA while papering over as insignificant the fundamental similarity that defines the ACA and makes it different from most other industrial democracies' approach to universal access to health care-- the individual mandate to BUY COMMERCIAL HEALTH INSURANCE and insure the profitability of the insurance industry. Yes, perhaps they are "only really alike" in that respect. That is because neither was designed to put patient care first, rather both were designed to maintain corporate profits first-- the ACA includes some mitigating requirements, like the proportion of premiums that must serve patient needs, and elimination of preexisting conditions clauses-- but it is fundamentally similar to the Heritage Foundation's intent to produce a plan that buttressed the status quo in the land of inaccessible health care and to Romneycare, which was presumably thought to improve its bipartisan chances of passage (a serious mistake in my view, since undermining or repealing it has been a partisan republican rallying cry from the very beginning).