One of the major reasons for the GOP’s disunity on health-care policy is that the Republican party’s position on health care was based on a defense of the pre-Obamacare status quo. Now that the there is a new status quo, many Republicans have lost the source of their unity, and they find themselves asking questions they have avoided for decades.
One way to think of the GOP’s position on health care is as a rough compromise between two groups. The first group is altogether skeptical of the federal role in health-care financing and has a sense (at various levels of specificity) that the federal government is messing things up. The second group has done a reasonably good job of adjusting to the system of tax-advantaged employer-provided health insurance for the working-aged, and Medicare for the old.
What these groups have in common is the belief that the Democrats will make things worse. The first group believes that the Democrats will impose a more regulated, more expensive system. The second group believes that the Democrats will want to raise taxes and insurance premiums for the working-aged and to ration Medicare for the elderly in order to expand coverage. The two groups of Republican-leaners didn’t have the same idea of what health-care financing should be, but they could agree to defend the status quo from the Democrats.
This defense of the status quo didn’t just unite Republicans with each other. It also united them with large groups of swing voters who were basically satisfied with their own health care and were very skeptical of any major proposed changes. Obamacare passed only because of short-lived Democratic super-majorities that had been produced by unrelated events — and Obamacare helped undo those majorities.
That’s all over now. Republicans are finally accepting that there isn’t going to be a return to the pre-Obamacare status quo. Republicans can’t agree on how health care should change partly because there has never been (at least in recent decades) a consensus Republican position on how health care should change. There has only been a consensus in favor of blocking change.
There are various wonks and ideologues who have ideas about how to reform health-care policy, but those ideas have very little buy-in from (or even understanding by) the Republican electorate. That is largely because most Republican officeholders and voters have spent the past three decades largely avoiding much discussion about health care past defending the status quo from Democratic, government-run, socialized medicine. You could hear this whenever you listened to a conservative talk show. When the discussion turned to what should be done, you got a mention of tort reform and a quick change of subject.
Ross Douthat correctly writes that “on health care policy, as on a range of issues, the Republican Party as an organism does not know what it believes in anymore.”
That is correct, but it is more than that. It would be easier if the party were divided into camps that had clear ideas of what to do next. There might be a compromise, or one side might prevail. I suspect that, in the current situation, neither the average Republican officeholder nor the average Republican voter knows what he believes in anymore. The confusion is at the cellular level.
There is also an opportunity here. However late they are to the game, Republican officeholders and voters are entering the conversation. Republican leadership should be open to different approaches and to the idea that they don’t know what policy mix will unite the party and appeal to swing voters. There is no time to waste, but for most people on the right, the health-care conversation is just starting. It started late, but it would be a disaster to cut it short.