Peter Suderman has an excellent post comparing the GOP’s rejection of the individual mandate to the Democratic rejection of premium support, offering a different lens through which to view the story told by Ezra Klein in The New Yorker.
A few months ago, I wrote a review essay for Foreign Affairs magazine on the death of the moderate wing of the Republican Party. For the most of the review, I discussed the thesis advanced by Geoffrey Kabaservice in Rule and Ruin, which is a sharp denunciation of the GOP’s conservative wing and a celebration of liberal and moderate Republicans from the Eisenhower era until the 1990s. One central point Kabaservice makes is that Republican moderates were a crucial part of the larger right-of-center intellectual ecology through the 1990s because their anti-ideological orientation freed them to embrace creative solutions to emerging social problems. Essentially, Republicans assigned moderates the responsibility for thinking through policy domains like health, education, and welfare, which were considered, during the Cold War years at least, less important that foreign and defense policy.
But as the demographic composition of the GOP base shifted, conservatives started contesting control over domestic policy. This was an uneven and incomplete process, and we can’t always draw clear lines. The supply-siders, for example, won over many moderate Republicans in the late 1970s and early 1980s while there were aging Taftites who were suspicious of the supply-side creed. What does seem to have happened is that the end of the Cold War and the emergence of the so-called “peace dividend” contributed to a larger shift in the political landscape. Domestic policy gained in relative prestige, particularly as southern conservatives who were particularly exercised by the failures of the welfare system gained in power and prominence relative to the declining moderate wing. Moderate Republicans, meanwhile, started going in different directions. Those who shared the Democratic faith in activist government, tempered by a desire for decentralization and fiscal rigor, often left the party to become Democrats. Those who shared conservative skepticism of big government, tempered by a recognition that Social Security and Medicare were here to stay, found themselves gravitating to the right.
The Dole-Chafee proposal, which Peter discusses, arguably represented a form “outsourcing” to the GOP’s moderate wing. Now that health care is seen as a high-salience issue, however, other voices are fully engaged, including judicial conservatives who are deeply concerned about the Commerce Clause. The “flip-flop” on the individual mandate happened in the context of cohort replacement, which is why the Rubiner story struck me as interesting. The Republican party of 2012 is different from the Republican party of 1993, or even 2006.
The classic story is that the GOP has changed because it has moved to the right. Many on the left lament this development. Yet one reason this happened is that a large swathe of the left was (fairly or unfairly) seen as discredited in the wake of successive events like Sen. Ted Kennedy’s 1980 primary challenge, Sen. Walter Mondale’s 1984 presidential defeat, and Jesse Jackson’s 1988 bid for the Democratic nomination. This coupled with the end of the Cold War contributed to a larger shift in domestic policy thinking. More recently, of course, the left has experienced an intellectual revival, driven in part by the 2008 financial crisis and the post-crisis economic stagnation. To return to Peter’s post, this is presumably part of why premium support has lost its purchase on at least some Democratic domestic policy thinkers.
The Republicans who care about health care in 2012 are interested in different things than the GOP moderates focused on the question in the early 1990s, e.g., they care a tremendous amount on the underlying cost of care, both because it contributes to the dramatic increase in entitlement spending and because it limits access to high-quality care. I think it is fair to say that they generally care more about the underlying cost of care than about coverage expansion per se, particularly if coverage expansion means expanding access to low-deductible medical insurance.