With Sahil Kapur’s piece today on Republican fears that Obamacare might actually succeed, I wanted to focus everyone’s attention on the seminal ‘Kristol Memo‘ from 1993, a document that shaped the successful effort to block health care reform in 1994 and, I believe, played a largely unheralded and pivotal role shaping the DC GOP in the last 20 years. You can read the actual memo here; and I strongly recommend that you do. The gist of Kristol’s prescription was massive resistance: no haggling or negotiating, as might have been the Bob Dole approach. Just no. No negotiation, no bill, no acceptance that there was such a thing as a crisis in care.
That was his strategy. It was based on two analyses. The first part of Kristol’s analysis was that reform would work and once it was in place it could never be repealed, much as Social Security and Medicare are now essentially inviolable parts of the national social contract. The second part was that health care reform would create another generation of voters with an experience that government could work concretely to solve major public problems and thus become a natural constituency for Democrats.
I think we’re already at the point where part one is already becoming clear. It’s an open question whether a President Romney would have been able to tamper significantly with the ACA. But by winning reelection, President Obama ensured that the ACA would remain in place untrammeled through the beginning of 2017, long past the point where there’d be any chance of uprooting it. Indeed, even today Republicans are creeping toward improving rather than repealing the ACA as their core position on health care policy.
Whether it will lock in a new generation of Democratic voters remains to be seen. The latest polls show the country evenly divided on the ACA. Those numbers do obscure that a small but significant percent of the opponents want more reform, not less. They’re largely single payer advocates, supporters of the ‘public option’ or people who just generally don’t think the law went far enough. Young people continue to be some of the biggest supporters of the ACA, notwithstanding the fact that are arguably ‘losers’ under the law (forced to buy coverage when they can often get away without since they tend to be young and healthy). But fundamentally, the analysis shouldn’t be about politics. What we can see now is that the ACA is not going anywhere. That should be enough.