Have Republicans Been “Moving Right” On Health Policy?

A conversation I was having over lunch yesterday reminded me that I think some of these discussions about Republicans moving to the right on questions like an individual mandate for health insurance get things pretty wrong. Was there ever actually a moment in time when leading figures in the conservative movement were actively working to steer the United States of America in the direction of something like the Dutch or Swiss health care system? I don’t think there was.

What they were, instead, was a couple of moments in time—one in the early 1970s and one in the early 1990s—when it seemed that Democrats might succeed in imposing either a Canadian-style (70s) or German-style (90s) system and some leading Republicans (Nixon in the 70s and Dole in the 90s) felt it was tactically imperative to formulate an alternative. By the winter of 2008-2009, the Democratic proposal had changed yet again and this time the Republican tactical theory had changed to one about the benefits of root and branch opposition.

This root and branch opposition has certainly been successful in many ways, but it of course failed to actually block the bill. Rather than thinking of this as a series of steps in which the GOP leadership “moved right” on health care policy, I think it’s better to construe it as shifting tactics in a decades long war. The Democratic position has consistently been that we should raise taxes to give more people health insurance and the Republican position has been a consistent effort to try to stop this from happening. Under Richard Nixon and Bob Dole this goal was pursued in part through tactical retreats which were designed to split moderate Democrats off from the progressive coalition. But each time the progressive drive was halted, the Republican support for the alternatives mysteriously melted away. Then under Mitch McConnell and John Boehner, the GOP dropped this highly successful tactic in favor of a tactic that didn’t work.