But if the Senate GOP's talking points about tax deductions for health insurance, health savings accounts, ending bans on pre-existing conditions, allowing insurance across state lines and draconian limits on malpractice awards sound familiar, they should. After all, during the Republicans' successful effort to smother "Hillarycare" in 1994, GOP strategist Bill Kristol authored an almost identical plan. And as it turns out, George W. Bush, John McCain, Mitt Romney and almost every other leading Republican have been regurgitating the same tired sound bites ever since.
As Politico reported Wednesday, Senate Republicans—in anticipation of a favorable Supreme Court ruling that never came—prepared talking points for the "replace" part of their health care mantra:
Republicans will then try to highlight a series of health care ideas that have long been popular with their party as their preferred alternative, including by allowing small businesses "to pool resources to purchase health insurance" for employees, opening the door for health insurance to be purchased across state lines, targeting malpractice lawsuits against doctors, expanding health savings accounts and giving state governments unspecified "incentives" to lower costs.Of course, for Republicans what is old is new. (Arguably, that's what makes them conservatives.) And what the GOP is offering now is little changed from what former Dan Quayle adviser and current Weekly Standard Bill Kristol laid out as a blueprint during the war over Bill Clinton's health reforms.
In his infamous December 3, 1993 memo titled "Defeating President Clinton's Health Care Proposal," Kristol warned Republicans that "The first step in that process must be the unqualified political defeat of the Clinton health care proposal":
Its passage in the short run will do nothing to hurt (and everything to help) Democratic electoral prospects in 1996. But the long-term political effects of a successful Clinton health care bill will be even worse--much worse. It will relegitimize middle-class dependence for 'security' on government spending and regulation. It will revive the reputation of the party that spends and regulates, the Democrats, as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining government.A month later, Kristol detailed "How to Oppose the Health Plan—and Why" with a set of bullet points that by now should look very familiar:
Reform insurance markets to make health insurance stable and portableAlmost 20 years later, Mitt Romney's plan isn't exactly a cut and paste from Kristol, but it's pretty close.
Limit pre-existing-condition restrictions under employer health plans
Eliminate barriers to small business insurance pools
Lower insurance premiums by making them tax-deductible
Permit the establishment of medical savings accounts
Reduce costs through malpractice reform
Simplify health care paperwork through administrative reforms
Reduce Medicaid and Medicare expenses by lifting the regulatory burden on states
Provide health insurance tax credits or vouchers to low-income families
Those words are enough to lay out a basic vision. Romney would turn Medicaid over to the states and -- though this appears in a separate policy paper -- cap its growth at inflation plus 1 percent, which would mean deep cuts to the program. He would allow private insurance to be sold across state lines, meaning that if health-care insurers find the rules in California too onerous, they can locate in South Dakota instead. This is basically how credit cards work today. He would cap non-economic damages in medical malpractice lawsuits and encourage "Consumer Reports-type" ratings of health plans. The broad idea, his campaign says, is to make the market for health insurance look more like the market for things that aren't health insurance.As it turns out, Mitt Romney—or at least the 2012 edition of him—is largely recycling President Bush's disastrous prescription for health care, one which was also championed by John McCain four years ago. Despite the clear success of his popular Massachusetts program in reducing both the ranks of the uninsured and the rate of growth of costs, Romney has largely repackaged Bush's stillborn proposals. That litany includes selling insurance across state lines, enacting draconian curbs on malpractice awards, supporting tax-free health savings accounts (HSAs) and, most importantly, giving tax deductions to individuals to private insurance while ending them for businesses. (The most generous estimates forecast that the Bush plan would have enabled insurance coverage for only 9 million of the 50 million people currently lacking it.) And as the Los Angeles Times explained, Romney's $1 trillion Rx could prove catastrophic:
But the key to his plan comes in these nine words: "End tax discrimination against the individual purchase of insurance." The problem is, there aren't any words after that.
Critics and independent analysts say the impact would probably leave a larger number of Americans without insurance...While offering consumers more choices, Romney's plan would give companies strong incentives to stop providing insurance to workers. It also would overhaul the 46-year-old Medicare and Medicaid programs for the elderly, poor and disabled.It's no surprise Klein asked, "Do Republicans Really Want Universal Health Care?"
In the wake of today's Supreme Court ruling, Romney and the Republicans are proposing to repeal and replace the Affordable Care Act with a set of talking points first crafted almost two decades before its passage. To put it another way, the more things change, the more things stay the same.
Then again, that's what makes them Republicans.