Our shifting health care debate — and how the "center" moved right

Obamacare was rooted in Republican ideas — and its history shows how far right both our parties have drifted

By Conor Lynch
September 25, 2017 8:58AM (UTC)
main article image
(Getty/Yana Paskova)

To get a good understanding of the two major parties’ political trajectories over the past 25 years, there is no better issue to look at than health care reform. This single issue reveals more about the political mood of America than any other, and as Republicans gear up to dismantle the Affordable Care Act yet again and replace it with their own sorry attempt at a health care bill — their “most radical” bill yet, according to Vox’s Sarah Kliff — now is as good a time as any to recall some of the history behind this polarizing issue.

What is essential to understand about the current health care debate in America — if one hopes to make sense of it all — is that the ACA was a centrist (if not conservative) piece of legislation. As those on the left never tire of pointing out, President Barack Obama’s signature legislation was a market-friendly plan that shared many of the same features as a Republican bill introduced in the early '90s.


This bill — the Health Equity and Access Reform Today Act (aka the Chafee bill) — was proposed in 1993 by Sen. John Chafee, a moderate Republican from Rhode Island, and co-sponsored by 18 of his Republican colleagues. One of the most important features of the Chafee bill was the individual mandate — an idea first proposed by right-wing think tank the Heritage Foundation.

The individual mandate, of course, is a central feature of Obamacare, and it has provoked some of the harshest criticism from Republicans, who declare it an assault on freedom. The individual mandate was also a basic feature of “Romneycare,” the Massachusetts health care bill that served as a template for the ACA. Romneycare was signed into law in 2006 by then-Gov. Mitt Romney, who of course went on to become the 2012 Republican presidential nominee. Scholars from none other than the Heritage Foundation helped craft it.

Obamacare, then, would have been considered a moderate Republican plan not merely in the early 1990s, but the early 2000s. This reality should convince any reasonable person that the ACA is not — as Republicans have insisted ad nauseam over the past seven years — “socialist” or even left-wing. It should also serve to illustrate how much the entire political spectrum has shifted steadily to the right over the past quarter-century.


To sum up this rightward trend: The more centrist and “moderate” Democrats have become over time, the more extreme and reactionary Republicans have become in turn.

This is obviously true on many other issues besides health care, whether it’s immigration, the environment, gun control, financial regulation, voting rights or taxes. It is hardly controversial to say that the Republican Party has become a thoroughly reactionary party over the past two decades, while the Democrats have become increasingly centrist (and borderline conservative on a number of issues). This trend began in the 1980s and was already quite apparent by the mid-'90s, with the rise of Newt Gingrich and the “New Democrats.” Indeed, in 1996 Hillary Clinton made a keen observation while discussing her conservative roots during an interview:

I feel like my political beliefs are rooted in the conservatism that I was raised with. I don't recognize this new brand of Republicanism that's afoot now, which I consider to be very reactionary, not conservative in many respects.

In the years since this interview, “Republicanism” has become even more reactionary. The irony is that Clinton would go on to face a truly reactionary Republican for president exactly two decades later — and, by default, she would be the conservative candidate in the race (as numerous conservatives argued during the campaign).


In a sense, the 2016 election was the culmination of this 20-year shift to the right. Donald Trump led the Republican Party to fully embrace the xenophobic and racial resentments that its politicians had historically exploited for political gain, and his reactionary crusade galvanized white supremacists who had long been shunned by the political mainstream. Clinton, meanwhile, offered a halfhearted defense of the status quo and preached gradualism, and at one point even tried appealing to Republican voters who were disillusioned with Trump.  Clinton admittedly moved to the left on certain issues in response to the success of Bernie Sanders' campaign, but her overall message was one of restraint and incrementalism.

In other words, as the Republicans became even more reactionary, the Democrats attempted to sell themselves as the reasonable party of moderation. Temperamentally, at least, Clinton was the Burkean conservative while Trump was the radical Jacobin. Voters were given a choice between a far-right populist and a “center-left to center-right” establishmentarian, and delivered a split verdict, with the Electoral College favoring the former and the popular vote going to the latter.


It is no great mystery why the political center has moved to the right since the close of the 20th century: There has been no real opposition on the left to resist the reactionary forces in play. By moving to the center and adopting moderate Republican ideas as their own, the Democratic Party essentially let the right set the terms of the debate, and policies that were once considered centrist were suddenly regarded as “socialist.”

This leads us to why Republicans have had such a difficult time repealing and replacing Obamacare — one of their primary campaign promises over the past seven years — since taking control of the legislative and executive branches. The simple reason is that the ACA was a center-right reform of our health care system, and the Republicans have no viable alternative (other than returning to the disastrous status quo ante of 2008).

In a way, then, the GOP’s radical crusade against the ACA has been most edifying. It has revealed that the Republican Party is, at heart, a party of reaction. Republicans react to their opponents on the left, and the more their opponents move to the center, the more Republicans travel to the right. This leads to the awkward position the GOP currently faces on health care. As a party of reaction, Republicans are much better suited to be the opposition party than the governing one.


The irony of the current situation is that Republican incompetence, cluelessness and cruelty has led to a surge in support for single-payer health care. Last week Sanders introduced his Medicare for All bill with a record 16 Senate co-sponsors (compared to zero when he introduced a similar bill in 2011). This shows that the left is making a comeback in this reactionary age. And if the last 30 years have shown us anything, it is that reactionary politics must be countered by true left-wing politics. Then, and only then, will the center truly become the center again.

Conor Lynch

Conor Lynch is a writer and journalist living in New York City. His work has appeared on Salon, AlterNet, Counterpunch and openDemocracy. Follow him on Twitter: @dilgentbureauct.

MORE FROM Conor Lynch