The individual mandate was a conservative idea, from the conservative Heritage institute and was promoted by conservatives such as Gingrich all the way up to the beginning of the ACA debate (IIRC April 2009 was the last recorded instance of Gingrich supporting an individual mandate.) That is well documented. It is true that Heritage was promoting the mandate as part of a package of conservative health care that would have replaced Medicaid etc, but the mandate was the idea that was taken from that and applied to Romneycare/ACA. (Oh, and OF COURSE it’s called Romneycare - Romney campaigned for it and signed it and most importantly was the executive who implemented it - don’t try to give Romney a pass on his two-faced paper thin denial and betrayal in 2009 - he’s a lying sack of shit on this issue.)
The individual mandate was only a piece of Romneycare/ACA, of course. The rest of ACA/Romneycare was basically the Swiss Model approach to health care. There are only 3 major models for extending health coverage or providing universal coverage. The Swiss Model itself is the moderate option of the 3 approaches to universal health care (Swiss Model is the moderate option, Single Payer is the liberal option and Nationalized Medicine is the leftist option). Basically what we in America did was take the moderate idea of the Swiss Model (heavily regulated insurance, subsidies for the poor) and replace some of the regulations and subsidies with an individual mandate. So Obama took a moderate plan, added a conservative angle and then proceed to offer that to Congress. He was in all honesty expecting the GOP to work with him on this as he correctly felt he was offering them a moderate option and also the most moderate/conservative option to extend health coverage that was possible.
And that leads to a big reason why I have over the years kept emphasizing the moderate/conservative roots of ACA: the Affordable Care Act WAS the bipartisan option. The ACA WAS the moderate option. The ACA was the most conservative possible option that would actually extend good quality coverage at affordable prices to a large number of Americans. That is why the GOP has flailed and failed so miserably to replace it. They don’t have any options that are to the right of the ACA that will actually keep or extend the ACA coverage gains without compromising in huge way (loss of coverage protections, loss of coverage subsidies, loss of Medicaid expansion, etc. etc.)
So in the big picture it’s true that ACA was not a purely conservative idea (the individual mandate was). But it’s also true that ACA was not a purely (or even mostly IMO) liberal idea. It was, if you know the history of health care in the developed world, a moderate idea, with the conservative spin of an individual mandate in place of heavier regulation, higher subsidies and automatic coverage. (Most Swiss Model countries don’t F’ about with an individual mandate, they just automatically enroll people who don’t buy coverage. The German system of compulsory insurance is a good example/)
And I emphasize this history not to say the ACA is a bad plan or that Single Payer is the True God and Bernie Sanders is Its Prophet. The Swiss Model, if implemented in a strong fashion with vigorous regulation, substantial subsidies, compulsory enrollment, a strong public option, etc. can be a very good health care system. Our ACA, since it has a fairly “modular” design, could easily be upgraded from what I call a “weak Swiss Model” to a “strong Swiss Model” by increasing the minimum benefits requirements, lowering the copay and deductible limits, increasing the subsidies, adding a public option, and adding automatic enrollment. That would deliver coverage and quality care fairly similar to single payer but with greater individual flexibility and less immediate disruption, although probably at a somewhat higher price.
No, the reason I don’t ignore the history of the moderate/conservative origins of the ACA is that I absolutely freaking REFUSE to give the GOP a pass for turning on this idea in 2009, for lying about the ACA, for misrepresenting the ACA as “socialized medicine”, for exaggerating the negatives, exaggerating the flaws and challenges of ACA, and falsely promising “awesome conservative alternatives”, magic-market-mushroom-care, etc. for the last 8 years. Obama, out of his naive belief that bipartisan compromise was possible in this country in 2009, offered the Republicans a moderate health care plan. THAT was their chance. They took a huge political dump all over it, used the negative attacks to weaken Obama’s Presidency and impede his agenda for 8 years, to scare Americans into voting them into power in 2010, and just generally lied, deceived, manipulated and exploited like MFers on health care for 8 years.
So I refuse to ignore this.
Lastly, the reality that the ACA was the most moderate to conservative option that would actually deliver good quality coverage gains for most Americans means that the GOP is truly in a corner now. Since they vociferously critized the overall setup of the ACA, they can’t do the same or a similar structure without rendering themselves vulnerable to attacks of “Obamacare 2.0!!” from their extreme edge. And since they also demonized almost every single individual aspect of the ACA (they criticized the minimum benefits requirements, AND the insurance regulation, AND the individual mandate, AND the subsides, and…), this means they cannot pick and choose useful pieces of the ACA without having the same problem. They are screwed. Because they screwed themselves.
