Hillarycare in the 1990s wouldn't have made Americans more liberal.

Bill Kristol's Still Wrong on Health Care

Jonathan Bernstein is a Bloomberg View columnist. He taught political science at the University of Texas at San Antonio and DePauw University and wrote A Plain Blog About Politics.
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Sahil Kapur dragged out Bill Kristol's famous 1993 memo about President Bill Clinton's health care reform plan. Kapur argues that Kristol's doomsaying about the politics of health care turned out to be true and that this dynamic will benefit Democrats now -- as Kristol feared would happen if the Clinton plan had been passed and implemented.

Wrong!

Well, half-wrong, anyway. Kristol was correct to say then that if health care reform passed, it would be difficult or impossible to repeal and would mark a permanent (as far as anything is permanent) shift toward more government responsibility in another policy areas. I have no argument with that.

But it's the electoral and ideological side that Kristol got wrong then, and it remains wrong now. Here's what he said, beginning by calling Clinton's reform plan "a serious political threat to the Republican Party."

"Health care will prove to be an enormously healthy project for Clinton ... and for the Democratic Party." So predicts Stanley Greenberg, the president's strategist and pollster. If a Clinton health care plan succeeds without principled Republican opposition, Mr. Greenberg will be right. Because the initiative's inevitably destructive effect on American medical services will not be practically apparent for several years--no Carter-like gas lines, in other words--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.

Of course, the Affordable Care Act hasn't been an "enormously healthy project" for the Democratic Party. That's not because Obamacare is different than the 1993 plan. It's because electoral politics doesn't work that way. People may based on how well they think the nation is doing, but at the margins ("retrospective evaluation" is the fancy term for that). What they don't do, however, is become more liberal as a result of successful liberal policies or more conservative as a result of successful conservative policies. Instead, public opinion is more like a thermostat -- the more liberal policy becomes, the more conservative the public tends to be (and vice versa). That seems to the case even when those policies are successful. So the public became more liberal during Ronald Reagan's presidency, and then more conservative when Clinton was in the White House. The pattern repeated with George W. Bush and Barack Obama.

The point here is that the electoral failure of the ACA -- though to some extent contingent on the particular law and the popularity of the president who signed it -- is largely the natural consequence of passing it. That is, if Obama had 60 percent approval instead of 40 percent (and had spent most of his presidency there), it's likely that Obamacare would be a lot more popular, but the law still wouldn't be helping Democrats win elections. And it certainly wouldn't have turned people into liberals, grateful for the wonderful good that government had produced for them. Just as Reagan's popularity didn't turn people into conservatives, and Clinton's even greater popularity didn't produce a nation of liberals.

Or, to go back to the most obvious example: just as wildly popular Great Society programs (such as Medicare) didn't lead to electoral success for Democrats in the 1960s and 1970s.

All of this hardly means that Republicans shouldn't have opposed the ACA. On policy grounds, health care reform was a huge victory for liberals. But greater fears that an ACA victory would translate into electoral gains were overstated at best, and probably even false. In 1993, and today.

This column does not necessarily reflect the opinion of Bloomberg View's editorial board or Bloomberg LP, its owners and investors.

To contact the author on this story:
Jonathan Bernstein at jbernstein62@bloomberg.net

To contact the editor on this story:
Max Berley at mberley@bloomberg.net