Under the Sun: The Health Care Debate, Then and Now

Each week in “Under the Sun,” Jonathan Sircy examines the history of a cultural practice that’s generating buzz at CaPC.

The year was 1993. Bill Clinton was president, the Contract with America was just a gleam in Newt Gingrich’s eye, and Congress was vehemently debating the merits of an individual insurance mandate.

Only that mandate’s proponents were chiefly Republicans. The health care package stalled because President Clinton would not budge in his support for an employer insurance mandate, among other things. The Republicans offered an alternative to Clinton’s plan, one that we can trace from Sen. John Chaffee’s 1993 couter-proposal through Mitt Romney’s Massachusetts health care law. They couched their compromise in the rhetoric of individual responsibility, a deeply cherished conservative belief. The Republicans thus decided that the individual citizen should strike a deal with the government: help with insurance costs in exchange for the responsibility of having insurance. The decision was decidedly non-libertarian.

But this is only one narrative we get when we look at the 90s health care debate, and it’s a political one. It answers questions such as: 1) what was the model for the Affordable Care Act and 2) how did the debate change between 1993 and 2010? Below, I use two recent New Yorker articles to place the current debate in its political context with this upshot: Obama’s plan looks very much like one that key Republicans touted in the 90s and Mitt Romney adapted for Massachusetts in the mid-2000s.

But the other narrative is religious. How did Christians react to the 1993 health care plan? Were their ideals or sticking points different than the ones they’ve articulated in the past four years? Below, I’ll examine two Christianity Today editorials as a synecdoche for the evangelical response. The magazine’s rhetoric remains either diagnostic (i.e. “these are the problems with today’s health care”) or idealistic (i.e. “this is how health care should look”), but the common refrain remains: “all human lives are of value.”

The Political Narrative

In two four-thousand word articles, The New Yorker has proposed the following narrative: mainstream Republicans are now opposing the very plan their party helped design.

In the June 2011 article “Romney’s Dilemma,” Ryan Lizza explains in detail how Mitt Romney’s greatest accomplishment is also his greatest political obstacle. As far as the Massachusetts reform bill goes, Lizza paints a complimentary picture of Romney, explaining how the then governor’s bi-partisan work not only set the stage for Obamacare’s success at the national level but also modeled how an executive can carve out a space for legislative compromise. The article establishes that Obamacare is less a version of socialist medicine than it is mainstream Republicans’ own plan writ large. The 2008 financial meltdown turned the party’s most demonstrative members to the far right, and suddenly the individual mandate plan that claimed Gingrich  and Santorum (yes, that Santorum) among its supporters was a federal incursion into individual liberty. Romney has recently dubbed Obama’s plan “a federal power grab” but has refused to renounce his own plan’s successes. Romney thus currently represents the Republican party’s attempt to have it both ways. The fact that the Bush Administration helped make Romney’s plan viable with over $300 million of federal money clinches the deal: the individual mandate is “compassionate conservatism” realized.

Ezra Klein’s 2012 article “Unpopular Mandate” uses the current health care debate as a test case for thinking through why politicians change their minds. Klein retraces Lizza’s steps, establishing that both Romney’s and Obama’s plan had their roots in a 1993 bill fronted by Sen. John Chafee. The question is: how did so many Republicans who supported the individual mandate change their minds on this issue? The answer: the 2008 meltdown. This changed voters’ opinion which then precipitated political change. While Klein’s argument smacks of ethical relativism (his article concludes with these two sentences: “Perhaps he’s right. Or perhaps that’s just what he wants to believe.”), he goes a long way towards challenging the “conversion” experience of Republicans who once championed the individual mandate and now decry it. Political realities, rather than “new” evidence, he maintains, were responsible for the change.

The Religious Narrative

No single Christianity Today article traced the arc from 1993’s health care debate to the 2010 Affordable Care Act. Rather the magazine has published editorials that outline key “goals” or “principals” for (evangelical) Christians regarding policy debate. A short comparison of consulting editor David Schiedermayer’s 1993 “Healing the Health-care System” and CT’s 2008 editorial board-approved “The Health Care Crunch” establishes small but crucial differences in what is, by in large, very similar rhetoric.

In his 1993 article, Schiedermayer lists five “goals” for health care reform: care for those in need, improved doctor-patient relationships, better promotion of disease prevention, a renewed economic emphasis (for doctors) on persons rather than procedures, and an institutional honesty about health care’s cost. As far as matching these goals with proposed policies, Schiedermayer wishes for something “less ambitious and costly than the Clinton plan but more aggressive than the Chafee…plan.” Conspicuously, Schiedermayer never mentions abortion, a sticking point for both Catholics and the Christian right in 1993, and he only mentions the “individual mandate” as a feature of the Republican proposal, never directly commenting on its viability. Instead, his rallying cry is Matthew 25:40, Christ’s call to care for the “least of these.”

The 2008 CT editorial takes a different approach. Rather than “goals” it focuses on “principles,” a sign that change will take place and that Christians must remain true to their core beliefs. The editorial’s four principles are: subsidiarity (with the claim that “[T]he federal government should be seen as the insurer, or health-care provider, of last resort”), freedom of conscience, financial stewardship, and access of the marginalized. The article includes “abortion” under the freedom of conscience banner, explaining that a system that makes all members “subsidize abortions” should be strenuously avoided. As to the particulars of an “individual” or “employer” mandate, the piece is silent. The article paraphrases Ecclesiastes 3:2, but there are no explicit scripture references. Like Schiedermayer’s article, it proclaims, “Every human life, created and loved by God, is of inestimable value.”

CONCLUSION

As we sort through the ramifications of the upheld Affordable Care Act, it’s easy to forget that national health care legislation has been around for nearly twenty years.

There are two important takeaways. First, the seeds for the blooming 2010 AFA were sown in 1993 and watered in 2006, only in the greenhouse of a different political party. This doesn’t make the policy right. It just means that Republicans can blame themselves as much as the president for Obamacare. Second, the time for “goals” is past. The health care debate has reached the “principles” stage. If we haven’t settled what those “first things” are, it won’t matter what reform goals we make.