The flip-flopping of big parts of the Republican Party (including some of the major conservative think tanks) on the individual mandate for health insurance purchasing is pretty embarrassing in itself, and is also an important smoking-gun indicator of the larger shift-to-the-right of the GOP, which party hacks and flacks have obvious reasons for denying. So it’s not surprising we are hearing denials and demurrals about prior support for the mandate, and moreover, “so’s-your-old-man” false equivalency claims that Democrats have done or are doing the same thing.
The false equivalency claim we will hear most about because it serves the secondary purpose of defending another highly controversial GOP health care position is that Democrats have flip-flopped from their previous advocacy of “premium support,” supposedly the big idea behind Paul Ryan’s Medicare voucher proposal. It adds a bit a credibility that it’s coming from a libertarian rather than an orthodox GOPer, namely Peter Suderman of Reason. But as Ezra Klein explains at WaPo, the analogy does not hold at all:
Premium support…was once endorsed by a handful of Democratic wonks and heterodox senators, though it was, from the beginning, a policy that gained the vast bulk of its political support from elected Republicans. It never gained any serious traction within the Democratic Party. The individual mandate was a Republican idea that garnered support from a diverse array of Republican leaders and institutions over the course of almost 15 years. And unlike with [premium support backers] Breaux and Kerrey, many of those Republican leaders and institutions — like Gingrich and Romney and Grassley and Hatch and the Heritage Foundation — are still around today….
Finally, on premium support, it’s not clear to me that [most] Democrats actually oppose it. Much of the opposition to Ryan’s plans has focused on the rate of growth in his Medicare vouchers. The initial version of his budget, which set that rate of growth at inflation and shifted excess cost onto beneficiaries, was, in many quarters, criticized explicitly for not being premium support. But opposing Ryan’s plan and opposing premium support are different things, and it seems to me that Democrats have left themselves room to compromise on the policy in the future — and, as I’ve written previously, I think such a bargain is well within the realm of plausibility. Republicans, conversely, have united around an argument that the individual mandate is flatly unconstitutional, and thus can never be implemented on a federal level no matter the policy it’s embedded in.
This is all good and true. I’d add that as I recall some early Democratic supporters of “premium support” were not backing a stand-alone Medicare proposal but were instead envisioning a universal health care system in which “premium support” was offered to all on a means-tested sliding scale. Whether you like that idea or hate it, it’s sure dramatically different from Ryan’s approach of Medicare vouchers whose value is deliberately reduced over time, alongside a Medicaid block grant (with steadily reduced federal support) and no steps to offer any direct assistance (other than the usual individual tax credits and “high-risk pools”) to people who aren’t covered by Medicare or Medicaid.
Republicans just can’t claim “equivalency” cover for their dramatic switch from being staunch advocates of an individual mandate to alarmists shrieking that it’s unconstitutional or even a form of slavery.