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Conservatives Have Shifted Right On Health Care...Or Have They?

This is an interesting chart (though a bit blurry) from National Review in 1993.  It lists the health care "parties" from left to right with single-payer health care on the extreme left and consumer-oriented reforms on the extreme right.  What jumps out is that a combination of mandates, guaranteed issue and subsidy (the building blocks of Obamacare after the public option was taken out) is positioned as the moderate conservative position.  One way to read the chart into the present is to argue that conservatives have gone far to the right on health care since what was moderate conservative in 1993 is now socalized medicine. 

I don't think such a reading would be correct, because the chart left out an important category.  For one thing, most conservatives could rightly argue that they never supported mandate/guaranteed issue/subsidize and never considered such a policy either moderate or conservative.  In 1993, I sure didn't.  Mandate/guaranteed issue/subsidize might have had a following among some conservative policy analysts and Republican politicians, but I don't remember that such a policy (and especially not mandates) was popular among the mass of conservatives.  My sense from listening to and watching, (and later reading through the right-blogosphere) conservative media and my conversations with conservatives over the last seventeen years is that neither mandate/guaranteed issue/subsidy nor consumer-oriented health care was the dominant position among most self-identified rank-and-file conservatives.  The dominant position seemed to boil down to several propositions:

1.  America had the best health care in the world and the health care system was basically functional.

2.  Socialized medicine was a menace that must be defeated.

3.  Premiums were rising too fast, but tort reform and making it easier for small companies to pool to buy health insurance would reduce frivolous lawsuits and defensive medicine, increase the supply of doctors, and make it easier for employers to offer affordable health insurance.

The first two propositions were the most important.  This position was oriented more toward protecting the then-existing system from radical change (understood, almost by definition, as coming from the left) than in its suggested reforms.  This helps explain the fairly low priority that health care politics took among conservatives between the defeat of Clintoncare and the credible threat of Obamacare.  Tort reform would have been nice, but conservatives had basically won in preventing socialized medicine and there were always other, more pressing issues. 

Ignoring this conservative position on health care (which I suspect is still the dominant one among conservatives as a whole) would continue to distort how we look at the politics of health care.  While the opposition to mandate/guaranteed issue/subsidize is much more intense now than in 2008, the change among conservatives is probably smaller than it appears.  Most conservatives are where they have always been, they are just more active and the priority of the health care issue has increased.  I also suspect that there is less change among most conservatives than might appear regarding consumer-driven health care reform.  Conservative policy analysts, conservative journalists, and more and more Republican politicians have come out in favor of various versions of consumer driven health care reform, but I wonder what the majority of conservatives who showed up at the town hall meetings and Tea Parties think?  My best guess is that they would be quite happy with a total repeal of Obamacare, plus tort reform, plus allowing employers to buy health insurance policies across state lines, and getting that, would be quite happy to move on to other issues.  I also doubt that they would be very enthusiastic about consumer-driven health care policies that would destroy the private, employer-provided coverage that gives them access the world's best health care system.  Which is to say that I suspect that supporters of consumer-driven health care (of which I am one) should take some, but not too much solace from the movement of policy analysts, conservative journalists and Republican politicians to their side, and that they have a huge job to do selling their ideas to their fellow conservatives - to say nothing of persuadable nonconservatives   

Update: I got the chart from this Stephen Spruiell post over at NRO's Corner.

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