John Moser's post put me in mind of Ross Douthat's comment that while individual Republicans might have credibility on the health care issue, the party as a whole (and especially the top congressional leadership) does not. I mostly agree with both John and Douthat, but I would like to add my own thoughts.
1. Parties are always getting better and worse. A Republican President imposed wage and price controls. Another Republican President appointed John Paul Stevens to the Supreme Court. Parties should never be trusted, and can never have clean histories, but they can be moved to better directions.
2. Republicans deserve alot of criticism for their neglect of the health care issue, but as Avik Roy pointed out in National Affairs many of the ideas for market-oriented health care only matured in the 1990s. The Republicans and most other center-right institutions were slow to pick up on and popularize these ideas, but not quite as slow as one might think. It wasn't like any of them had been taking those ideas in with their mother's milk. My first exposure to those ideas was in a Christopher DeMuth speech on CSPAN.
But the slowness in engaging with and popularizing those market-oriented health care ideas had consequences. One of them is that you get taunted for your party's past flirtation with a policy of mandating and subsidizing what amounts to comprehensive private prepaid health care as a way of avoiding a single payer system. Those taunts are actually the least of the Republican's problems. The biggest problem is that the failure to popularize those ideas in the past, imposes costs on the party leadership if they want to talk about them now.
Take Douthat's criticism of the Republicans for not offering a Ryan or Daniels approach to transforming the health care system as an alternative to Obamacare. In the real world, the past failures to popularize market-oriented healh care put all of the short term political incentives against such a strategy. There would have been no internal consensus within the party about which type of market-oriented policy to follow. There would not even have been a real consensus in favor of such a general approach. Does anyone think that the two Republican Senators from Maine would stick their necks out for any market-oriented health care policy without clear evidence that the public was strongly in favor of such an approach? Another problem is that the public starts off with zero understanding of those ideas and a great deal of anxiety about losing their access to our health care system. The Democrats would have been able to launch a devastating series of attacks (at least as effective as those launched against Obamacare) and the Republicans would have been on the defensive having to spend enormous amounts of time trying to explain what was wrong with the Democratic attacks. I wish they had. I think the long term investment would have been worth it, but I'm not trying to win a congressional election in November. As a tactical matter, it made sense to combine an attack of Obamacare's mandates, Medicare cuts, and tax increases with offering an alternative that consisted of a series of uncostly regulatory changes that would put downward pressure on premiums but leave the system untransformed. If the choice had been between Obamcare versus Ryancare (which included Medicare cuts), rather than Obamacare vs. a center-right tweaked status quo, public opinion might well have been more favorable to Obamacare in the short run. That might well have translated into an easier time passing Obamacare and fewer Republican gains in Novemeber.
Douthat is of course right that by not making the harder but more farseeing choice, the Republican congressional leadership missed one more chance to begin the process of educating the public about market-oriented health care. It is an irony that the political incentives that made that choice so hard were put in place by the failures of earlier Republican Presidents and congressional leaderships. It is a vicious circle. Or maybe not. Maybe the problem is one of expectations. Maybe it makes no sense to expect the congressional leadership to unite their party around a set of policies the public does not yet understand. Maybe the congressional leadership enters into the picture at some later time, when tens of millions more people have been exposed to the arguments for market-oriented health care and have heard the criticisms of market-oriented health care answered in detail. The first step of getting the public to gain a basic understanding of market-oriented health care is not going to be taken by John Boehner. It will have to be taken, if it is taken at all, by back bench or more junior leadership members of Congress, by governors and presidential candidates, and by all the institutions of the right of center that have an audience. There is no one else.