A healthcare history lesson for the GOP

House Budget Committee Chairman Rep. Paul Ryan (R-Wis.) last year's Republican vice presidential nominee, is pursued by reporters on Capitol Hill in Washington, following a closed-door GOP meeting regarding the federal budget.
(J. Scott Applewhite / Associated Press)

Two different narratives have been at play in Washington lately to explain what caused the government shutdown. In the first, House Republicans are to blame for trying to hold Democrats and the president hostage over a law that was duly passed by Congress. In the other, Democrats are to blame for their rigid refusal to compromise on Obamacare.

But there’s a part of the story that seemingly has been lost in history: Democrats have already compromised on healthcare reform by adopting Obama/RomneyCare in the first place.

Fundamentally — and infuriatingly for the Democratic base — Obamacare is inherently a compromise because it is a health insurance reform law rather than an overhaul of the structure of our nation’s healthcare system. A significant contingent of Democratic voters and activists has always supported a single-payer healthcare system, in which the government, not private insurance companies, covers healthcare costs for all Americans (think Medicare for all).


This would have been a fundamental transition from our current system, in which most people receive healthcare insurance through their employers (which causes big problems for those who lose their jobs or don’t qualify for employer-sponsored healthcare). It is also the approach taken by most other modern democracies around the world, including Canada and much of Western Europe, which have both lower mortality rates and lower costs. Instead of having a huge variety of individual companies, with each collecting a middleman’s fee, a single-payer system reaps huge benefits in simplicity and quality control.

Yet the single-payer system had already been compromised away when the final 2009-10 healthcare negotiations began. The deep opposition of some Americans to expanding government presented an insurmountable obstacle to adopting this rational, efficient and humane approach to insuring the health of the people of the nation. Recognizing this political reality, many Democrats compromised, even those who considered the single-payer approach to be by far the best policy.

Instead of pushing for single payer, they rallied around another approach: the “public option.” The public option would have preserved the current employer-based system of private health insurance coverage while providing a government-run healthcare insurance alternative as well as a safety net for the uninsured. Importantly, it would have also injected much-needed competition into an environment where private insurance plans are increasingly consolidated.

Still, this compromise of abandoning a single-payer system for a public option was not enough for Republicans and some conservative Democrats. Even though a public option was included in both the House and Senate versions of healthcare reform, politics prevailed and yet another huge concession was made. Instead of a single-payer system or even a public option for those who chose it, Democrats went along with the Obama compromise of adopting RomneyCare, the old Republican plan signed into law by Mitt Romney when he was governor of Massachusetts.

This plan builds on the existing system of insurers and insurance plans and was explicitly designed to mimic previous Republican plans in order to assure passage in Congress. Notably, it includes the “individual mandate,” which 19 Republicans first proposed in 1993 as a legislative alternative to President Clinton’s healthcare reform bill. Today, Republicans attack the individual mandate as unconstitutional.

For many Democrats, these compromises have been hard to swallow. Frustration still lingers among liberals over the abandonment of the single-payer system. In surveys on healthcare, 11% of Americans oppose the administration’s health plan because it does not go far enough. Among Democratic activists, that percentage is far higher.


The Democratic base has reason on its side in favoring a single-payer system. But in politics, reason is often not enough. When others feel strongly on the other side, the best thing for the nation is often compromise. Hence, the Democratic Party reluctantly adopted RomneyCare, a.k.a. Obamacare, to get Republican approval.

Despite all these compromises and concessions, House Republicans still forced a government shutdown. Having coerced the Democrats into adopting a Republican health insurance reform plan, they then accused the administration of refusing to compromise. What kind of shell game is this?

The Democrats have compromised over and over again. Now it’s the Republicans’ turn to play fair.

Jane Mansbridge is a professor at Harvard University’s Kennedy School and a member of the Scholars Strategy Network.