My Bloomberg View colleague Megan McArdle floats a counterfactual history of the last few years: If Hillary Clinton had defeated Barack Obama, the Affordable Care Act would have died, with all sorts of positive consequences:
I think that Hillary Clinton would have pulled back when Rahm Emanuel (or his counterfactual Clinton administration counterpart) told her that this was a political loser and she should drop it. ... I doubt she would have had the debt ceiling debacle or the deep gridlock of the last four years, because it was Obamacare that elected a fresh new class of deeply ideological Republicans who thought they were having their own transformative political movement, and they were willing to do massive damage to their party, their own political fortunes and, in my opinion, to the country in order to take a stand against "business as usual" -- business that included legislating or paying our bills.
I think this logic (Obamacare and thus Tea Party) is mostly wrong, for a number of reasons. First of all, the Tea Party preceded the ACA; the original Tea Party mobilization was a response to the economic stimulus package in spring 2009, a few months before health-care reform became the crucial issue (Steve M. has the timeline).
But more broadly, I think it's wrong because, as Kevin Drum described it awhile ago, the Tea Party response is pretty much what happens every time a liberal Democrat is elected, from Roosevelt to Kennedy to Clinton to Obama. Basically, the 2010 Republican landslide was a function of a depressed economy (which hurt Democrats) and a liberal Democratic president (which brought out a particular type of Republicans). There is some evidence that health-care reform in particular cost Democrats some seats, turning a landslide in the House into a debacle (although I still am very skeptical of that finding), but there's very little chance that avoiding health care would have produced dramatic change. It's worth noting, too, that quite a few House radicals (Louie Gohmert, Michele Bachmann, Steve King) were in place before 2010. A radical-infested Republican Party simply wasn't new in 2010.
As for the other half of McArdle's alternate history, I think it's highly unlikely that Clinton, who ran on health-care reform just as much as Obama did, would have abandoned the No. 1 long-term priority of the Democratic Party after an election in which Democrats won a huge landslide. The odds are strong that she would have rolled out almost exactly the same plan that Obama tried, and that the initial reaction would have been practically identical: strong support from mainstream liberals, cautious but real support from moderate Democrats, and blanket opposition from Republicans.
The thing is that once the train was moving, there never really was any good place for the president to get off. Yes, Obama's chief of staff apparently advised cutting a deal, but Obama never had anyone to deal with or a logical deal to cut. McArdle suggests that perhaps Clinton would have settled for only Medicaid expansion, but it's unlikely that she could have found Republican votes for it (given that it would have to have been bundled with a pay-for such as the actual ACA Medicare cuts or increased taxes which Republicans were eager to run against), and it would have been easy to exploit as "distribute the wealth" program that had nothing for middle class voters.
No, once the president and congressional Democrats moved to the ACA, the least-bad option was always to pass it as long as that was possible, and as it moved through Congress passage always seemed, and in fact was, possible. That was particularly the case after the Scott Brown's Massachusetts victory in January 2010. By then every Senate Democrat and most House Democrats had already voted for reform; at that point, as they eventually realized after the shock wore off, they already had taken the plunge, and retreat would leave them equally vulnerable without at least salvaging the enthusiasm of partisan Democrats. Is it certain that Clinton would have accepted that logic? I suppose not, but it sure seemed obvious to me at the time.
What's a lot harder to know is whether small changes around the margins might have made a difference. With Clinton in office instead of Obama, would Arlen Specter have defected? Would Clinton have made any difference in the pace of the bill through Congress? Would she have been able to prevent Brown's victory? My general feeling is that Obama performed better than par on Specter, right at par on the pace of the bill, and worse than par on replacing Ted Kennedy. Any of those, and presumably several other small things, might have either made passage somewhat easier or impossible, and perhaps presidential skills really did matter.
But on the big point? No, the 2010 election results and the post-2010 Republican Party were probably cooked in regardless of which president the Democrats nominated in 2008. As long as it wasn't John Edwards, at least.
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