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The man who helped kill Clintoncare explains why Obamacare can’t be killed

In 1993, Republican strategist (and Weekly Standard editor) William Kristol was running the Project for the Republican Future, where he thought about how to assure a — you guessed it — Republican future. And at the time, the path forward seemed clear: Republicans had to kill President Clinton's health-care plan.

This was far from consensus when Kristol proposed it. Many congressional Republicans thought they would need to bargain with Clinton, propose their alternative, get Democrats to make some concessions, and eventually compromise on something. That's how Washington worked, after all. You couldn't beat something with nothing.

Kristol, predicting the more partisan shape of the politics to come, cut through that nonsense. His famous (or, if you prefer, infamous) memo is a seminal document not just because it helped drive the Republican strategy against Clinton's health-care bill, but because it stands, even today, as the clearest rationale for the anti-cooperative lawmaking that has become the norm.

Bill Kristol

William Kristol, author of the 1993 memo that helped take down President Bill Clinton's health-care bill.

Chip Somodevilla/Getty Images

"Any Republican urge to negotiate a 'least bad' compromise with the Democrats, and thereby gain momentary public credit for helping the president 'do something' about health care, should also be resisted," Kristol wrote. "Passage of the Clinton health care plan, in any form, would guarantee and likely make permanent an unprecedented federal intrusion into and disruption of the American economy — and the establishment of the largest federal entitlement program since Social Security."

If Republicans let any version of Clinton's bill pass, Kristol continued, the political consequences would be grim. "It will relegitimize middle-class dependence for 'security' on government spending and regulation. It will revive the reputation of the party that spends and regulates, the Democrats, as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining government."

Kristol's memo has attained the status of legend in Washington. In a 2010 Slate column, Jacob Weisberg accused Kristol of killing the "Responsible Republican," writing that his "message marks the pivotal moment when Republicans shifted from fundamentally responsible partners in governing the country to uncompromising, hyperpartisan antagonists on all issues."

I think that gives Kristol too much credit, and the objective realities of American politics too little agency. American politics was polarizing with or without Kristol, and the zero-sum lawmaking that dominates the Republican Party today was probably an inevitable result of these trends — Kristol simply saw this earlier, and leaned into it more eagerly, than his peers.

Either way, we now live in the world Kristol foresaw. Today's GOP lawmakers wouldn't need a memo to know that working with President Obama to pass a massive new entitlement doesn't dovetail with their electoral or ideological interests. Where Republican strategists once had to work to prevent cooperation, today obstruction has become the norm, and it's compromise that requires an extraordinary effort.

But 22 years later, it's not just the politics that have changed; it's the policy, too. Democrats did pass a massive health-care reform bill — and they passed it over the kind of lockstep opposition from Republicans that Kristol proposed in 1993. So we can now look back at Kristol's memo and try to ask what he got right and what he got wrong.

"I was trolling before anyone knew what trolling was"

For all his apocalyptic pronouncements — and there are a lot of those — Kristol is about as happy a political warrior as you'll find. I reached him after he landed in Israel, over a crackling phone connection, and he was a lot more cheerful than I would have been after an international flight.

Kristol freely admits he was trying to shock the Republican Party into a political strategy many of its members would have been too genteel to mention, much less follow. "I was trolling before anyone knew what trolling was," he laughs. But trolling, he argues, was what Clinton's bill called for. "When I wrote that memo, there was a real prospect of it getting bipartisan support."

In retrospect, Kristol thinks his memo was misinterpreted as more Machiavellian than it actually was. "I wasn’t scared of [Clinton's bill] because it was good policy, but because bad policy can become institutionalized," he says. "When these things get passed it’s hard to unwind them."

Obamacare, he continues, proves the point. Already, congressional Republicans are falling all over themselves to show that if the Supreme Court repeals the law's subsidies, Republicans will somehow fix the resulting mess. A party that can't even permit the Supreme Court to destroy Obamacare is never going to be able to do it alone.

Now that Obamacare is delivering health insurance to millions of people, Kristol says, it can be replaced, but it can't simply be eliminated. "You need a credible alternative. You can't just return to the health system of 2009."

Why single-payer may have been more popular than Obamacare

In his original memo, Kristol warned that in the short run, Clintoncare's passage would "do nothing to hurt (and everything to help) Democratic electoral prospects in 1996," and in the long run would "revive the reputation of the party that spends and regulates" while striking "a punishing blow against Republican claims to defend the middle class by restraining government."

Democrats always took a certain comfort in Kristol's memo: if they could just get health reform over the finish line, vast political riches awaited them.

But Obamacare hasn't worked out that way. In a 2012 paper, political scientists Brendan Nyhan, Eric McGhee, John Sides, Seth Masket, and Steven Greene estimated that the 2010 vote share of congressional Democrats who supported health reform was 5.8 points lower than comparable Democrats who opposed it. Running the numbers, the researchers conclude that "health-care reform may have cost Democrats their House majority."

Nor does Obamacare look to be getting more popular with age. A March poll conducted by PerryUndem for Vox found that 83 percent of Americans still hold the same opinion on Obamacare they did in 2010. Of those who changed their minds, 58 percent of them have become more negative toward the law. This is true despite the fact that the law is covering about 17 million people at a far lower cost than Congress initially projected.

Kristol notes that though Clintoncare's details are mostly forgotten now, the plan was much more ambitious than Obamacare — it would have upended the health insurance of most Americans. That's part of what made it easier to defeat, he says.

Obamacare's relative modesty is a reaction to the lessons of the 1990s. The White House was wrong when it promised that everyone who liked their health insurance could keep it, but the overwhelming majority of Americans will see little or no change from Obamacare. That makes it hard for the law to build a constituency in the way, say, Social Security does.

Similarly, Social Security sends out checks that say Social Security on them. It's one program, and everyone who gets it knows they're getting it. Obamacare isn't. In California, the private insurance is routed through a program called "Covered California," while the public insurance is delivered by Medi-Cal. In Kentucky, the private insurance runs through the state's "Kynect" program; in one of my favorite anecdotes about Obamacare, a Huffington Post reporter watched a Kentucky resident who was thinking about signing up for Kynect tell a health worker, "This beats Obamacare I hope." By design, no one ever gets a check with the word "Obamacare" on it.

Kristol's perspective on this will be of some comfort to liberals. "I was never convinced that single-payer wouldn’t be more attractive than Obamacare," he says. "I think there was some truth to the left-wing critique of Obamacare. You’re building this giant contraption, making people worried about disruption, but you’re helping a rather limited number of people. In a funny way, if you’re doing a middle-class entitlement, you should do a big middle-class entitlement."

But even conservatives recognize Obamacare's new deal

Obamacare's political legacy is likely to be a fading negative for Democrats. At this point it won't hurt them much, but it's unlikely to ever help them much, either. In 2014, House Minority Leader Nancy Pelosi told Vox that Democrats were "not running on or from the Affordable Care Act," and that's probably going to be the party's strategy after Obama, too.

Instead, Obamacare's legacy will be its substance: it has permanently reshaped the social contract in America. It is now the federal government's role to make heath insurance affordable and available to all its citizens, and any Republican president who seriously wants to repeal or reform Obamacare will need to propose a replacement that fulfills that basic bargain.

Kristol now chairs the 2017 Project — another effort meant to dream up a Republican future. Under the heading "A Winning Alternative to Obamacare," the organization warns that "While most Americans would personally like to see Obamacare repealed" — I don't think that's a correct read of the polling, but agree to disagree — "they are not likely to yank newly obtained insurance away from millions of their fellow citizens."

Kristol's group goes on to propose a trillion-dollar replacement that would give every American without employer or government-provided insurance a refundable tax credit that would be at least enough to let them purchase bare-bones, catastrophic coverage. The plan, they say, would be "a historic blow for limited government and liberty."

That is Obamacare's legacy. It won't help the Democrats much, but it will do an enormous amount for the uninsured.

Watch: The dysfunction of the American health-care system