"Waterloo" is a post the neoconservative commentator David Frum made to his blog, FrumForum, on March 21, 2010. Earlier in the day the United States House of Representatives had passed the Patient Protection and Affordable Care Act (ACA), clearing the way for President Barack Obama to sign the sweeping health care reform into law. Frum took his title from an earlier prediction by South Carolina Senator James DeMint that the ACA would be a "Waterloo" for Obama and his presidency if Republicans could prevent its passage, much as they had done with Bill Clinton's similar efforts in 1993, which purportedly contributed to the Republicans taking majorities in both houses of Congress in 1994.
Frum called the bill's passage a Waterloo for Republicans, none of whom had voted for the bill or contributed to its passage in any way. But while their anger over that, he conceded, might indeed rally their base to retake Congress once again in that fall's elections, he counseled, the circumstances of the defeat did not augur well for the party's long-term prospects. Despite the ACA's deep unpopularity among Republicans, Frum warned that they would never be able to repeal it since its reforms were more popular with Americans than most Republicans acknowledged. He was specifically critical of talk radio hosts and Fox News for inflaming Republican opposition to the point that party leaders who otherwise wanted to do so were averse to cooperating with Obama and congressional Democrats who had sought the bill, since it was in those outlets' interest for government to remain dysfunctional no matter which party was in charge.
The post became the most-read in FrumForum's history, drawing over a million views and crashing the site's servers. Many of the Republican outlets that had urged non-cooperation with Democrats on the ACA, such as The Wall Street Journals editorial page, were in turn critical of Frum. Within a week, he was asked to leave his fellowship at the American Enterprise Institute (AEI), an influential neoconservative think tank, over the post. While some of his critics noted that he had barely been present there for the previous three years, Frum maintains his dismissal was in response to the anger he had aroused among American conservatives. Some other critics called Frum's complaints about extremist rhetoric and efforts to enforce ideological orthodoxy among Republicans as hypocritical in light of his own writings earlier in the decade, particularly a 2003 National Review cover story that attacked paleoconservatives, including many by name, as "unpatriotic" for, among other things, their refusal to support the Iraq War.
After winning control of the House that fall, and the Senate in 2014, Republicans passed bills repealing the ACA, which eventually became popularly known as Obamacare, many times, none of which ever had the votes to overcome a veto. In 2017, after the election of Republican Donald Trump, the House passed the American Health Care Act, a bill intended to "repeal and replace" Obamacare, but the Senate never considered it. Almost seven years after his original post, Frum wrote that even though it was "my suicide note in the organized conservative world" he stood firm in his prediction, and urged Republicans to take a more cooperative role in health care reform.
Background
Historical politics of the American healthcare reform debate
Since the beginning of the 20th century, progressives and later activists from the liberal and leftist side of the political spectrum had sought the establishment of universal health care through a mandatory government-run health insurance system or other programs. While these initiatives had often failed because most Americans who did have such insurance were accustomed to receiving it through their employers, the idea gained more traction with the public during the Great Depression, leading President Franklin D. Roosevelt to propose such a program as part of the New Deal. However, opposition from the American Medical Association (AMA) led to health-related provisions being removed from the Social Security Act prior to its 1935 passage.
Harry Truman, Roosevelt's successor, included plans for universal health coverage in his 1949 Fair Deal program, which again failed in the face of AMA opposition. Shortly afterwards the Internal Revenue Service ruled that employer contributions to health-insurance plans for their employees was a tax-deductible business expense, making those plans the primary means of health care coverage for most American workers in the private sector. Reformers' attention thus turned to groups less likely to have access to that coverage, such as the poor and the elderly; Medicaid and Medicare, created in 1965 as part of the Great Society initiatives of another Democratic president, Lyndon Johnson, met the respective needs of those parts of the population.
Opponents of national health insurance, and later Medicaid and Medicare, had attacked those proposals as "socialized medicine" and, after the onset of the Cold War, begun linking them to communism, arguing that even with limited programs there was not only a slippery slope from the government paying doctors to telling them how to do so, those programs themselves were the leading edge of a greater encroachment on all political freedoms. In the 1960s, those opponents began to include not just physicians but members of a nascent American conservative movement, who believed that government had become too large and intrusive, not just in health care but in all aspects of life.
In 1961 Ronald Reagan, who was elected governor of California five years later, released a recording of a speech he gave against further government involvement in health care, in which he warned that Medicare would be followed by "other federal programs that will invade every area of freedom as we have known it in this country until one day ... we will awake to find that we have socialism." In 1964, Republican presidential candidate Barry Goldwater, who had won his party's nomination with strong support from the conservatives, suggested that once Medicare was in place there would be programs for other benefits. "Having given our pensioners their medical care in kind," he asked, "why not food baskets, why not public housing accommodations, why not vacation resorts, why not a ration of cigarettes for those who smoke and beer for those who drink?"
Bills to introduce universal coverage continued to be introduced in Congress, primarily by Democratic Senator Ted Kennedy, but failed. Republican presidents Richard M. Nixon and Gerald Ford were opposed to all but the most modest expansions of existing programs, and Kennedy and his allies could not reach agreement with their successor, Democrat Jimmy Carter, later in the decade, on a plan even though he supported the idea in principle. Reagan defeated Carter in 1980; while he was not opposed in principle to universal coverage, he believed it should not be provided by national insurance, and Congress did not seriously consider any proposals for it under either his administration or that of his successor George H.W Bush.
In 1992 another Democrat, Bill Clinton, was elected President. He had made securing universal coverage a campaign promise, and shortly after taking office began having his staff put together a bill to that effect. Opposition to the bill arose again from the industry and American conservatives. Their arguments now included not just the cost of the program and the tax increases that might be necessary to fund it, or its impracticability, but a generally libertarian principle that the state should not be involved in providing citizens health care at all. Leonard Peikoff, heir to the estate of influential novelist Ayn Rand, who had promoted a philosophy of maximum individualism through her work, reiterated her argument in a speech to opponents that those unable to afford their own healthcare costs could and should rely on charity or the free market rather than make any claim on the labor of health care professionals through the government.
There were nevertheless some Republicans in Congress who believed the problems with health care were real and that the country would benefit from addressing them. But the neoconservative strategist Bill Kristol counseled Republicans to oppose the Clinton plan without reservation rather than work with the administration, primarily for long-term political reasons. If the plan passed, he warned, "[i]t will revive the reputation of the party that spends and regulates, the Democrats, as the generous protector of middle-class interests," he warned. "And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining government." The bill ultimately died without even a committee vote, and Republican opposition to it was cited as a key reason the party retook control of the House in 1994 for the first time in 40 years, as well as the Senate, having made those elections a "referendum on big government".
Opposition to big government and increased entitlement spending on health care did not prevent Republicans from adding a prescription drug benefit to Medicare under the administration of George W. Bush in 2003. But when Democrat Barack Obama succeeded Bush in 2008, on a campaign promise of universal health care, Republicans once again united in opposition when Democrats, who had retaken the majority of both houses in 2006, began working on the Patient Protection and Affordable Care Act (ACA). Arthur C. Brooks, president of the American Enterprise Institute (AEI), a leading neoconservative think tank, cast the effort to block the ACA as a fight for the essence of American capitalism in the face of encroachment by European social democracy.
Obama reached out to moderate Republicans for support, but none of them would reciprocate, fearful of possible primary challenges from the Tea Party, as the populist movement that arose in backlash to Obama's election and in particular the health care reform effort became known. Republicans believed that if they could prevent the passage of the ACA, they could damage the Obama presidency sufficiently enough to not only recapture Congress as they had done during Clinton's first term, but set the stage for a Republican victory in the 2012 election. In July 2009, a few months into the debate on the bill, South Carolina Republican Senator James DeMint said that it would be the new president's "Waterloo" if he failed to deliver and disappointed his base. The party leadership in Congress thus decided to oppose the ACA outright and not offer any amendments or work with the Democratic majority in any way, although some members were willing to do so.
David Frum
After getting degrees from Yale and Harvard Law School, the Canadian-born Frum became part of the neoconservative movement in the mid-1980s, serving as editor of The Wall Street Journals editorial pages and later writing a column for Forbes. Typically for a neoconservative, he supporting an activist American foreign policy that confronted certain foreign governments as insufficiently liberal. Frum was not afraid to criticize other factions, as he did in his 1994 memoir Dead Right, where he suggested that right-wing movements should pay less heed to social conservatives and strict supply-side economics advocates.