Last week, House Budget Committee Chairman Paul Ryan announced that his party would not offer a "singular alternative" to the Affordable Care Act. For good reason. Four years after they first declared they would "repeal and replace" Obamacare, the CBO concluded the most recent House GOP trial balloon would increase the national debt and cause 1 million workers to lose their insurance.
Nevertheless, the Washington Post reported Sunday "House Republican leaders are adopting an agreed-upon conservative approach to fixing the nation's health-care system, in part to draw an election-year contrast with President Obama's Affordable Care Act." But the GOP strategy is nothing new under the sun. After all, the Republicans' outline contains many provisions already included in the Affordable Care Act. And as it turns out, the House GOP is basically recycling the same health care proposal Republicans candidates have been running on since Bill Kristol first offered it as an alternative to Bill Clinton's plan two decades ago.

As the Post explained the Republicans' midterm approach:

This is the first time this year that House leaders will put their full force behind a single set of principles from those bills and present it as their vision. This month, House leaders will begin to share a memo with lawmakers outlining the plan, called "A Stronger Health Care System: The GOP Plan for Freedom, Flexibility, & Peace of Mind," with suggestions on how Republicans should talk about it to their constituents.

Now, that GOP memo (or at least a version of it) has been publicly available for some time. And what it offers--besides prepackaged sound bites and anti-Obamacare talking points--is a rehash of proposals designed not to cover 30 million Americans, but instead to prevent Democrats from successfully doing it:

The plan includes an expansion of high-risk insurance pools, promotion of health savings accounts and inducements for small businesses to purchase coverage together.
The tenets of the plan--which could expand to include the ability to buy insurance across state lines, guaranteed renewability of policies and changes to medical-malpractice regulations--are ideas that various conservatives have for a long time backed as part of broader bills.

Make that a very long time.
Of course, for Republicans what is old is new. (That's what makes them conservatives.) And what the GOP is offering now is little changed from what former Dan Quayle adviser and current Weekly Standard editor Bill Kristol laid out as a blueprint during the war over Bill Clinton's health reforms over 20 years ago.
In his infamous December 3, 1993 memo titled "Defeating President Clinton's Health Care Proposal," Kristol warned Republicans "The first step in that process must be the unqualified political defeat of the Clinton health care proposal":

"Its passage in the short run will do nothing to hurt (and everything to help) Democratic electoral prospects in 1996. But the long-term political effects of a successful Clinton health care bill will be even worse--much worse. 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."

A month later, Kristol detailed "How to Oppose the Health Plan--and Why" with a set of bullet points that by now should look very familiar:

• Reform insurance markets to make health insurance stable and portable
• Limit pre-existing-condition restrictions under employer health plans
• Eliminate barriers to small business insurance pools
• Lower insurance premiums by making them tax-deductible
• Permit the establishment of medical savings accounts
• Reduce costs through malpractice reform Simplify health care paperwork through administrative reforms
• Reduce Medicaid and Medicare expenses by lifting the regulatory burden on states
• Provide health insurance tax credits or vouchers to low-income families

Now, history is repeating itself. Again. During the last presidential election, Mitt Romney--or at least the 2012 edition of him--is largely recycled President Bush's disastrous prescription for health care, one which was also championed by John McCain six years ago. Despite the clear success of his popular Massachusetts program in reducing both the ranks of the insured and the rate of growth of costs, Romney largely repackaged Bush's stillborn proposals. That litany includes selling insurance across state lines, enacting draconian curbs on malpractice awards, supporting tax-free health savings accounts (HSAs) and, most importantly, giving tax deductions to individuals to private insurance while ending them for businesses. (The most generous estimates forecast that the Bush plan would have enabled insurance coverage for only 9 million of the 50 million people then lacking it.) And as the Los Angeles Times explained, Romney's $1 trillion prescription would have been catastrophic:

Critics and independent analysts say the impact would probably leave a larger number of Americans without insurance...While offering consumers more choices, Romney's plan would give companies strong incentives to stop providing insurance to workers. It also would overhaul the 46-year-old Medicare and Medicaid programs for the elderly, poor and disabled.

It's no wonder Ezra Klein asked, "Do Republicans Really Want Universal Health Care?"
Of course not. The answer to Klein's question is the same as it was 20 years ago. Republicans aren't afraid that Obamacare will fail, but that it will succeed. That could mean that an American public grateful for access to health care might provide Democrats with an enduring majority for years to come. And that would be very unhealthy for Republicans, indeed.