Continuing my healthcare focus... I've largely ignored the politics surrounding the healthcare reform debate, mostly because the lack of a firm proposal has made the political arguments especially disconnected from anything real. That has been changing in the last few weeks, as we've begun to focus (not entirely well) on specifics. And now I think is the time to admit that the politics of healthcare reform... are not looking good.
This isn't surprising, and much of the unwinding of the political momentum has been predictable. Along with others, I've been arguing for months (okay... years, but let's focus on recent events) that we needed a full debate, in public, about our health care issues in the United States. Instead, for months, the major efforts to craft health care reform took place largely behind closed doors, and any debates about big issues took place largely among people very familiar with all the policy issues and who, generally, agreed on potential solutions.
The net effect has been, much as I and others expected, that as the reform bill's proposals have become more widely disseminated we are re-arguing points that many knowledgable people consider settled. As well, an issue like controlling costs of care now has the ability to derail the whole debate precisely because the people crafting the bill kept the cost of care debate out of their discussions. Had the reform bill been subjected to a more public (or... transparent) process, I suspect a number of key objections could have been raised and dealt with sooner.
As it stands, and as I remain convinced, the healthcare reform bill is looking kind of doomed. And politically, that may be very damaging to Democrats.
Or maybe not.
I don't think the failure of the Obama Administration to turn their healthcare reform plans into legislation has been a policy failure; I think it's a political one, the same one that's been dogging them since Barack Obama decided to run. Too cautious, too "academic", too insular... the Obama folks have once again waited too long and acted too cerebral on the specifics of a plan. The President needed to come out - or to have a well spoken representative take the lead - sooner and more forcefully, not with vague general concepts he likes, but specific policy proposals that would shape the reform process.
Now, the White House says they will be "fighting hard" for reform... but in many ways, as others note, that ship has sailed. Though Obama apologists like Ezra call it brilliant "strategery", the "he's been keeping his powder dry until it matters" argument just doesn't hold up; what he's done looks more like dithering, and failure to take a solid stand when it mattered.
The only route now will be to take the current bills and tinker with them to find just enough votes to make them pass; this will lead to two fairly conflicting measures, because what the Democratic caucus in the House can pass differs considerably from the Senate. Then, if that can be accomnplished, the two bills have to be force fit into a compromise that can still get enough votes in both houses. It's likely the Senate will dominate that process. And what we will wind up with - if we wind up with anything - will likely be a hodgepodge of conflicting ideas that may make little, if any, real difference.
Failing, politically, to get a good piece of health care reform legislation may well hurt both Congressional Democrats and the President... but I'm not sure how much, really. It seems clear that progressive activists will be deeply disappointed with failure to do something comprehensive; but at the same time, some of the most lefty voices have been advocating loudest for a move to Single Payer, which was never in the cards to begin with, and their disappointment started long ago. Other progressives may well be satisfied if smaller, more piecemeal fixes replace the comprehensive effort.
Whether this hurts Obama and Democrats with more conservative voters... I'm not so sure. The growing solidification of opposition on the right is mostly a "no, not this" response rather than a "we have a better idea" type response. The best anti-reform argument conservatives have been able to muster is to run against the National Health Systems of Canada and Great Britian. That may make for effective soundbites... but it's hardly a thoughtful policy debate, either. There's essentially zero chance that we could go from our current employment based healthcare model to anything resembling the NHS; and wise conservatives know that.
Indeed, the continuing political story of healthcare is that Republicans are nowhere. Just the question of whether there's a problem tends to lead a rancorous internal debate among Republicans about whether anything needs to be done at all. Starting from behind square one - which has been the Republicans real weakness since about 2004 - on healthcare has made healthcare a lose-lose issue for Republicans and that doesn't seem likely to change even if the reform bill is derailed. You'd have to have a promising healthcare alternative to really make the failure stick.
The reason I think the healthcare reform plan will fail, poltically, is just this calculus: as much as failure to accomplish a signature issue will damage Barack Obama, a failure on healthcare isn't something Republicans can then turn to their advantage. We'll still have millions of people without insurance, rising costs, and with high unemployment, the sense that there's a crisis we can't solve. And moderate Democrats may well convince themselves - many already seem to have - that having to defend a bad bill may be worse than saying "we tried, and we need to try again." And all of the politics on healthcare, really, is the politics of dancing... around the issue. Don't stop the dance... and that probably means, don't do reform now, and try again later.
Comments