Reflections on the Health Care Bill

I hope I’m wrong in thinking that the health care bill that just passed Congress is an imprudent mistake. As I’ve said many times before, this is the way to improve on the current system. President Obama’s reform efforts are going to insure lots of new people, an achievement to celebrate, but I’d have preferred bringing about that outcome via different means — I am particularly terrified of the fiscal implications of this bill, which exacerbates the American government’s addiction to living beyond its means.

Obviously Democrats bear a lot of blame for weaknesses in the bill, and some of them will rightly pay the price for serving their constituents insufficiently well in 2010. At the same time, David Frum is exactly correct about the approach taken by conservatives and Republicans:

At the beginning of this process we made a strategic decision: unlike, say, Democrats in 2001 when President Bush proposed his first tax cut, we would make no deal with the administration. No negotiations, no compromise, nothing. We were going for all the marbles. This would be Obama’s Waterloo – just as healthcare was Clinton’s in 1994.

Only, the hardliners overlooked a few key facts: Obama was elected with 53% of the vote, not Clinton’s 42%. The liberal block within the Democratic congressional caucus is bigger and stronger than it was in 1993-94. And of course the Democrats also remember their history, and also remember the consequences of their 1994 failure.

This time, when we went for all the marbles, we ended with none.

Could a deal have been reached? Who knows? But we do know that the gap between this plan and traditional Republican ideas is not very big. The Obama plan has a broad family resemblance to Mitt Romney’s Massachusetts plan. It builds on ideas developed at the Heritage Foundation in the early 1990s that formed the basis for Republican counter-proposals to Clintoncare in 1993-1994.

Barack Obama badly wanted Republican votes for his plan. Could we have leveraged his desire to align the plan more closely with conservative views? To finance it without redistributive taxes on productive enterprise – without weighing so heavily on small business – without expanding Medicaid? Too late now. They are all the law.

No illusions please: This bill will not be repealed. Even if Republicans scored a 1994 style landslide in November, how many votes could we muster to re-open the “doughnut hole” and charge seniors more for prescription drugs? How many votes to re-allow insurers to rescind policies when they discover a pre-existing condition? How many votes to banish 25 year olds from their parents’ insurance coverage? And even if the votes were there – would President Obama sign such a repeal?

We followed the most radical voices in the party and the movement, and they led us to abject and irreversible defeat.

There were leaders who knew better, who would have liked to deal. But they were trapped. Conservative talkers on Fox and talk radio had whipped the Republican voting base into such a frenzy that deal-making was rendered impossible. How do you negotiate with somebody who wants to murder your grandmother? Or – more exactly – with somebody whom your voters have been persuaded to believe wants to murder their grandmother?

I’ve been on a soapbox for months now about the harm that our overheated talk is doing to us. Yes it mobilizes supporters – but by mobilizing them with hysterical accusations and pseudo-information, overheated talk has made it impossible for representatives to represent and elected leaders to lead. The real leaders are on TV and radio, and they have very different imperatives from people in government.

So what happens next? While I agree with many Megan McArdle critiques of the bill on substance, I think she is uncharacteristically wrong when she writes this:

One cannot help but admire Nancy Pelosi’s skill as a legislator. But it’s also pretty worrying. Are we now in a world where there is absolutely no recourse to the tyranny of the majority? Republicans and other opponents of the bill did their job on this; they persuaded the country that they didn’t want this bill. And that mattered basically not at all. If you don’t find that terrifying, let me suggest that you are a Democrat who has not yet contemplated what Republicans might do under similar circumstances. Farewell, Social Security! Au revoir, Medicare! The reason entitlements are hard to repeal is that the Republicans care about getting re-elected. If they didn’t–if they were willing to undertake this sort of suicide mission–then the legislative lock-in you’re counting on wouldn’t exist.

Oh, wait–suddenly it doesn’t seem quite fair that Republicans could just ignore the will of their constituents that way, does it? Yet I guarantee you that there are a lot of GOP members out there tonight who think that they should get at least one free “Screw You” vote to balance out what the Democrats just did.

If the GOP takes the legislative innovations of the Democrats and decides to use them, please don’t complain that it’s not fair. Someone could get seriously hurt, laughing that hard.

The Democrats campaigned on health care in 2008, and at the time a majority of Americans supported reforms. Later the Republicans managed to change the polling numbers through some mix of valid critiques and outright lies. Most polls on the subject revealed that Americans were confused about the issue. Many people didn’t understand the questions being asked of them, or else held mutually exclusive positions at the same time. Much as I hate the outcome in this case, I’d much rather that elections influence policy than that politicians win mandates at the ballot box, and are thought to lose them because poll numbers shift. How easy is it to move poll numbers? How reliable are polls on complicated questions? We’re a republic rather than a democracy for a reason.

Moreover, I think that Megan’s comparison to Republicans dismantling Social Security and Medicare is unpersuasive. I highly doubt that the GOP is ever going to run on a “repeal Social Security and Medicare” platform, but if they do so as the centerpiece of a successful campaign, winning the White House and majorities in both houses of Congress, their critics will be exactly wrong to vilify them should they go ahead and more or less make good on their promises.

3 Responses to “Reflections on the Health Care Bill”

  1. How it's playing in Peoria (6 PM News Update) | Internet Buzz Says:

    […] Reflections on the Health Care Bill […]

  2. mfarmer Says:

    I’m disappointed in your response. Frum is exactly wrong, but then I suppose it depends on whether you believe this is the first step toward single payer, and whether you believe single payer is a good idea. On this issue, I believe the moderate position is a cop-out. Yes, very disappointed. I can’t understand some of you guys who seem so sharp in so many areas, but when it comes to issues like this, you appear to purposefully ignore the reality and dangers. Oh well, perhaps I’m the one that’s wrong and this will somehow not be as tragic as I think it will be. If no one else is going to freak, I guess I’ll shrug and just wish it had been a little better, then blame the conservatives — those assholes.

  3. Health Care and the Noble Lie | Politics In Vivo - Political and Cultural Commentary, and Whatever Else... Says:

    […] always-excellent Conor Friedersdorf, like Megan opposed to the health care law, but unlike Megan, making sense in the aftermath: The Democrats campaigned on health care in 2008, and at the time a majority of Americans supported […]

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