Can Health Reform Be Bipartisan?
Most of you visiting this site will already know the answer to this question. At the risk of spoiling the surprise: no, it can’t. But let’s take a closer look at exactly why. The conclusions can make us more effective advocates when dealing with those who either frame any health reform measure as less legitimate without broad Republican support (yes we’re looking at you Mr. President), or just want to get something done, regardless of effectiveness.
Such an analysis can take two basic perspectives. First, we can approach this subject as an activist committed to a meaningful public option. I’m afraid that by kneecapping single-payer advocates early in the debate, leading health reform advocates including the President have set up a very unfavorable environment for the public option. And all to get groups to the table that have just about zero chance of supporting any useful health reform measure. It’s nice to have opposition groups having to at least pretend they have some interest in being part of a solution, but at what cost?
The problem is that the public option really is in its very nature a compromise between private insurance and a single-payer system. The current system is a disaster. A single-payer system isn’t immediately viable given that people who currently have coverage are afraid of losing it and that fear can be manipulated by forces of the status quo. But it is pretty well established that single-payer is the most efficient way to do health care. Heck, even the American Medical Student Association says so! So a public option is seen as a sort of middle ground, a way of effectively placing the two systems against each other in competition. This competition will either force private companies to be more efficient or drive them out of business if they cannot. And hey, if public health care is the disaster that the foot-draggers say it is, nobody will choose it.
But with single-payer forced off the table, the public option becomes the “radical left” alternative rather than a middle-ground. So moderates of both parties will be afraid to back the public plan even if they like it personally, because they will be seen as kowtowing to the liberal leadership and supporting European-style socialism. So as the Overton Window shifts rightward (more on the Overton Window in a forthcoming post), the new “compromise” position excludes the public option. Even Max Baucus, who is famously agnostic on the public option, now acknowledges that single-payer should have been included for this reason.
And make no mistake, it will be very tough to hold the progressive position as the health debate winds its way through Congress. All we have to do is look at the path of the climate-change bill to see how badly watered down a sweeping change proposal must become to garner even a razor-thin majority. If even moderate Dems will have trouble supporting a robust public option, why should we ever expect Republicans to get on board?
This brings us to the second approach to this question: think like a mainstream Republican politician. Ewwwww.
Okay putting aside the disgust of having to emulate complete sociopathic selfishness, it’s pretty clear that I don’t have much to gain from the success of a Democratic-led health reform plan. Even if we manage to water it down to the point where it is acceptable to us conservatives, they and President Hussein Obama will get all the credit. If it works, people will grow more amenable towards big government and trust the Democrat Party more as a result. That is bad news for conservative Republicans who have stood against everything the Democrats have tried to do thus far (except health care in this thought experiment). Of course, if health care reform efforts fail to be effective, we will have supported it and all our asses will get primaried by Club-for-Growthers.
So as you see, the political incentives are completely for Republicans to oppose any form of health reform and hope it fails to achieve real change. In this model, it doesn’t especially matter that much whether it passes or not with almost entirely Dem support, although it’d be especially nice if it was killed by intra-party fractures. The key is that the health care system does not improve as a result, or else the Republican Party is cooked for a couple decades regardless of whether they support the reforms.
Democrats really need to figure this out, sooner rather than later, because prolonged commitment to bipartisanship is only gonna serve to handicap the most effective sorts of reform. Until that happens, they are getting played for fools yet again.
UPDATE: E.J. Dionne gets it. He also concurs with my point in the comments about Baucus.