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.



5 comments so far

  1. Chris on

    I think there real hope, on health care at least, that they are starting to “get it” about the bipartisanship on signatures reforms.

    Baucus’s staff told health care lobbyists not to attend a GOP event if they wanted their voices to be heard by Democrats. They took a lot of heat for that, but it shows they don’t want to waste their time negotiating with organizations acting in bad faith against reform.

  2. jeremydc on

    Really, Chris? Your example is Baucus?! This is the same guy who’s gone out of his way to hear what Chuck Grassley has to say and is working with this Gang of 7 that he actually calls a “coalition of the willing”. While he has little respect for the proud wingnut faction of the GOP, Baucus still is a true believer in classic head-in-the-sand Broderism, and he almost singlehandedly controls the fate of the public option.

    Now there are some other very promising signs within the Senate Dem caucus, most notably from the often wishy-washy Chuck Schumer. He seems to be leading the push for the public option within the Senate Finance Committee and emphatically smacked down Conrad’s half assed co-op idea last week. While I don’t always agree with his policies, Schumer is perhaps the savviest political strategist in the Senate and I think he quite clearly understands the GOP’s incentives on health care that I laid out in this post.

    On a related note, there is enormous pressure on Reid to deliver a decent health care bill. If he fails, I predict Schumer will roast his ass in the next Congress’s leadership fight.

  3. Chris on

    Baucus isn’t the ideal person to write the bill, but he’s demonstrating awareness that certain health care lobbyists/Congresspeople have previously engaged in dual track advocacy working both to moderate reform, while simultaneously trying to torpedo the entire effort. That was key failure of the Clinton health care effort. Grassley is basically a responsible actor, and no more ideologically opposed to reform then Evan Bayh.

    As for Reid, I’ve given up thinking about what would get him removed. It’s been clear for a long time they could have a stronger leadership with virtually any of the potential candidates.

  4. Chris on

    Hey, check out this article on Reid telling Baucus to ditch efforts get the GOP on board with health care reform.

    Reid’s still Reid, and Baucus is still Baucus is still Baucus, but the dynamics in terms of the strategy and effort on the part of Progressive politicians and Progressive groups is in rare form. The only thing holding back complete unity among the center left is Obama’s inconsistent rhetoric.

    • jeremydc on

      Funny. I was literally just about to post this same article right here. Except I interpreted as yet another reason why your holding up Baucus as the key example of Dems “getting it” is just silly. Baucus remains deeply mired in the muck of High Broderism, given that even Harry Reid is telling him to wise the hell up.

      But it’s a REALLY good sign to see Reid finally striking the right chord on the issue and trying to move his caucus where it counts. The question is, will he do more than ask really nicely, pretty please Mr. Baucus would you kindly not value Chuck Grassley’s opinion over the majority of your own caucus?

      Yes the progressive infrastructure is really coming into its own with this fight. It’s a beautiful thing to see.

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