The Duck of Minerva

Health Care Reform

24 June 2009

I don’t usually post on domestic policy issues. I’m even less likely to waste bandwidth explicitly seconding sentiments found on a big-time website. But, I’m afraid, that’s what I’m going to do here.

Theda Skocpol, author of, among other things, a bookthat insiders assure me gets a great deal right about why the Clinton health-care plan failed, gets it right.

Key leaps forward for U.S. public social provision — Social Security, Medicare, etc. — have NEVER happened through “bipartisan” compromises and they always happen in close votes. They have always sqweaked through after gargantuan effort, strong presidential pressure, and refusal to allow eviscerating compromises. Think of Social Security if the Clark amendment — allowing corporate opt-out — had passed in 1935. We would not have it. And conservatives and the medical and insurance establishments cried “socialism” in 1965, too. We would not have Medicare if we had listened.

Obama and the Democrats are coming off a historic, landslide election. They have all the popular support for robust reform they will ever have. Good policy design as well public desire for change and considerations of social justice and economic efficiency insist that they enact health care reform with a strong public plan in the mix. That is the only way to move toward cost control and guaranteed access with quality to all — especially for Americans in lower economic strata or in rural states where one or two private insurers call the tune. There is no need for “bipartisanship” and the calls for it from some weak-kneed Democrats are merely excuses for doing the business of the medical-insurance establishment. Senators Baucus, Conrad, Feinstein, Nelson, Landrieu, Bayh — this means you. All of you come from states where people really need robust reform and you should step up.

So far, though, the Democrats have managed to avoid one of the problems that doomed reform the last time around: a proliferation of alternatives offered by a slew of Senators, think tanks, and opinion-editorial writers. But beyond that, she’s totally right. The Senate Democrats can play the bipartisanship game as long as they want, but only so long as their endgame involves passing reform via the reconciliation process.

None of the “compromises” on the table are likely to garner enough Republican support without weakening reform beyond acceptable limits, although some of the ideas aren’t necessarily bad. For example, I can see an acceptable endgame in which the public-option bargaining chip gets traded in for two concessions from private stakeholders: (1) the creation of regional health cooperatives constituted with sufficient bargaining leverage to mitigate that lost from abandoning a public option and (2) the implementation of government mandates and strong regulatory powers concerning a portfolio of plans that private insurers would have to offer. But I just don’t see this kind of alternative as making much headway on the bipartisanship front.

So, when it comes down to it, I understand why Democrats from “Red States” are trying to cover their behinds. But pointing to a moderate Republican or two who voted for the bill isn’t going to make any difference to their re-election prospects. Swing voters are unlikely to turn against them for standing up to health insurance companies, who, I suspect, are locked in a tight competition with Wall Street firms for “least popular sector of corporate America.” And here’s the deal: there will be a backlash–aided by corporate money–against Democrats whether or not they pass a bill. However, if they pass a bill we’ll also see, for lack of a better term, a countervailing “prolash” in favor of the Democratic party. That lack of a “prolash” arguably made a big difference in the 1994 debacle that crippled the party for the next twelve years.