Health Care Reform and Political Constraints

How likely are more sweeping health care reforms in the US? Not very likely at all.

Many in the comments threads of my two recent posts on health care reform indicate that a lot of people are convinced that the PPACA is naught much more than a Trojan horse (or maybe Pandora’s Box) that contains within it radical reforms and that it will only be a matter of time until such reforms are unleashed.

It is all well and good to assume that Nancy Pelosi hopes that the recently passed health care bill will eventually lead to more sweeping reforms at some point in the future.  Indeed, I am sure that she and many of her political fellow travelers hope that.   But hope and two bucks will get you acoffee at a DC Starbucks.  Hope, however, will not get legislation passed, let alone something major like moving to a single-payer healthcare system.

There is a little problem that is being ignored by many, it would seem, and it is called “political constraints.”  In other words, one has to weigh the fact that for any further changes to take place that the proponents of change will have to have the votes (i.e., the political power) to put forth such a result.  Who care what some politicians may hope for?  What matters is what are the odds that those politicians are going to have the needed votes to accomplish their goals?

Just looking at what it tool to pass PPACA should be more than sufficient to allay fears on the right regarding major changes to the system. Let’s consider the following facts:

  • Major health care reform aimed at moving the system to one of universality has been on the Democratic Party’s agenda for decades (and to no avail, including many decades of Democratic control of the Congress).
  • The last time the issue was even seriously debated prior to the passage of the PPACA was in the early 1990s.
  • For the PPACA to pass it required a super-majority of 60 votes in Senate alongside a substantial majority of Democrats in the House (not to mention a landslide presidential victory).
  • Indeed, in an excellent example of the nature of the political constraints I am talking about:  a special election in Massachusetts, flipping only one seat in the Senate, almost derailed the entire reform effort.

The bottom line is that it is highly unlikely that the Democrats will have the requisite votes to pass any sweeping health care reform any time soon or that there will be sufficient political will to motivate another round of reforms for that matter.  As such, it would seem to me that it is wiser to evaluate the current policy based on what it is, not one fears it might could be at some indeterminate (and low probability) event in the unforeseeable future.

To put the entire post in one simple line:  given how difficult it was to get the PPACA passed in the first place, why would anyone think that something more dramatic is going to be passed anytime in the foreseeable future?

Anyone who thinks that more reform is coming, especially reform as dramatic as a true government “takeover” simply isn’t paying attention to the reality of how policy is actually made.

FILED UNDER: Health Care, US Politics
Steven L. Taylor
About Steven L. Taylor
Steven L. Taylor is a Professor of Political Science and a College of Arts and Sciences Dean. His main areas of expertise include parties, elections, and the institutional design of democracies. His most recent book is the co-authored A Different Democracy: American Government in a 31-Country Perspective. He earned his Ph.D. from the University of Texas and his BA from the University of California, Irvine. He has been blogging since 2003 (originally at the now defunct Poliblog). Follow Steven on Twitter

Comments

  1. TJM says:

    In the foreseeable future? Of course not. But we know that universal coverage via single-payer system is the sought-after goal.

    Today the Senate voted to repeal DADT. Most of us knew this was the sought-after endstate in 1993, when it was passed as a half-measure toward allowing openly-gay service members to remain in the armed forces. That was obvious when then-President Clinton was criticized for not obtaining a full repeal of the ban. For the past 17 years, we’ve seen those people push forward with a movement to obtain this repeal. Likewise, most of us see the health care reform legislation as a half-measure toward universal health care. Similarly, the desired endstate is quite evident if you listen to and read the views of the many passionate advocates that were involved in the process. It may not have any hope in the next 4 years, but neither did DADT have hope of repeal in the 90s.

  2. @TJM:

    I fear you miss the point. Yes, it is the goal of some, but it is going to take a substantial amount of political will and power to achieve that goal. That aint gonna happen any time soon.

  3. Put another way: for some a single-payer system is the goal. For others, the goal is to block a single-payer system. The political calculus has to be taken of those two (and other) factions before one can act as if the goals of one group are more likely than the goals of another.

  4. tom p says:

    >>>”Many in the comments threads of my two recent posts on health care reform indicate that a lot of people are convinced that the PPACA is naught much more than a Trojan horse (or maybe Pandora’s Box) that contains within it radical reforms and that it will only be a matter of time until such reforms are unleashed.”

    Count me as among the hopeful.

    >>>”Hope, however, will not get legislation passed, let alone something major like moving to a single-payer healthcare system.”

    taking note of the # of derogatory comments by the “conservatives” towards “hope and change” I wonder at the fact that this has to be pointed out??????

    >>>”The bottom line is that it is highly unlikely that the Democrats will have the requisite votes to pass any sweeping health care reform any time soon or that there will be sufficient political will to motivate another round of reforms for that matter. ”

    Steve, unfortunately you are probably correct. No matter HOW much evidence accumulates that the “free market” does NOT work in health care, a majority will continue to beleive in the tooth fairy.

    And one more thing Steve, your continued insistence on referring to “Obamacare” as “the PPACA ” marks you as a “socialist commie pinko fag of an Obama-ite”….

    You need to be s**t and p****d on, then have your head c*****d off and s**t down the h**e….

    and just in case anyone could not figure that last part out….. SARCASM!!!!!!!!!!!!!!!!!!

  5. Trumwill says:

    I would take it a step further. The PPACA has actually stalled any sort of single-payer system for some time to come. The political capital has been spent. A price has been extracted and the Democrats are not going to be anxious to go through what they went through this year for a long, long time. If the PPACA is successful, it is a release-valve for the frustrations of our current health care frustrations and without that, the political will isn’t there. If the PPACA is a monumental failure, the political trust isn’t there since the party that would move us to a single-payer system is the party that gave us this.

    But ultimately, it comes down to the fact that I can’t imagine anyone is going to want to touch this potato again for a long time. On the upshot for PPACA supporters and Democrats more broadly is that it also likely means that the push for repeal is going to likely be a pretty short one and relatively limited in scope.

    If the passage of this law means anything, it’s that reforming our health care system means making some unpopular decisions. The public wants to have its cake and eat it, too, and there is always a party out of power that can point to either the cake not had or the cake not eaten and cry bloody murder.

  6. @Trumwill: I absolutely agree.

    Indeed, that was part of my point about the confluences of events that allowed the PPACA to pass in the first place.

  7. An Interested Party says:

    “…given how difficult it was to get the PPACA passed in the first place, why would anyone think that something more dramatic is going to be passed anytime in the foreseeable future?”

    Paranoia and fear of “the left”…

    “The PPACA has actually stalled any sort of single-payer system for some time to come.”

    But there were never enough votes in the Congress to pass a single-payer system, so what we are left with is probably the “best” that anyone who wanted that is going to get…

  8. […] Health Care Reform and Political Constraints […]

  9. TJM says:

    @Steven Taylor
    Oh, I get the point. I stated it twice in my brief comment. I was simply adding, “but…” because your point seems to be addressing a concern that no serious observer has. Of course we’re not going to do single-payer “in the foreseeable future.” Of course it will take a long time. I offered the example of DADT: 17 years. We all knew DADT enactment in 1993 was a step toward permitting openly gay service members – not in the foreseeable future, but at some point. Likewise, I think we all know that single-payer is the goal of the proponents of this health care reform legislation. Yes, it won’t occur in the next five years – but I’m not sure what serious observer thinks that it will.