Health Care Reform and the State of the Republic
While not at all pleased by the outcome of the year-long sausage making extravaganza that gave us a health care reform bill that virtually no one likes, I’m much closer in agreement Steven Taylor than with Megan McArdle over what it all means for the system.
Do we, as Megan suggested at the apex of her depression, “now in a world where there is absolutely no recourse to the tyranny of the majority?” Not hardly.
In November 2008, the voters elected a Democratic president and sent overwhelming Democratic majorities to the House and Senate. Thanks to Arlen Specter’s fecklessness, a defection gave the Dems a “filibuster proof” 60 votes in the Senate. And, yet, we wound up with a bill that — while exceedingly distressing to libertarian and fiscal conservative types like Megan and myself — was much, much milder than anything that conservatives could reasonably have expected. Certainly, much, much milder than Obama had campaigned on and so full of compromise that a goodly portion of the Progressive Coalition had to be arm twisted into voting for a bill they hate almost as much as I do.
How did that happen? Because the Republicans are just as skilled at using the various tools of legislative trickery available to them as the Democrats, managing to drag this thing out so long as to have it seem dead when Scott Brown was elected to fill Teddy Kennedy’s seat.
The Dems came back with a resort to a tactic that many of their own leaders deemed too foul to use the day after Brown’s victory: misuse of the budget reconciliation process in a way that would preserve the pre-Brown Senate package with some dubious “fixes.” Not exactly according to Hoyle, to be sure, but they did in fact manage to get 60 legitimate Senate votes for it last December.
As to the prospects of the Republicans, however, I tend to side with Megan’s future hubby, Peter Suderman rather than David Frum. While Frum’s right that the short-term blow this defeat sends to the Republicans is “crushing” and that many conservatives are living in a fantasy world about the extent of the voter revolt that’s coming in November, Peter’s quite right that Frum’s Rodney King vision of how American politics works is Pollyannish.
RomneyCare may have been developed with Republican establishment support, but if your focus is good policy rather than good politics, it’s not worth defending. Neither would any potential compromise along similar lines have been.
Frum doesn’t spell out exactly what deal he thinks Republicans should’ve cut, but the ground that he’s implicitly suggesting should’ve been given up was basically the whole enchilada: the insurance mandate, the subsidies, the government run and regulated marketplaces, the expansion of Medicaid. These are rotten policies that, in just a few years, have already had rotten outcomes. What would have been gained by ObamaCare opponents caving and supporting something along these lines?
The bottom line is that the Republicans had a very weak hand, at least largely of their own making, after the elections of 2006 and 2008. As noted earlier, it seemed inevitable after Obama won that we’d see something much, much worse than this (from a conservative perspective). It’s truly amazing how much of a firewall they managed to erect given how little leverage they had.
Moving beyond electoral politics into leadership — two very different things that are frequently conflated — I tend to agree with my colleague Dave Schuler’s longstanding insistence that the Republicans should have, at the very least, offered an actual bill of their own to show how they would have proposed to solve the actual problems which exist with our health care system.
Despite its many good even great qualities our system is looney. There’s no conceivable way that everybody can get all the healthcare they want and healthcare providers can get whatever they want for providing it. Furthermore any system in which the government with its deep pockets and regulatory capability bids against private individuals for healthcare services is neither good nor sustainable. It’s a flywheel ready to spin off.
But, given the vagaries of electoral politics, one understands why they didn’t. Then again, as Dave explicates at length in two recent posts, the Democrats haven’t solved them either.