Winning the Healthcare Fight
David Frum frets that conservatives might be in for a Pyrrhic victory in the health care fight if they define winning as “beat back the president’s proposals, defeat the House bill, stand back and wait for 1994 to repeat itself.”
[W]e’ll still have the present healthcare system. Meaning that we’ll have (1) flat-lining wages, (2) exploding Medicaid and Medicare costs and thus immense pressure for future tax increases, (3) small businesses and self-employed individuals priced out of the insurance market, and (4) a lot of uninsured or underinsured people imposing costs on hospitals and local governments.
We’ll have entrenched and perpetuated some of the most irrational features of a hugely costly and under-performing system, at the expense of entrepreneurs and risk-takers, exactly the people the Republican party exists to champion.
That’s essentially the argument Dave Schuler’s been making for months. And it’s right as far as it goes: We’re not talking about a free market system that’s functioning superbly and needs only to be saved from the depredations of socialism; large parts of the system are already on the federal budget and the trends are unsustainable.
So, what does Frum propose conservatives do? Well, nothing in that post. Fortunately, he follows it up with this a rather detailed set of bullet points which he says is “non-exhaustive.” Allowing the self-insured to buy insurance with untaxed dollars, support for private co-ops, a government rating system, outlawing certain insurance company bad practices, moving away from employer-financed insurance, tort and malpractice reform, and so on. He then concludes:
We should of course fight against any so-called public option. Direct government provision ought to be the conservative red-line; No deal at all is preferable to a deal that includes a bigger government entry into the insurance business.
Which, ironically, is the Republican position that he’s complaining about!
Reality check: We have a Democratic president with overwhelming Democratic majorities in the House and the Senate. There is no way — zip, zero, zilch, nada — for Republicans to pass tort reform or any number of other programs that they might prefer. The time for that was in 2001 when they had the presidency and both Houses of Congress.
All the Republicans can really do is throw sand in the gears and try to prevent creation of a massive new government entitlement program. If public option becomes reality, not only will it be permanent but it will likely become increasingly less optional.
Tactically, the only way to achieve that is to attack the weakest parts of the Democratic plan so as to put pressure on Democrats in more conservative states and districts to break from the pack and vote against the package. That’s not done by wonkish talk about fantasy alternatives but rather by making Obamacare the target.
And, lo and behold, it seems to actually be working.
Frum’s approach, by contrast, would make it much more likely that conservatives lose the big fight on public option. It concedes that what we have now isn’t working and that the government must step in and do something. Given who’s in charge, that something would not look much like Frum’s list.