Rocks, Hard Places & Obamacare

posted at 10:03 am on July 1, 2009 by Karl
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The New Republic’s Jonathan Cohn thinks Pres. Obama will get to sign some form of big-government healthcare “reform” bill this year, but wonders whether it will be a law that people end up hating, like the Medicare Catastrophic Coverage Act of 1988:

After the bill passed with overwhelming, bipartisan support, a backlash developed, memorably culminating in a “riot” of angry seniors who chased a beleaguered Dan Rostenkowski–then chairman of the House Ways and Means Committee–into his car after a Chicago meeting. Less than two years after passage, before the bill’s implementation, Congress voted to repeal the act, again with sweeping margins.

What had soured the public? As political scientist Jonathan Oberlander recounts in The Political Life of Medicare, a major factor was the sense among seniors–the program’s intended beneficiaries–that the program’s limited upside wasn’t worth the cost they were paying…

Cohn argues that the current proposals on Capitol Hill, getting scaled back in the face of the price tags marked up by the meanies in the Congressional Budget Office, run a similar risk:

Put aside, for a moment, the policy merits of these moves. The politics are lousy. Obama would be in danger of producing legislation that seems to offer little up-front benefit, particularly for the electorally vital middle class. And if some of these people end up paying even modestly higher taxes to help finance reform they’re not likely to be happy about it. It’s hard to imagine such legislation provoking a backlash that could produce total repeal. It’s not so hard to imagine such legislation creating bad political feelings, the kind that linger around until the next Election Day and pave the way for legislative retrenchment later on.

Of course, holding out for more generous subsidies, a robust public plan, or other reform elements that deliver clear, short-term benefits would obviously carry its own set of political risks. To get something through Congress, Obama probably needs some centrist support–or, at the very least, he needs to make a good show of courting it. But Obama must be wary of conceding too much. Even in strictly political terms, a good bill that passes with a narrow margin may preferable to a weak bill that carries huge majorities.

This is a nice try on Cohn’s part at dressing up the building Lefty demand for the most partisan, most socialistic government takeover of healthcare that the Democrats can muster. The problem is that even the flawed NYT/CBS poll told us that fewer than 25% of a sample largely skewed towards liberals are willing to pay as little as $500 a year to finance Obamacare. Indeed, that same poll told us that only 44% approve of how Obama is handling the issue, and fewer than 40% trust him on the issue. And those numbers are about what the latest RNC-sponsored poll found. (That poll also found 56% wanting to vote for a check-and-balance on Obama and the Democrats, but I digress.) A bare majority of likely voters told Rasmussen they favor the Democrats’ health care reform plan over the weekend, but those with strong opinions tilt the other way, with only 24% strongly favoring the plan, and 34% strongly opposed. Passing a more bloated law could easily increase the size of Cohn’s imagined mob, not shrink it.

The larger point is that the political trade-offs in the healthcare debate are as difficult for the Democrats as the policy trade-offs. Ultimately, they are unlikely to get meaningful support from the GOP (and I include Sen. Olympia Snowe in that statement). House Leftists threaten to kill a bill that does not include a strong government-run insurance plan, while their special-interest allies threaten moderate Democrats leaning against a big-government plan.

The political and policy tensions were always going to be there, as they were when the Clintons failed to take over the healthcare system. That is why Ezra Klein makes sense in theorizing that Obama’s strategy is to get a couple of bills — any bills — into a House-Senate conference, write the real bill there, and force it on moderate Democrats. The only flaw in that theory is the presumption that none of the moderates would filibuster. That’s why the Senate’s admitted Socialist, Bernie Sanders, is already working on the Democratic caucus to swear off a filibuster. It is a strategy that may yet underestimate Senators’ instincts for self-preservation, as voters and stakeholders will quickly figure out which votes matter as the debate unfolds. But given the competing political interests involved, it may be the most logical track for the Democrats to take.

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