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Wednesday, August 19, 2009  

Health Care: Now with Less Grassley

There's a good article in the Times today explaining why the White House and some in the Congressional leadership are looking to pass health care on a party-line vote after deciding that the Republicans are not interested in negotiating in good faith. Most notably, Sen. Chuck Grassley (R-IA) recently reiterated his insistence that even if he gets everything he bargains for in committee, he'll still vote no on the floor without wide support from the rest of his party. I don't know why Grassley decided to tip his hand like that, but it gets very difficult to justify making concessions in exchange for zero votes.

Yglesias wonders whether the Administration and its allies were really naive enough to think that a decent bipartisan bill was possible, or whether the focus on a bipartisan process was a rope-a-dope meant to flush out Republican obstructionism. I have no evidence for either claim, but my hunch is that it was naivete. Because in a plausible version of the right-left divide in American politics, what you'd see is Democrats emphasizing expanding access to care and regulating private insurance, perhaps at the expense of industry profits. Republicans, on the other hand, would be wary of adding to to the long-term deficit (bear with me here) and of stifling innovation by tamping down profits. Such a scenario would lead to a reform that would expand coverage, mandate coverage for pre-existing conditions, and so on for liberals while conservatives insisted on raising revenue by closing tax loopholes on expensive employer-provided plans and finding some cost savings in Medicare (I'm leaving out the public plan for the sake of simplicity; obviously that would not be an easy sell). In other words, you'd see the priorities of both sides being reflected, imperfectly, in a final bill that could be embraced by some, if hardly all, of the members of both parties.

What we've seen, of course, is one side try to do the work of both expanding coverage and controlling costs while the other has devoted itself to torpedoing the whole thing. Ross Douthat had an excellent column yesterday explaining why this was a bad thing for Republicans to do:

Medicare’s price tag, if trends continue, will make a mockery of the idea of limited government. For conservatives, no fiscal cause is more important than curbing this exponential growth. And by fighting health care reform with tactics ripped from Democratic playbooks, and enlisting anxious seniors as foot soldiers, conservatives are setting themselves up to win the battle and lose the longer war.

Maybe Republicans will be able to cast themselves as the protectors of entitlements today, and then impose their own even more sweeping reforms tomorrow. That’s the playbook that McConnell, Brownback and others seem to have in mind: first, save Medicare from Obama; then, save Medicare from itself.

But for now, their strategy means the country suddenly has two political parties devoted to Mediscaring seniors — which in turn seems likely to make the program more untouchable than ever.

Ross is right on the merits of the case, but it shows how little the merits have to do with anything. The Republicans got pounded in 1996 for trying to cut the growth of Medicare; after that, they decided to do things a little differently. They were last seen adding an enormous, unfunded obligation to Medicare in the form of a prescription drug benefit.

And why, exactly, should we expect anything different? Policy is not a zero-sum game, but electoral politics is. Any measure that fails in Congress will retroactively be labeled by all as "unpopular," an "overreach," and so on. All the talk of "starting over" is entirely idle. The point is to stop the process, kill it, and never start it up again. The point is to defeat the president and ride his failure to reform health care to mid-term election victory.

Moreover, when you can do this by riling up your base--old white people and the defiantly paranoid--you've got a political opportunity on your hands too great to turn down. The fix was in on this one from the start, and it's unfortunate that Obama has seen his popularity--and thus his clout with his party in the Clown College Senate--slip so far before getting real about this bill. The good news, however, is that Max Baucus and Ben Nelson, whatever their real political instincts on this issue, probably won't want to be seen as the guys who killed health care.

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posted by Benjamin Dueholm | 10:30 AM
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