Obama's Moderate Health Care Plan

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JONATHAN CHAIT MARCH 22, 2010

Obama's Moderate Health Care Plan

Is President Obama's health care reform a moderate bill, as Democrats claim, or an something more extreme, like Republicans say? William Bennett offers up the Republican case:

On Saturday, the president said “this is a middle of the road bill.” It is not. The National Journal aggregation of polls has a 7 percent national opposition deficit (50 percent oppose, 43 percent support). Not one Republican — not Olympia Snowe, not Sue Collins, not Tom Coburn, and not Jim Inhofe — is supporting this. ... Last night’s vote still had 34 Democrats voting against it, which means that more Democrats joined Republican opposition than did Republicans join Democrats in support. By definition, this is not middle of the road.

This is a fair summation of the Republican position. The two measures of whether the law is moderate are its status in opinion polls and the presence or absence of support from the opposing party. I consider both these measures flawed.

First, it's true that more polls show the public opposed to health care reform than in support. On the other hand, significant chunks of opposition comes from the left. In the latest CNN poll, 39% favor the health care bill in Congress, 43% oppose it as too liberal, and 13% oppose it as not liberal enough. (Polls about health care like this one that don't identify the bill as supported by Obama or the Democrats seem to have lower support, perhaps because they don't cue low-information Democratic partisans to support it.)

Likewise, a December ABC poll found that 42% of Americans thought Congress's health care plan entailed too much government involvement in the health care system, 34% the right amount, and 21% not enough government involvement. Several other polls have produced similar findings. In December Nate Silver analyzed yet another poll showing a similar result, and mapped out the electorate like so:

All of this is to say that Obama's position commands the center of the political spectrum.

The Republicans' second measure is the lack of Republican support. It's true, no Republican supports Obama's plan. Republicans like Bennett site this fact as ipso facto proof that the plan is extreme. This definition inherently rules out the possibility that Republicans are opposing a moderate plan out of some combination of partisanship and ideological extremism. Suppose Obama decided to embrace the Republcian proposal as his own, and then every Republican subsequently abandoned the proposal, making it a Democrats-only plan. (This may sound ludicrous, but it happened in 1994.) By the Republican definition, the lack of GOP support would prove that Obama was supporting an extreme proposal.

Moreover, public opinion and Republican Congressional support are also problematic measures of a bill's moderation because the two can interact. As Mitch McConnell has explained, the fact of united Republican opposition has helped turn the public against the bill:

“It was absolutely critical that everybody be together because if the proponents of the bill were able to say it was bipartisan, it tended to convey to the public that this is O.K., they must have figured it out,” Mr. McConnell said about the health legislation in an interview

So I'd propose that the ideological character of the plan can only be determined by referring to its policy content. If Obama's claim about his plan's moderation were correct, would would we see? We'd see that Obama had modeled his plan after other proposals that had gained the support of Republicans. The lack of Republican support in Congress would not refute the claim of moderation -- we would explain this as evidence that the GOP had moved to the right and/or embraced a partisan strategy of opposition.

And indeed, this is exactly the case. Obama's plan closely mirrors three proposals that have attracted the support of Republicans who reside within their party's mainstream: The first is the 1993 Senate Republican health plan, which is compared with Obama's plan here, with the similarity endorsed by former Republican Senator Dave Durenberger here. The second is the Bipartisan Policy Center plan, endorsed by Bob Dole, Howard baker, George Mitchell and Tom Daschle, which is compared to Obama's plan here. And the third, of course, is Mitt Romney's Massachusetts plan, which was crafted by the same economist who helped create Obama's plan, and which is rhetorically indistinguishable from Obama's. (The main difference are that Obama's plan cuts Medicare and imposes numerous other cost-saving measures -- which is to say, attempting to craft a national version of Romney's plan would result in something substantially more liberal than Obama's proposal.)

The odd thing about Romney's status as current Republican presidential contender is that he'd have no chance at all if he had not run in 2008. If Romney were arriving on the national scene now, his health care plan would utterly disqualify him. In fact, as I've written, I think it will. But the conservative view of Romney's plan from 2008 provides an instructive glimpse into how even very conservative elements of the GOP were willing to regard a plan that resembled Obama's ideologically. In its 2007 editorial endorsing Romney for President, National Review made just one glancing reference to his universal coverage scheme:

[Romney] knows that not every feature of the health-care plan he enacted in Massachusetts should be replicated nationally, but he can also speak with more authority than any of the other Republican candidates about this pressing issue.

Right-wing talk show host Hugh Hewitt wrote an entire book endorsing Romney. In it he praised his health care plan effusively, specifically singling out elements like universal coverage and the individual mandate:

This brilliant bit of legislating was born from a partnering between Romney and his policy team with the conservative Heritage Foundation. Put simply, the problem of the uninsured is a problem for everyone, as the uninsured still consume health care and the costs of that care must be covered from somewhere, usually general fund tax revenues and in the form of higher premiums assessing the covered population.

Of the approximately half-million uninsured in the Commonwealth as 2006 opened, however, about 200,000 were healthy ‘risk takers’ who preferred spending dollars on Red Sox tickets or good and services other than premiums for health care insurance that they figured they probably wouldn’t need until pregnancy or their middle years arrived.

What Romney and Heritage discovered is that in fact thousands of these risk-takers end up needing health care, and of the expensive sort. They don’t have insurance, so the state and the medical care providers eat the costs, which means the taxpayers and/or premium payers eventually get the bills.

To this group of people who are able to insure themselves but unwilling to do so, the Romney plan gives no choice but lost of encouragement: beginning in January of 2008, they must either insure themselves or be subject to a costly fine. There are provisions the assist in making insurance plans widely known and some common purchasing power deployed as well, but it is primarily a stick that is wielded in their direction.

Today, of course, Republicans deem the individual mandate unconstitutional. Every Senate Republicans voted for a resolution calling the mandate unconstitutional, even though several of them had negotiated over plans containing such a mandate without objecting to it, and one of them Olympia Snowe, voted out of committee a plan with an individual mandate.

Obama is signing what was, until recently, a moderate Republican health care plan by every substantive comparison or definition. The unanimity of Republican opposition says more about Republicans than it does about the plan itself.

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posted in: jonathan chait, cnn, obama, republcian, barack obama, bob dole, dave durenberger, george mitchell, hugh hewitt, jim inhofe, mitch mcconnell, sue collins, tom coburn, tom daschle, william bennett, congress, medicare, republican party, massachusetts

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