THE PLANK DECEMBER 19, 2009
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The United States is on the doorstep of comprehensive health care reform. It's a staggering achievement, about which I'll have more to say later. but the under-appreciated thing that strikes me at the moment is that it never would have happened if the Republican Party had played its cards right.
At the outset of this debate, moderate Democrats were desperate for a bipartisan bill. They were willing to do almost anything to get it, including negotiate fruitlessly for months on end. We can't know for sure, but Democrats appeared willing to make enormous substantive concessions to win the assent of even a few Republicans. A few GOP defectors could have lured a chunk of Democrats to sign something far more limited than what President Obama is going to sign. And remember, it would have taken only one Democrat to agree to partial reform in order to kill comprehensive reform. I can easily imagine a scenario where Ben Nelson refused to vote for anything larger than, say, a $400 billion bill that Chuck Grassley and a couple other Republicans were offering.
But Republicans wouldn't make that deal. The GOP leadership put immense pressure on all its members to withhold consent from any health care bill. The strategy had some logic to it: If all 40 Republicans voted no, then Democrats would need 60 votes to succeed, a monumentally difficult task. And if they did succeed, the bill would be seen as partisan and therefore too liberal, too big government. The spasm of anti-government activism over the summer helped lock the GOP into this strategy -- no Republican could afford to risk the wrath of Tea Partiers convinced that any reform signed by Obama equaled socialism and death panels.
The role of Olympia Snowe is interesting here. Snowe negotiated seriously for months, and Democrats met what seemed to be her substantive concerns, but, like the Russian army retreating before Napoleon, she insisted that the bill be drawn out indefinitely. Snowe demanded that the process not be rushed, but she never defined what a reasonable time frame would be. In the summer, "taking your time" and "doing it right"meant waiting until after the August recess. In the fall, it meant until after Thanksgiving. Now it means until after Christmas. If it lasted until next year, eventually Republicans would demand that the process not be rushed before the midterm elections, and that the fair thing would be to let the people decide in the 2010 elections.
The GOP leadership has every incentive to stretch the process out as long as possible. It runs out the clock on the first two years of the Obama presidency, after which high unemployment and the natural effects of an off-year election would produce a Congress far less likely -- perhaps totally unwilling -- to cooperate with Obama. Snowe might have diverged from the party line on substance, but she seems to have agreed to hold the line on process. At some point, process becomes substance. Thus Snowe effectively removed herself from the negotiations.
And so Democrats found themselves all alone. It seems to be around August when the party realized that bipartisan dealmaking was not at hand, and it had to pass a bill or face the same calamity as it did in 1994. Politically speaking, there were no good options left, but passing a bill offered the least bad option. The unified partisan front of the Republican Party forced the Democrats to adopt their own unified partisan front, something that appeared impossible as recently as this last summer. This passage from the New York Times is telling:
Faced with Republican opposition that many Democrats saw as driven more by politics than policy disagreements, Senate Democrats in recent days gained new determination to bridge differences among themselves and prevail over the opposition.
Lawmakers who attended a private meeting between Mr. Obama and Senate Democrats at the White House on Tuesday pointed to remarks there by Senator Evan Bayh, Democrat of Indiana, as providing some new inspiration.
Mr. Bayh said that the health care measure was the kind of public policy he had come to Washington to work on, according to officials who attended the session, and that he did not want to see the satisfied looks on the faces of Republican leaders if they succeeded in blocking the measure.
Evan Bayh! When you've turned the somnolent, relentlessly centrist Indiana Senator into a raging partisan, you've really done something. The Republicans eschewed a halfway compromise and put all their chips on an all or nothing campaign to defeat health care and Obama's presidency. It was an audacious gamble. They lost. In the end, they'll walk away with nothing. The Republicans may gain some more seats in 2010 by their total obstruction, but the substantive policy defeat they've been dealt will last for decades.
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21 comments
Amen to this, I am struck constantly by how Republicans are screaming this is such a catastrophe, yet fail to point out what in this bill is so bad. (except by lying, like on abortion funding). If and when this bill is signed, and old people find they still have coverage, and people who have it at work find no adverse affects, it will be interesting to see what lies they come up with next. And since it is probable that this will be a jobful recovery, and if the unemployment rate is declining, November might not be as great as they imagine it will be. Of course Republicans will scream about deficits, but all Democrats have to remind voters is what Cheney famously said "Reagan proved deficits don't matter." and that only Democrats produce balanced budgets.
- blackton
December 19, 2009 at 6:41pm
While I agree with your analysis over all and think it would be nice if this blunder hurts them in some way, I am pessimistic about the American voter. As an aside: This is the second website I've seen in fifteen minutes that misspelled "Napoleon" in exactly that way, and I am wondering if I missed a memo.
- frippo
December 19, 2009 at 6:51pm
Napolean -- Same brilliant generalship and delusions of world domination, 50% less fat.
- ratnerstar
December 19, 2009 at 7:10pm
frippo, don't you know anything? Napolean is the English version of Napoleon, like Pierre is Peter, or Juan is John, or Jesus is Jesus. like that. ratty, that was funny.
- blackton
December 19, 2009 at 7:54pm
Did I miss something? Has health care reform been adopted by Congress? Or even the Senate? No, not yet. An odd time for Mr. Chait to offend Senators Bayh, Nelson, and Snowe.
- raylward
December 19, 2009 at 8:26pm
No ray. If Chait ever said anything NICE about Senators Bayh, Nelson, and Snowe, much less Lieberman, it would be an offense.
- Robert Powell
December 20, 2009 at 7:12am
Ratty - you killed.
- WandreyCer
December 20, 2009 at 10:25am
- I won't debate your "never would have happened if the Republican Party had played its cards right." but mostly because I don't ponder the"never would...if". There is still the opportunity for the Republicans to forever bear a label, a party that furthered the first comprehensive legislation of this century or a party that to a person sought to defeat the bill. Their strategy or how it impacted the final result will be analyzed but the final score, who voted for the bill, will demand less explaining with each day after the bill passes. Social Security and Medicare aren't remembered for the process and the passage of this bill will probably put the nail in any further discussions regarding what happened to the Clinton effort. Most of life and most of history is counted up as wins or loses and we know which side is better to have been on. No, I don't know if the GOP could have, would have helped or hurt the effort by cooperating. But history is on the side of progress and I see little short term and no long term gain for the party that opposes this legislation and it succeeds. The GOP may file your article away in their bragging rights folder but smart money says they squandered any opportunity for taking credit in reforming health care. The details? Not so important and they can't run from the final score. There will be a winner and it won't the them. -
- michael
December 20, 2009 at 11:31am
Euh ... two words. Chicken, count.
- icarusr
December 20, 2009 at 5:49pm
Snowe negotiated seriously for months, and Democrats met what seemed to be her substantive concerns, but, like the Russian army retreating before Napoleon, she insisted that the bill be drawn out indefinitely. Snowe demanded that the process not be rushed, but she never defined what a reasonable time frame would be. I'm not sure that the Russian retreat past Moscow is the right analogy here given that the Russians almost immediately went on the offensive and won the war. Perhaps, Jon Chait read a corrupt translation of War and Peace.
- ndmackenzie
December 20, 2009 at 6:13pm
I thought the Republicans became irrelevant when suddenly in the media there were no "death panels" and no "Tea Baggers" and nobody was shouting down legislators at town meetings and there were no accusations of socialism. The only thing I heard was John McCain saying he agreed with Howard Dean, claiming Dean said that we should wait and start over. The debate was among the Democrats and I thought the media watched the Democrats wanting only to know what the Democrats were going to do next.
- Nusholtz
December 20, 2009 at 9:28pm
I think it's still not too late to get some Republican votes on the final bill if the Dems would throw them what should be a fairly easy bone on addressing junk lawsuits and/or allowing competition across state lines.
- Robert Powell
December 21, 2009 at 2:08am
NDMac: I think you're missing Chait's point: Snowe retreated repeatedly, but presented no ultimate prize, a la the Russians in 1812. The Russians avoided a climactic battle, and Moscow refused to make a full surrender, and instead the scorched earth and delays sapped Napoleon's army entirely. With Moscow worthless, Napoleon retreated and the Russians pursued by maneuver while studiously again avoiding an all out, up or down battle. Napoleon's defeat was one not of offensives, but partisan strategy and failed logistics. Time was the enemy of victory, both in 1812 and 2009: In 2009, however, as Chait points out, the lack of substantive process led the Democrats to take their battles elsewhere and proceed without the GOP. Looking towards the future, that could well be enough.
- Crock1701
December 21, 2009 at 2:19am
Bob, I agree about junk lawsuits, but whatever happened to States rights? Amazing how Republicans are all for states rights when it is an issue of deregulation, but for a state to have more regulations, then that calls for the Federal government to step in.
- blackton
December 21, 2009 at 9:19am
So is Snowe definitely out of the picture? If it's a bill Lieberman and Nelson can vote for, what's her objection? Or is this just one of those things they do in the Senate, where she and Reid agree that he won't ask for her vote unless a Democrat drops out and she's needed to reach 60 votes?
- baxterjones
December 21, 2009 at 11:42am
Robert Powell, I'm agree on the need to curtail malpractice suits, but do you really think that adding such a provision (plus allowing insurance purchase across state lines) would attract Republican votes? I doubt anything would get the support of a significant number of Republicans. Does anyone get what happened with Snowe? She seemed to be negotiating in good faith earlier, but her reason for not voting for the bill is too ridiculous to be taken seriously. Does she have a real objection, or is the party just threatening to Scozzafava her?
- WillPastor
December 22, 2009 at 12:12am
Will-- I think it's worth a try. Both are good ideas, and Republican talking points--not necessarily mutually exclusive. Question is short-term advantage by stone-walling/painting as radical any Democrat initiative vs. long-term advantage by getting on the train of a new entitlement as it's leaving the station with a legitimate claim to having improved the bill.
- Robert Powell
December 22, 2009 at 5:00pm
I'm not so sure tort reform and selling across state lines are good ideas. Has it occurred to you that potential malpractice liability actually causes physicians and other medical providers to exercise greater care than they otherwise would? Lack of due care substantially increases health care costs independently of malpractice liability (and independently of the human suffering they cause). It would be interesting to see an analysis of the relative costs of malpractice after "tort reform" and the costs of malpractice liability and defensive medicine in the absence of tort reform. As to permitting the sale of insurance across state lines, wouldn't that be virtually meaningless in the absence applicable antitrust laws?
- dhurtado
December 22, 2009 at 11:26pm
On the first point, the several hundred thousand deaths per year attributable to avoidable medical errors indicate to me that leaving our safety in the hands of lawyers hasn't really been all that effective. A more direct and systematic approach focused on drastic financial penalties for institutions and practitioners with poor records, combined with cash incentives for those that do well in this area, is likely to be much more effective. On the second, I'm in favor of repealing anti-trust exemptions. Well, okay, the NFL should be allowed to keep its exemption. But insurance companies? Please.
- Robert Powell
December 23, 2009 at 8:33am
But how does that cut RP? If there are hundreds of thousands of deaths per year attributable to avoidable medical errors, might it be even worse in the absence of the threat of lawsuits and multi-million dollar liability? One of the rationales for tort reform is that the threat of malpractice suits causes the practice of "defensive medicine," i.e., causes medical providers to be overly cautious rather than insufficiently cautious, resulting in billions of dollars in waste and excessive costs. Is that a crock? If medical providers are being overly cautious, how can negligence nevertheless be so rampant? Moreover, when most people, particularly medical providers, talk about reining in malpractice litigation, they are not talking about replacing it with a system along the lines of what you suggest. From the standpoint of medical costs, wouldn't such a system have the same ills as the threat of malpractice suits? Wouldn't the threat of "drastic financial penalties" also cause the practice of "defensive medicine" and overkill? And who would decide which institutions and practitioners have performed poorly so as to be penalized? Wouldn't there have to be some adjudicative body, if not the courts, to determine whether penalties are justified? Why would that be any less costly than litigation? And would insurances companies sell policies to cover the risk of liability under this new system? Finally, setting aside the deterrence component of malpractice liability, what about the compensatory component? Should the victims of medical malpractice not be compensated for their injuries?
- dhurtado
December 23, 2009 at 7:26pm
All good points, dhurtado. This is highly speculative stuff, but my reading indicates that simple things like hand-washing and more systematic attention to avoiding medication errors would save many thousands of lives that the current system doesn't. It's unlikely that tort reform could make the situation worse, especially since no one is talking about removing liability for serious and clearly attributable mistakes. Some say it would have no effect at all, but politically (which is what this post was all about) such language in the bill could provide cover for some Republican votes in my view. There's been a lot of talk about outcomes affecting reimbursement rates under the new system, so I'm assuming the same mechanism could be effective in addressing the more mundane, but still deadly, issue of sloppy hospital proceedures.
- Robert Powell
December 24, 2009 at 5:41am