Paul Krugman says:
I believe that universal health care has to be THE central item in a progressive agenda--not just because it’s the right thing to do, but because of its political economy implications. As I explain in Conscience of a Liberal, Republicans went all-out in 1993 to block health reform because they feared that success would reinvigorate the progressive agenda. And they were right.
This is troubling. Imagine you're a Senate Republican. You think the health-care system is getting a bit out of control, and you find it unacceptable that 45 million Americans lack health insurance. So you're thinking about signing on to Ron Wyden's universal-coverage bill, as five of your GOP colleagues have already done. Then, along comes Krugman to tell you, oh, by the way, Kristol was right in 1993--if we get our foot in the door by passing health care, you can count on a broader Kucinichization of America. What are you gonna do? Chances are, you'll be a lot less likely to support the bill. Krugman continually insists Republicans will fight universal coverage tooth and nail at every turn, and then frames the issue in such a way as to ensure that they will.
Now, obviously, a lot of liberals would like to use health care as a springboard for other items on their wish list. But given the painful history of universal-coverage proposals and the momentum the issue has now, it seems like a grave mistake to tie it to a whole bunch of less-popular stuff on the agenda. (Unless, of course, you're supremely confident that the Democrats will pick up enough Senate seats as to render Republican support unnecessary--but that's a huge gamble. As Daniel Patrick Moynihan put it, a big health-care reform bill "passes with 75 votes or not at all.") The right strategy would be to reassure Republicans that universal coverage isn't the first step towards a single-payer system, huge new taxes, and a dramatic expansion of the welfare state in other areas.
It always surprised me that Karl Rove would constantly brag about how privatizing Social Security was the opening salvo in a piece-by-piece demolition of the social safety net--and then he proclaimed himself shocked, shocked when Democrats showed no interest in helping Bush partially privatize Social Security. It would be a bitter irony if universal health care were to elude our grasp again because liberals made the same mistake.