Archive for March 16th, 2010

The Politics of Health Care Reform

As a political scientist, I find the politics behind an issue like health care reform often more interesting than the debates about the policy itself.  That isn’t to say that the “horse race” is more important than the significant issues at stake — whether or not health care reform is passed will dramatically impact the future of this country.   But as we get within a week of a health care vote, I want again to write purely about the politics of the matter, not the policy itself.

A while back I wrote that President Obama must pass health care reform if the Democrats are to have a chance to avoid a cataclysmic November off year election.   The reason is simply that the President needs a win to appear affective and maintain public support, the Democrats look inept if they can’t pass something, their base will be demoralized, and once health care has passed other issues can be pushed to the front of the agenda.   When the Republicans run against the passed bill, the Democrats will bring up salient issues currently before Congress and say, “let the GOP debate the past, we’re looking forward to continue bringing the US out of the mess we inherited.”   One must not forget that the energy of the base is the most important thing in an off year election.  If the Republicans fail to stop health care reform, their base may be demoralized, especially if by fall the Democrats are playing to issues that independents are with them on.

I am rather optimistic that health care reform will indeed pass — things seem to be going the Democrats’ way.  First, President Obama postponed a foreign trip to be here for the vote, and the rhetoric from the White House is not only optimistic, but definitive.   That is putting a lot on the line, making a “no” vote ten times more devastating for Obama if he loses.  They know the inside game better than any pundit or observer, they would have to calculate their odds as very good before heading down this path.

Second, the Republicans are talking more about “reconciliation” (the process to be used to avoid a filibuster) than the policy itself.   This is a tactical mistake.   The GOP has polls that say the public doesn’t want the reconciliation process to be used, but when push comes to shove, the American people don’t really care about or have a long term memory of the process used to pass something.  Moreover, process discussion cedes the high road (policy discussion) to the Democrats — perhaps the Republicans are either too  “inside the beltway” in their thinking, or focused on an “inside politics” game, namely putting psychological pressure on House Democrats.   If so, that’s probably a bad strategy — not only can the Democratic leadership more effectively impact their members, but if it becomes an overtly partisan thing, it’s harder for party members to break ranks.

Finally, the pressure being brought to bear on Democrats to vote yes is immense.   Labor is threatening to pull support from members who vote “no,” and to even seek opponents for them in the next primary.   The President has the powers of the Oval office and is putting pressure on waverers.   The Speaker of the House still has considerable power, and inside deals can be cut — sometimes involving issues still months away.  Activist groups are rallying and calling to pressure House and Senate Democrats — and almost all of them are pushing for a yes vote.   These are groups that will “get out the vote” in November (especially Labor), help raise funds, and whose endorsement is often needed.    All of this can sway members who even a week earlier might have been pretty sure they were going to vote “no.”  When it’s clear this “isn’t a normal vote,” but one where rewards and punishments are tied to how a member votes, well, it’s often an offer a Congressperson or Senator cannot refuse.

For President Obama and House Speaker Pelosi, this vote is a personal test of their leadership.   If Obama “raises health care reform from the dead,” passing what appeared defeated after the Massachusetts special election, then his leadership will be hailed from pundits and politicians alike.  Clinton couldn’t do this, Obama could, despite immense pressure and at times looking like it was game over.  If Obama fails, it will add to a string of difficulties that have dogged the President since the summer, and almost assure a strong set of Republican gains in the fall.  To be sure, Clinton lost health care and bounced back, and Obama could too.   But Clinton also lost much of his agenda when that happened; Obama wants to continue to press forth his.

The Republicans may be overplaying the process card, but they are remaining united, and seem to have no wavering members who the Democrats could pluck.   They also have polls that they shove in the faces of moderate Democrats, or Democrats who were pulled into office on Obama’s coattails last fall.    Why should they fall on the sword for Obama and Pelosi?   Why should they risk electoral suicide?    Since most members put staying in office ahead of all else, this remains a strong argument from the GOP, though one with an ironic twist.   The best outcome for some House members is if health care passes (helping the Democrats in the fall overall), but they vote no (meaning they keep support from moderates).  If they vote “no” but the Democrats go weakly into the fall, that “no” vote probably does most of them no good, even amongst independents.

Then there are the Kucinich Democrats, those who think this bill is too meek and won’t accomplish what’s necessary, and refuse to support this because it doesn’t have things such as a public option.   The problem with this position is that holding out for the best can guarantee continuance of the worst.   If health care reform dies, the Republicans will pick up numerous seats in both the House and Senate, and the next chance for major reform might be over a decade away.   Passing this now and then improving upon it is a far better path.   Politics is the art of the possible.   The Democrats (and Ted Kennedy) rejected a much more “liberal” possibility back in the 70s, and now nearly forty years later still haven’t gotten anything significant passed into law.  Idealism must be tempered with pragmatism.

Obama can lose and still get re-elected and have a good Presidency.   But if he loses, he may well lose his opportunity to be the “agent of change” people wanted.   Change is a funny thing; people want it in the abstract, but don’t like it when it affects them.   The problem now is that change is necessary; if not done voluntarily, it will be forced upon us.   There are many aspects of this health care bill I do not like.    However, I’m still hopeful that Obama can be the transformational President so many of us hoped we were getting back in November 2008.   He has taken his time to get going, but now faces a test that will define his Presidency, the future of the Democratic party, and perhaps this country.  The stakes are exceedingly high — and that’s why looking at the politics behind the policy can be so fascinating.