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.

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  1. #1 by Jay Burns on March 16, 2010 - 05:52

    While I do not want the health care bill to pass, and believe it will do more harm than good, I believe your analysis is sound.

  2. #2 by classicliberal2 on March 16, 2010 - 23:17

    Obama has already blown it, and Kucinich is entirely correct. Kucinich isn’t holding out for perfection; he’s just holding out for health care reform, which is what this bill is supposed to be all about, but which it doesn’t contain.

    The health care bill hasn’t energized the Democratic base, and won’t. The way it has been handled–concession after concession after concession to people who have given up nothing in return, until the final bill is nothing but corporate welfare that would make EVERYTHING about the current system worse–has, instead, utterly turned off a growing portion of the Democratic base. There’s no reason to think passing it in its current form would energize that base, or provide any bounce at all from the general public (which is also opposed to it in its present form), or do anything except severely cripple Democrats in the future (when things start going into effect, and people realize how badly they’ve been screwed).

    I don’t think there’s any basis whatsoever for the suggestion that failing to pass it would harm Democrats in November–that damage has already been done–and I can say, without ANY reservation, that the only thing the bill will do for the Republican base, whether it passes, dies, or goes into limbo, is energize it. Democratic dicking around for all these months has ensured that.

    You’re quite correct about the procedural matters. No one will care. No one has ever cared before–time after time, Republicans used reconciliation, and not only was it NOT a subject of controversy, it was something that was barely even mentioned in the press (something about which I was writing recently on my own blog). We have Democrats in office now, though, so as usual, the press becomes the Republican water-carriers and tries to scandalize it. The same thing is happening now with self-executing rules, presently being scandalized by Republicans and the corporate press (not much light between the two). Previously, it was relatively uncontroversial, and Republicans used them FAR more than Democrats. Now, Democrats are in charge, it’s a scandal.

    In the larger scheme of things, people don’t really care about this sort of procedural wrangling, but when it’s presented, unrebutted, as some sort of scandal, it leaves a bad impression, and impressions are important.

    • #3 by Scott Erb on March 17, 2010 - 02:11

      Yeah, but if this isn’t passed, nothing will be done for a long, long time. Probably, when something is does, it will be a GOP program. Start with this and improve it — otherwise, the consequences could be bad. Also, I think you are wrong about this energizing the base. Already major labor and activist groups are pushing hard on this, with a new amount of energy, especially as Obama gets into it. If it passes, there will be a lot of media coverage of the “historic moment,” and the images will serve the Democrats well going into the fall.

      But you see the politics as well anyone: The House Democratic party is not liberal. If something passes, it’s probably the best this House and Senate could possibly do. And there might not be this many Democrats in the majority for quite awhile. Politics is the art of the possible, and I think this is all that is possible — and even with that, they may not get it done. The votes aren’t there for something more substantial. Maybe if he had done it earlier he could have, but that moment is gone.

      • #4 by classicliberal2 on March 17, 2010 - 04:14

        The moment IS gone; it’s been gone since shortly after this began. You start with the fundamentally flawed premise that the bill presently under consideration does something to reform health care.

        It doesn’t.

        It isn’t some sort of improvement that can be improved even more at some indeterminate point in the future. If it was, I’d be supporting it myself.

        Instead, it makes the present bad situation worse. Not just a little worse. Waaay worse. And it makes it even harder–maybe impossible–to change it in any good way. The bill in question is NOT a health care reform bill. It is–and this can’t be stressed strongly enough–a corporate welfare bill. It gives massive government subsidies to low-income people, who, at the point of the government gun, must spend it on private insurance companies, who then route a portion of it into the pockets of politicians in order to keep any positive changes off the table in the future.

        It makes everything worse. I can’t hammer on that hard enough, either. Without the public option, there’s absolutely nothing to curb costs. Health care costs rise at 3 to 6 times the rate of inflation every year, and all this bill does is force people into that system on the blind hope–unsupported by any facts–that, if more people sign up, costs will go down.

        Contrary to the false claims of its supporters, it does NOT fix the problem of pre-existing conditions. Companies that continue to refuse to sign up people based on them can, after a lengthy legal process, be fined only $100/day, while those that do sign them up can charge them whatever exorbitant premium they want, or just raise everyone else’s rates an unlimited amount to make up for it. They’re also legally allowed to collude and fix prices.

        The reason it is–nowhere to run, nowhere to hide–VERY bad politics to pass it is because, while you may be able to squeak out the very short-term gains you’re talking about (and I strongly dispute that, given the evidence), once it starts to go into effect, you can’t bullsh!t people anymore. Democrats WILL be slaughtered at the polls for the mess they’ve made of this, once that starts happening. The health care industry WILL have, in effect, federal subsidies, making them even more invincible, and the feds WILL, in effect, be funding the campaigns of those the industry choose to purchase, a job our wonderful Supreme Court has just made a lot easier.

        Those in the Democratic caucus in congress seem to have completely lost their minds over this.

  3. #5 by Michael Arnis on March 17, 2010 - 06:27

    Scott,

    The politics of major reform is fascinating and all that is left to be sorted out. You’ve made a convincing case that the D’s will gain momentum by passing reform, but I wonder how well either party will govern after the vote. One professor — from years ago — was fond of saying that politics is the glue that binds us. Now it seems to fracture us.

    Politics should also discipline us. Some rules of the game seem lacking these days… When I first begin working in state government, there were huge costs for defeating a bill, or causing havoc, by lying. For example, claiming that someone’s bill contained death panels was a lifelong death sentence for any future bill, heck any amendment, that elected official cared to introduce. You lost your integrity and any future support from members of either party for such a bonehead maneuver. By contrast, claiming a bill is a government takeover (of health care, in this case) is a critique just inside the ballpark. Proponents would be expected to refute the comment and opponents would be expected to back it up. Votes decided the outcome.

    Pundits, however, had to fact check whether the President was going to put seniors to death. Only then could they comment on it. Did they really think he might…? I too admire the President for not holding a grudge and for his willingness to listen to and analyze all sides of an argument. At what point do outrageous acts and comments become costly rather than rewarded?

  4. #6 by Scott Erb on March 17, 2010 - 14:14

    Well, Kucinich is now a “yes,” with huge qualifiers. I think his logic is sound.

  5. #7 by Mike Lovell on March 17, 2010 - 16:13

    I still say we shave things down a bit and work a few issues at a time instead of complete overhaul, with 90% or more of the decision makers having no idea what the hell is going on or what will happen.

  6. #8 by Affectionate_beauty on April 2, 2010 - 12:11

    How you think when the economic crisis will end? I wish to make statistics of independent opinions!

    • #9 by Scott Erb on April 20, 2010 - 15:20

      I think we’ll get a global rebound by next year, but I’m worried about a renewed crisis due to high debt levels, especially in the US. The US has been living off exceedingly large amounts of debt for decades, which is unsustainable. I expect that the US will be forced into a major restructuring of the economy — perhaps not as painful as what happened to Russia, but the US will find its superpower status also called into question.

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