Why Is This Night Different From All Other Nights

Petey says I'm all wrong, and things will be very different in 2009 from when health reform went down to defeat:

1. You have a plan that's been vetted by the electorate.
2. You don't have a messy and secret planning process to get attacked for months, letting opposition mobilize.
3. You have a President with an actual mandate, for himself and his plan.
4. You have a Democratic caucus that is capable of holding together.
5. You have the self-interested willingness of fringe Republicans to peel off.

2 is irrelevant. Clearly, in some sense the disagreement just hinges on 4 and 5 -- obviously if all Democrats plus some Republicans are prepared to support dramatic health care reform, then dramatic health care reform is possible. I think all Republicans and some Democrats would welcome the existence of a dramatic health care reform proposal as an opportunity to demonstrate their value to their paymasters in the health care industry.

Thus, this winds up falling back on 1 and 3 -- the idea that the existence of a mandate for change is likely to alter the voting preferences of legislators. I know that a lot of people find this hard to believe, but as best I know very few political scientists or other scholars of American political institutions believe that this is actually how things work.

Last, I'd note one other thing that's changed since 1993. Back in 1993, opposing a popular Democratic health care plan must have struck GOP legislators as kind of risky and a bit crazy -- a young gun kind of notion coming from Bill Kristol and Newt Gingrich at odds with conventional thinking and the views of other party elders. Now, the GOP has, among other things, the example of 1993 to fall back on -- evidence that successful congressional obstruction will be politically helpful to the obstructors even if the obstructed policy is a popular one.

Comments

Back in 1993, opposing a popular Democratic health care plan must have struck GOP legislators as kind of risky and a bit crazy -- a young gun kind of notion coming from Bill Kristol and Newt Gingrich at odds with conventional thinking and the views of other party elders.

I think this is where the Mickey Kaus criticism comes into play, because this is entirely made up. You're pulling that out of your ass. And you have to, because you were 12 in 1993.

You are officially a concern troll, by the way.

Posted by Freddie | June 1, 2007 6:16 PM

"And you have to, because you were 12 in 1993."

Books and older people are wonderful resources for extending your knowledge to a time before you were fully aware, and indeed, to a time before you were even born.

I can talk about the causes of the fall of the roman empire, even though I'm not a 2,000 year old man.

Posted by Petey | June 1, 2007 6:21 PM

2009 may not be the absolute perfect time to try health care reform with everything absolutely perfect. But we're not likely to see a better one anytime soon.

And I don't get why 2 is irrelevant.

Posted by Antid Oto | June 1, 2007 6:22 PM

"You are officially a concern troll, by the way."

He's only a concern troll if he's spouting this line because he doesn't want a left-leaning healthcare bill passed. Otherwise, he's simply wrong.

Posted by Petey | June 1, 2007 6:22 PM

You are officially a concern troll, by the way.

I guess I misunderstand the meaning. By definition, I believe the term excludes a person posting a view on their own blog, no?

Posted by sangfroid826 | June 1, 2007 6:23 PM

Books and older people, Petey, would constitute evidence, which is useful for substantiating empirical claims such as the one I quoted. Matt fails to provide any, and since he's the one making the claim, the responsibility is on him.

Of course, you aren't a big fan of evidence or argumentation supported by anything other than the fact that you really, really think something, so I'm not surprised by your comment.

Posted by Freddie | June 1, 2007 6:24 PM

He's only a concern troll if he's spouting this line because he doesn't want a left-leaning healthcare bill passed. Otherwise, he's simply wrong.

That's the point. By definition, concern trolls claim to support a certain position, then do everything they can to undermine it.

Posted by Freddie | June 1, 2007 6:26 PM

I think you're missing a factor that will make many middle-class voters more receptive to comprehensive health-care reform: how f*cking annoying it is to get your health insurance company to pay for anything.

As a student, I wasn't working full-time in 1993, but judging from how my older coworkers talk -- and I live in a blue state for a company with many union workers who have what passes for *exceptional* healthcare coverage these days -- insurance companies have grown ever increasingly obnoxious in the intervening 15 years. I have to bug my insurance company to pay for about one of every other visits to a doctor -- visits that are clearly covered under my policy. I gather that my experience is not atypical ...

Posted by annelina | June 1, 2007 6:27 PM

"And I don't get why 2 is irrelevant."

Agreed. Look at the experience of Bush trying to gut Social Security.

In the time that the administration was hashing out their plan, opposition was mobilizing. As the administration would float various ideas, they each would piss someone off, and opposition would solidify even more.

By the time they unveiled their plan, with the wonderfully mellifluous "clawback" mechanism, it was officially dead.

Having a plan in hand that's already been attacked and defended in the fire of a national election, and is pretty much ready to go without all the messiness we saw in 1993 or 2005, is a big tactical advantage.

Posted by Petey | June 1, 2007 6:28 PM

I think that US legislators tended to know, even before 1993, that when given the choice between concentrated interests and soft public opinion, the organised interest wins every time.

Posted by otto | June 1, 2007 6:31 PM

On 4 - they held together in the face of Social Security Privatization, didn't they? That's when I started believing, as the fans say.

And you don't need to convince the vast body of GOP legislators to go for it. You just need to peel off enough to break a filibuster. So even if the majority buy the Kristol memo this-is-the-hill-to-die-on story, a few renegades who are afraid of having a crusading Democratic president camp out in their district during re-election will suffice.

Posted by Neil the Ethical Werewolf | June 1, 2007 6:34 PM

Also:

6. The air war will not be one-sided this time.

The right was able to move public opinion about the Clinton plan because they went up on the air with an unopposed TV ad buy.

If someone on the left had spent a mere $20 million on an ad buy in 1993, public opinion could have likely been saved, despite all the political mistakes the Clinton team made.

Does anyone think we won't have the resources to avoid an unopposed ad buy this time around?

Posted by Petey | June 1, 2007 6:34 PM

Petaye right, Matty proud.

I don't claim to know if some landmark health care bill is signed into law by the president in 2009 or 2019 but I do think it is coming the next decade or so for all the good reasons that were flogged to death on the last thread on the subject.

Just because matt has spent his entire conscious life in a political environment that has changed little doesn't mean that big changes haven't happened in the past (some of us can remember when things were different) and won't happen again.

Posted by Linus | June 1, 2007 6:35 PM

#2 is irrelevant to Matt, because he assumes a priori that the outcome of messy and secretive Democratic planning processes is going to be benign. In fact, he probably assumes that if they're secretive, they'll be even more benign than if they have to be conducted out in the open, because they won't have to involve irrational compromises.

It's not irrevant to the electorate, because most people don't make those rather remarkable assumptions. On the contrary, most people assume that if you're planning something in secret, it's because you know they'd fight you tooth and nail if they knew what you planned to do.

Posted by Brett Bellmore | June 1, 2007 6:39 PM

"Thus, this winds up falling back on 1 and 3 -- the idea that the existence of a mandate for change is likely to alter the voting preferences of legislators. I know that a lot of people find this hard to believe, but as best I know very few political scientists or other scholars of American political institutions believe that this is actually how things work."

To take one recent and infamous example, why do you think 77 Senators voted to give George Bush authorization to go to war in Iraq without the restrictions many of them wanted?

Would political scientists and other scholars of American political institutions not argue that public opinion and the threat of future elections was able to alter the voting preferences of legislators in that case?

Posted by Petey | June 1, 2007 6:40 PM

I can talk about the causes of the fall of the roman empire, even though I'm not a 2,000 year old man

Right, but we might reasonably trust a 2000 year-old man's opinions about what happened more than someone who only had access to the books. As far as that goes, I don't recall the losses occurring because of the healthcare plan in specific.

Posted by SomeCallMeTim | June 1, 2007 6:42 PM

I agree that Matt's description of "Back in 1993" is completely wrong. But he might be right about 2009. I think our next president could push through a landmark health care bill. But will the next president try hard enough? I don't know. I have no confidence in any of them.

Posted by Gary Sugar | June 1, 2007 6:45 PM

I think the implication is that 3 feeds into 5. That is, if Dems win, Mitch McConnell will not be able to get up the next day and give a press conference saying "62% of the public voted for someone other than John O'Clinton, and I intend to represent them on the Senate floor." So, in that sense, a Presidential win will strike more fear of electoral defeat into the heart of Senate Republicans. So agree a bit with his thinking.

But I don't think it will be enough, because the number of truly moderate Senators has decreased. In '93 you had Specter, Cohen, Danforth, Durenburger, Chafee, Jeffords, Packwood ... today it's just Snowe, Collins, and Specter. Maybe Coleman if he survives.

Posted by Nicholas Beaudrot | June 1, 2007 6:48 PM

4. You have a Democratic caucus that is capable of holding together.

This is definitely the weak link in Petey's argument. Although the Democrats are indisputably MORE LIKELY to hold together than they were in 1993, their ability to hold together on an issue of paramount importance to the health insurance industry (or banks, or telecom companies, or any other white-collar industry) is still suspect. The ability of 51 Democratic Senators to introduce 52 competing reform bills should also never be underestimated.

All that said... I tend to think that 2009 is probably a real window of opportunity for universal health care, and that's worth taking a few risks to achieve. But it's going to be an uphill battle.

The absolutely crucial matter is that whatever plan emerges must have strong, proven public support. (It also needs to be marketed well, per Petey's Point #6.) Force the Republicans to filibuster a popular bill, and the 1993 analogy ceases to have any relevance.

Posted by LaFollette Progressive | June 1, 2007 6:49 PM

"But he might be right about 2009. I think our next president could push through a landmark health care bill."

Given that Matthew's position is that the R Senate caucus will hold together in a bloc opposing cloture, if you think our next President could push through a bill, you don't think he's right about 2009.

Posted by Petey | June 1, 2007 6:50 PM

"The absolutely crucial matter is that whatever plan emerges must have strong, proven public support. (It also needs to be marketed well, per Petey's Point #6.) Force the Republicans to filibuster a popular bill, and the 1993 analogy ceases to have any relevance."

Yup. There's no guarantee the Republicans won't hold together as a bloc. It is an uphill struggle.

But if you hold public support, then it becomes a win-win situation. We either get a bill, or we get an issue to bash their heads in with in 2010.

I'd argue that holding the D caucus together as a bloc is actually the crucial part of the whole equation. Doing that lets you actually get the bill out of committee to the point where it becomes a cloture battle. And doing that lets you pin the blame entirely on the other side of the aisle for a plan that has public support.

But I don't think holding the D caucus together is all that much of an uphill struggle. The SS battle was good exercise for the muscles. And with an election vetted plan, it will have been officially decreed a reasonable plan.

Finally, reason #72 why I like John Edwards is that I think he'll run better than Clinton or Obama in solid red states, and better than the usual Democratic nominee. This means that the Republican margin in states like the Dakotas and Nebraska and Montana will be less than usual, providing a bit of extra cover for the Ben Nelsons and Max Baucuses of the world.

Posted by Petey | June 1, 2007 7:00 PM

Re: 2 is irrelevant.

Not entirely.
One of the Clintons' biggest mistake in 1993 was putting healthcare on the back burner while leading with the other two priorities: deficit reduction and NAFTA. The first of those was probably right to take first place in the list, but NAFTA should have been delayed, or better yet, tied in some way to healthcare reform (a big piece of the "flexisecurity" deal that liberal free traders keep advocating). The proverbial iron of healthcare reform was hot in 1992 when Clinton was elected. Even Bush 41 had proposed a plan (letting the unisured buy into Medicaid), and GOPers were rushing various plans of their own into public view (most of them of course were thinly disguised give-aways to the insurance industry, not unlike Medicare part D in this decade did for Big Pharma). Had Clinton made a serious healthcare proposal to Congress in his first 100 days the momentum would have been irrestible, and corporate interests (other than insurance) would have held off knowing that NAFTA was being, in effect, held hostage. But by delaying as they did, the Clintons allowed passions to cool, the opposition to organize while they created a rather dreary impression of leaden bureaucracy with Hillary's top secret commission and Ira Magaziner's off-putting wonkery. In short, they lost the moment.

Posted by jonf | June 1, 2007 7:03 PM

Are there historical antecedents for the notion of an "election vetted plan" getting enacted into law where it otherwise might not have?

Posted by Steve | June 1, 2007 7:04 PM

The secrecy is not relevant in itself. Some expert can scratch the first draft of a healthcare plan in a single evening, and the methods that the expert uses to develop that healthcare plan need never go outside the confines of the expert's cranium. It's the next few drafts of the healthcare plan that count, and those will be drawn up by Congress. Whatever else you might think about Congress, its processes are about as open as you're ever going to get (provided, of course, that you're not trying to shove a bill through at 4 am like they did with the Medicare bill a few years back).

The tardiness was relevant. Bills submitted early are not as susceptible to obstruction as bills submitted late, when the work piles up and you need to pick your battles more carefully.

Probably the most damaging part of the process was that they spent too much time and effort trying to mollify forces that were going to oppose the bill no matter what. It gained the Clinton team nothing and signaled to the opposition that they could roll the Clintons pretty easily, which is what they then proceeded to do.

Posted by ploeg | June 1, 2007 7:20 PM

"Are there historical antecedents for the notion of an "election vetted plan" getting enacted into law where it otherwise might not have?"

I can't think of any off the top of my head.

Though considering that the first Clinton budget with its tax hike only passed by 1 vote, one could say that having campaigned on the tax hike made the difference.

-----

I don't think having an "election vetted plan" is a magic wand that will make all opposition disappear. But I do think it does a few things.

- It takes away the opposition's line of attack that the bill is just crazy / dangerous. We just went through a campaign where those concerns were aired and the candidate still won.

- It takes away the opposition's line of attack that the public doesn't want a major healthcare bill. We just saw the guy campaigning for the bill win.

- It settles down fears in the D caucus that they're being asked to support something that'll lose elections.

- It makes the R caucus look bad if they try to deny cloture. We've just seen the public will expressed on the issue.

It may not be a magic wand, but it does make everything easier.

Posted by Petey | June 1, 2007 7:21 PM

If I may makea double post, there's also one other factor at work now that was absent in 1993: GOP-led healthcare reform. Two GOP governors have come up with major overhauls of their states' healthcare systems, based on long-time proposals from conservative think tanks. Now I'm sure we can all criticize both Romeny's and der Arnold's plans in a myriad of ways, but they have forced the GOP away from being the party of monolithic obstructionism, raising the bar in effect. Should healthcare reform be pushed at the national level in 2009 I suspect the GOP will rush to embrace "free market" proposals and will seek to push legislation as hard as they can in that direction with the insurance companies funding them (and also any Democratic fellow travellers, and there will of course be some).

Posted by JonF | June 1, 2007 7:22 PM

"they created a rather dreary impression of leaden bureaucracy with Hillary's top secret commission and Ira Magaziner's off-putting wonkery"

To that end, it was rather helpful that the impression was accurate.

Posted by Brett Bellmore | June 1, 2007 7:27 PM

"they created a rather dreary impression of leaden bureaucracy with Hillary's top secret commission and Ira Magaziner's off-putting wonkery"

Political scientists or other scholars of American political institutions should teach Hillarycare and the Bush SS plan to each and every one of their students as cautionary tales in precisely how not to attempt to pass major legislation.

Posted by Petey | June 1, 2007 7:33 PM

If that was leaden bureaucracy, what's the current system? Polonium bureaucracy?

Posted by Neil the Ethical Werewolf | June 1, 2007 7:49 PM

This discussion is completely ignoring (5). And (5) ain't gonna happen under either Obama's or Edwards' plan, since for some unfathomable reason they've decided to continue the ridiculous legacy of tying health care to employment.

Posted by Brautigan | June 1, 2007 8:18 PM

Matt -

You have a strong point here, BUT if I were advising a legislator in 2009, I would be hesitant to point to 1993 as an example of how to behave.

The Republican Party is massively unpopular, and it becomes more unpopular every day. Blocking a major Democratic initiative, particularly one that sounds good, would be a lot more likely to get a legislator into trouble in 2009 than in 1993.

I don't know if healthcare reform will happen in 2009, but I think it would be good to get a lot more of these people on record. It might pave the way for change in 2010 that leads to reform in 2011.

Posted by MDtoMN | June 1, 2007 8:18 PM

I'm sure I'll like get hit by a bus or run over by a dune buggy or something by the time universal health care passes so I'll leave it up to someone else to say oops Matty crapped his pants and link to this thread when it does.

Posted by Linus | June 1, 2007 8:25 PM

MDtoMN,

Like others here you suffer from the delusion that the American people think in the kind of strongly partisan terms that you do. They may be pissed off at the GOP, but that won't make them any more likely to support to a Democratic health care plan they don't like.

To shut Petey up, I hope that if they win the Dems do push for really dramatic health care reform. Preferably single-payer, with lots of mandates and coercion and government intrusion. It will crash and burn, of course, and the issue will be taken off the table for another 15 years, just like after the HillaryCare meltdown. It'll be a badly needed lesson in the dangers of overreaching. Clinton received that lesson in the 1994 elections, and Gingrich got it in 1996. Petey still doesn't get it.

Posted by Seamus | June 1, 2007 8:41 PM

Yeah, Matt's showing his age, here. The public perception of health care has changed a great deal since 1993. Then, about a third of the country, mostly Democrats, thought there was a problem. Now, about two-thirds do. The difference is that the portion of Americans who are insured has seen a big increase in their premiums along with other problems with actual health care. The argument in 1993 was between the haves and the have-nots. And there were more haves than have-nots in 1993. And while that's still true today, it's the case that in 1993 the haves were pretty satisfied with their health care but today, in 2007, they're not.

Posted by Keith M Ellis | June 1, 2007 8:45 PM

Yeah, Matt's showing his age, here. The public perception of health care has changed a great deal since 1993. Then, about a third of the country, mostly Democrats, thought there was a problem. Now, about two-thirds do.

It took me about 30 seconds with google to find this 1993 New York Times piece on public opinion regarding health care. Quote:

Fired by a sense of crisis, a majority of Americans say they are willing to accept substantial changes in their health-care system, including government price controls, new taxes and longer waits for nonemergency appointments, according to the latest New York Times/CBS News Poll. They have high expectations for President Clinton's promised health-care plan, the poll found, and they consider changes in health care an issue at least as urgent as the Federal deficit, which is near the top of the public's agenda.

Again, that's from 1993. I don't know whether it's youth, faulty memory, or just being too lazy to actually look anything up, but this idea that polls and surveys showing really deep and widespread public dissatisfication with the nation's health care system is something new or recent is just total nonsense. It's been that way for decades. But when push comes to shove, that dissatisfaction doesn't translate into support for drastic reform.

Posted by Seamus | June 1, 2007 9:14 PM

Seamus - I never suggested that Americans would be more likely to support a "Democratic health care plan they don't like." Health care reform, if it is going to succeed, needs to be presented as a plan they WILL like. However, I think the relative popularity of the parties and the perception of the parties will have a large impact on the ability of the Democrats to sell the plan and the Republicans to smear the plan.

As for the overreaching concern - Maybe it would be overreaching. But then again, what isn't overreaching? Was the Clean Air Act overreaching? The Civil Rights Act? Clean Water Act? Medicare? None of these were foregone conclusions - they took a massive amount of mobilization, pushing, and changes in public perceptions.

I just think it's a mistake to think - 2009 will be 1993 or 1996. There are several things that may be different in 2009. Why wouldn't we say it was 1977? or 1964? 2009 will be its own thing, and it's probably best understood in that light.

Personally, I would argue that the Democrats should have an idea of a number of things they would like to do, and then decide what they'll do in 2009 when 2009 rolls around.

Posted by MDtoMN | June 1, 2007 9:23 PM

See I read Seamus's poll from 1993 and think point 2 above is even less irrelevant than I thought it was. If Bill Clinton had made his health care plan his top priority, involved Congress in writing the plan at the start of his administration and then fought for it, he probably could have passed it. Instead he expended a whole lot of political capital on NAFTA and balancing the budget. He had his priorities.

I'll submit, though, that if the 2009 Democratic President happens to be Hillary Clinton, she will have rather a different problem with the legacy of 1993 than any other Democratic President would have.

Posted by Antid Oto | June 1, 2007 9:29 PM

I should add that I'm not especially hoping for a Democratic President to make health care reform his/her absolute top priority. To me global warming is the number one most pressing issue we face.

Posted by Antid Oto | June 1, 2007 9:33 PM

By the way, pollingreport.com has a lot of polling data about public opinion on health care and health care reform. Most of the time-series data only goes back as far as the 2000/2001 timeframe, but there is little to suggest any large movement of public opinion in favor of major reform since that time. The one poll I see reporting data from 1993 suggests that support for an increase in government funding is now much weaker than it was back then. According to that NBC News/Wall Street Journal pool, in 1993 66% agreed with the statement "I would be willing to pay higher taxes so that everyone can have health insurance," whereas in 2007 only 53% agreed with that statement (although the 2007 figure is at least higher than the 47% who agreed in 1991). Overall, the data show no clear trend of an increase in public concern about health care or public support for major reform.

Posted by Seamus | June 1, 2007 9:43 PM

If the Democrats win in 2008, the situation for health care reform will be different from 1993.

1. The Democratic House leadership will have more legislative tools for getting big bills through with small margins. Ironically enough, they'll be able to thank Denny Hastert and Tom DeLay for that.

2. The Republicans will be just as united as they were in 1993. As was the case in 1993, they will also be hoping the health care debate as a way to make the Republican Party more appealing.

3. The health insurance and pharmaceutical industries have even more money to use in their inevitable campaign against health care reform. Of course, the Democrats and their allies on the left will be better armed as well.

4. Health care reform is winnable for the Democrats, but it's hard to see the fight as anything but extremely ugly and debilitating.

Posted by Ric Caric | June 1, 2007 9:53 PM

On a bet, the difference between the 1991 and 1993 numbers is recession. I really don't want that advantage in 2009.

Posted by SomeCallMeTim | June 1, 2007 9:55 PM

It's not irrevant to the electorate, because most people don't make those rather remarkable assumptions. On the contrary, most people assume that if you're planning something in secret, it's because you know they'd fight you tooth and nail if they knew what you planned to do.

Except, of course, that the plan that emerged was contemporaneously popular with the public, so your argument is empirically wrong.

Posted by Scott Lemieux | June 1, 2007 10:05 PM

Thus, this winds up falling back on 1 and 3 -- the idea that the existence of a mandate for change is likely to alter the voting preferences of legislators. I know that a lot of people find this hard to believe, but as best I know very few political scientists or other scholars of American political institutions believe that this is actually how things work.

Budge and Hofferbert, 1990. By coincidence, I was just reading this article right before reading this post. I question the real-world applicability of some of their findings, but they find a pretty strong relationship between "party says they'll do X if they win," "party wins" and "party does X."

Posted by Aaron S. Veenstra | June 1, 2007 10:24 PM

If not then... when?

Posted by Freddie | June 1, 2007 11:45 PM

People have told me that early-'93 polls don't accurately capture the mid-'94 environment, because of the dramatic upswing in the economy from the first point to the second.

Posted by Neil the Ethical Werewolf | June 2, 2007 5:01 AM

The point that Clinton spent resources on ratifying NAFTA is good. It's possible that Bush will sign a new WTO round treaty and leave it to the Democrats to ratify it, which would create the same sort of problematic dynamic.

Posted by otto | June 2, 2007 6:36 AM

I'm one hell of a lot older than Matt, and I know from living through them that ever since the 1965 Voting Rights Act, Democrats in Congress have been really lousy at blocking the initiatives of Republican presidents, and really terrific at destroying the initiatives of Democractic ones. Unless a Democratic president has some sort of drastic weapon to wield against the Cowards Caucus, Matt is right, no reform.
The Iraq funding bill shows us the Cowards remain in firm control of the party in Congress, not through numbers, but because of their willingness to betray the Democrats when push comes to shove.

Posted by JMG | June 2, 2007 8:46 AM

The ability of 51 Democratic Senators

55-56, or this whole debate is probably moot.

Posted by David | June 2, 2007 9:06 AM

Matt is right, no reform.

So we don't try? We don't pursue a policy that is desperately needed, overwhelmingly popular, and, by the way, a moral imperative? Because it's not politically possible? Then why not give up on politics at all? Why continue to try?

I have to ask-- for both Matt and the commenters-- what is the value of saying that you support government funded health care if you won't actually support going forward with legislation? What's the use?

Posted by Freddie | June 2, 2007 9:29 AM

Is anyone saying they don't support reform? I think most people are advising caution in speed and goals, and that's all. I personally think that it'll be done piecemeal, though I don't know how the pieces are split up.

Posted by SomeCallMeTim | June 2, 2007 10:16 AM

Your Vichy attitude to health care is pretty alarming and strangely reminiscent of your support for the invasion of Iraq, which seemed to be covered with political timidity. Know one should say that passing universal healthcare will be easy, but if we use the Bush Tax Cut as a political example (using the Senate budget process as filibuster cover)it is emminently doable.

You are also very grossly underestimating the political upside if it succeeds, which could be at least as great as Social Security. In short Matt, stop being such a wimp.

Posted by AJ | June 2, 2007 10:33 AM

Is anyone saying they don't support reform? I think most people are advising caution in speed and goals, and that's all. I personally think that it'll be done piecemeal, though I don't know how the pieces are split up.

Maybe you're right. I just get so angry with this constant liberal-pessimism that masquerades as being
"sober" or "realistic" or whatever else. The progressive movement effectively undercuts itself by assuming the country is more conservative than it is, or that the opposition is just always going to win through dirty tactics or better organization or whatever else. I agree with Matt that resentment politics have damaged conservative's ability to develop a coherent set of policy goals. But they have been very effective in tilting the general public consciousness toward a vision of an America where liberal politics just can't win. And I hate that people who supposedly support policies like these buy into that meme, because it forces them to set the bar so low. The Republicans of the mid-90's that are invoked here succeeded in part because they had a grand vision that they pursued unapologetically. I am for realism but not to the point that you undercut your own movement.

Posted by Freddie | June 2, 2007 10:40 AM

A coupe more point on the incremental approach to healthcare refrom is that it is far from clear that it "builds momentum" for further reform. But, it may instead act as a release valve for reform, dampening the pressure to go further.

On the policy side, because of the rising cost situation with healthcare reforms that aren't comprehensive enough to create new market structures like Edwards regional healthmarket and possibly Obama's national mechanism, are going to be inefficient patch jobs at best.

Posted by AJ | June 2, 2007 11:29 AM

"55-56, or this whole debate is probably moot."

60+ or the debate is probably moot. I suspect as the Democratic majority gets incrementally larger, the Republicans will get more conservative, united, and obstructionist. Each additional Democrat will be a little more to the right of his caucus. Each incremental policy gain will create complacency and backlash.

It takes a landslide or realignment to enact radical change, and even then it is very hard & costly work. Then it needs indefinite defense.

But landslides and transformational moments are luckily not that uncommon, once every twenty years or so. In the lack of super-majority moments, I don't think the Rove strategy is actually all that dumb. Bush accomplished a lot with a minority.

Posted by bob mcmanus | June 2, 2007 11:54 AM

Bob McCmanus,

Will you stop hating your country if Dems give you Canadian-style health care?

Posted by harry | June 2, 2007 1:34 PM

the Republicans will get more conservative, united, and obstructionist.

We don't even know if McConnell will survive reelection.

Each additional Democrat will be a little more to the right of his caucus.

Like Sherrod Brown ? Tester ? Whitehouse ?

Posted by David | June 2, 2007 2:22 PM

"Will you stop hating your country if Dems give you Canadian-style health care?"

No, but I will be able to hate it much longer. Thanks for caring.

Posted by bob mcmanus | June 2, 2007 2:56 PM

So we don't try?

Because trying has costs. It consumes political capital, diverts resources from other goals and risks creating a backlash. The failure of HillaryCare effectively took the issue of national health care reform off the table for 15 years. No one even tried to make it a big issue in the '96, '00, and '04 elections, and the modesty of current Democratic reform proposals shows how much damage that defeat is still causing. If the Democrats had instead pursued a less ambitious, incremental approach, like first guaranteeing health insurance to all children, they might actually have accomplished enduring change.

But if you truly think the country is ready to sign off on dramatic reform--even the paleoliberal fantasy of single-payer--have at it. You'll fall flat on your face--again.

Posted by Seamus | June 2, 2007 3:53 PM

I think the short form here is that the American people know what a healthcare plan that works looks like- it looks like Medicare, the VA, or Kaiser-Permanente.

Democratic legislators, however, have become accustomed to doing the work of governing. In the statehouses they're passing bills that require everyone to buy insurance and offer subsidies for the poor.

I imagine that what will come is incremental reform, and each of these creates a new vested interest in things-as-they-are.

In 1932 the Democrats campaigned on Repeal of Prohibition and that repeal was enacted in short order after the election. But things have to be pretty bad to get everyone working together.

Posted by serial catowner | June 2, 2007 7:23 PM

Re: It consumes political capital, diverts resources from other goals and risks creating a backlash.

Well, on domestic policy I simply cannot think of a more important goal, or even one that comes close. So if we succeed at some sort of healthcare reform with universal coverage I will consider any costs paid as well worth the price. What else is there of that magnitude? I mean, positive progressive policies not just stopping the Right from leading us into more disasters or cleaning up the messes they have left.

Re: The failure of HillaryCare effectively took the issue of national health care reform off the table for 15 years.

Hmm. So we should take it off the table ourselves instead? Just why do you want a progressive majority in Congress and a Democrat in the White House then?

Re: But if you truly think the country is ready to sign off on dramatic reform--even the paleoliberal fantasy of single-payer--have at it.

On single payor, I agree. It almost certainly is a bridge too far. But the country has been ready for universal healthcare for years and years. Unless we are not to believe the polls on the subject? In that case canwealsoassume the country is really four-square behind Bush on Iraq too?

Posted by JonF | June 2, 2007 7:37 PM

Well, on domestic policy I simply cannot think of a more important goal, or even one that comes close.

Keeping the Southern Republican Party out of the Executive seems more important. It's almost easier to point to the parts of government they didn't intentionally act to fuck up the government. Given enough time, they really will ruin this country.

Posted by SomeCallMeTim | June 2, 2007 7:53 PM

You're not listening. The point is that there is a cost to trying and failing, and if the risk and cost of failure is sufficiently high (and in this case I think they're extremely high), the risk isn't worth taking, no matter how important you consider the issue. In fact, the more important you consider the issue, the more you stand to lose from a repeat of the HillaryCare debacle that poisoned the well for major reform for at least the next three election cycles. I think it's still poisoned, in fact. That's one reason why none of your candidates are proposing plans remotely as ambitious as HillaryCare.

Posted by Seamus | June 2, 2007 8:06 PM

It's almost easier to point to the parts of government they didn't intentionally act to fuck up the government. Given enough time, they really will ruin this country.

If you really believe that, it would seem to be a pretty strong reason to oppose a single-payer system indefinitely. Sooner or later, the GOP is going to be in control of congress and the White House again, and if they're as bad as you say why would you want to give them control of the funding for something as important as health care? In Britain, Labour always attacked the Conservatives for failing to spend enough on the NHS (Britain's single-payer health care system), leading to chronic shortages and rationing of care. Whatever the flaws of systems based on private and multiple sources of funding, they allow spending to grow in response to consumer demand, rather than being held hostage to the budget decisions of whoever is in power in Washington.

Posted by Seamus | June 2, 2007 8:23 PM

The GOP wasn't always and may not always in the future be dominated by its Southern conservative members. And it takes time to ruin anything, so the questions are, "How sure are we that we can get national healthcare reform, and how long will the GOP get the Executive if we make the attempt?"

Posted by SomeCallMeTim | June 2, 2007 8:59 PM

Re: Keeping the Southern Republican Party out of the Executive seems more important

Um, I did note that I was speaking about POSITIVE policies, not stopping the Right or cleaning up their messes. And in any event, several rightwing pundits were very candid about something they feared back in 1993: if a government-designed universal healthcare program is implemented in this country, the middle class will have a huge new reason to vote Democrat, much as they do already with Social Security. So such a program, by the Right's own fearful admission, would work to the Democrats' advantage. But let's say I'm wrong about that and the Democrats will have a better chance of staying in office if they act like Republicans (and not just Republicans Lite, since Romney and Schwartzeneggar, true Republicans lite, have attempted universal healthcare plans in their states). What does that mean about Iraq? Because I can guarantee that any demagoguery the GOP indulges in over healthcare will seem like Mother Goose nursery rhymes compared with the fiery vitriol with which that the Right will nuke the Democrats (Treason! Stab in the back! pro-Islamofacist!) if/when a Democrat president gets us out of that mess. So does Iraq also have to bleed forever lest the GOP regain power and, er, keep Iraq bleeding forever?

Re: The point is that there is a cost to trying and failing, and if the risk and cost of failure is sufficiently high (and in this case I think they're extremely high), the risk isn't worth taking, no matter how important you consider the issue.

Oh, I am listening quite well. See my words above and you too, please, apply them to Iraq. It's going to be far, far more risky leaving Iraq than anything else a Democrat president could possibly do, and it will hand the GOP a multi-megaton warhead to use in the future. Will you also counsel us to stay in Iraq out of fear of failure?

By the way, for the first time I actually have some sympathy for the Nader voters of 2000, whom I long have scorned. I am no far leftwinger, but if you guys don't even have the guts to appeal to a very modestly liberal-centrist like me, then why should I vote for you. Might I not be better off looking to Romney who did have the gust to try universal healthcare, however flawed his planmay be?

Re: In fact, the more important you consider the issue, the more you stand to lose from a repeat of the HillaryCare debacle

Hillarycare had a lot of problems and was, quite simply, a very bad plan. I agree: let's not do that over again. How about something much simpler (something that will however evolve into something better over time)? A pay-or-play plan. That's pretty much what the voters want-- leave their own health insurance untouched, but put a fall-back public plan in place for the uninsured. The genius of it is that the fall-back plan will gradually grow with time as employers (and employees) realize that they're better off paying, say, %7 of payroll into that plan than purchasing health insurance from private insurers. Thus we get to something like a single payor system (with doubtless some role left for the insurers) gradually, naturally, without a lot of upheaval.

Posted by JonF | June 2, 2007 11:37 PM

It's a good idea to force these sort of votes, it'll make it much easier to remove people in congress who's primary purpose is to line the pockets of insurance company executives. It's much easier to get people to vote against someone when theres a noticeable negative effect to their corruption. If we could have said in 2006 that a vote for Joe Lieberman was a vote against healthcare, Ned Lamont would be in congress right now.

You don't only hold votes to pass legislation, you do it to force your enemies to take a stand. Knock a couple of these people out of congress and make it clear you're prepared to go after the other cronies too, and you'll see people fall into line. They won't have much of a choice.

Posted by soullite | June 3, 2007 7:56 AM