A reader chimes in …
You ask: “Am I the only one who thinks that if the Dems pass a bill with mandates and subsidies for poor and moderate income people to purchase it but no public option or competition with the insurers, that it will be pretty much a catastrophe for the Democrats in political terms?”
Actually, I think you have that precisely backwards. In political terms, such a bill would be a tremendous boost for the Democratic Party.
It would leave the present system intact in most of its essentials, thus assuaging the fears of the vast bulk of the electorate. One substantial group of voters – those for whom the subsidies render health insurance more affordable – would be fairly pleased. A smaller group, mandated to buy coverage it can scarcely afford, would be discontent, but mostly because the Republicans had thwarted Democratic efforts to help it – and, in cold political terms, this isn’t a constituency likely to defect. And the public at large would see that Obama had promised health care reform, and then delivered it, with few painful trade-offs or compromises. A fairly clear-cut political victory.
No, the problem is that such an arrangement would deliver a political victory, but fail to achieve most major policy goals. It wouldn’t do much to rein in costs, to improve the quality of care, or to provide a greater sense of security. It’s politically feasible, and a political triumph, precisely because of its modest aims and feeble provisions.
It wouldn’t do much, but it would do something. Most importantly of all, it would firmly establish the provision of universal healthcare as a federal problem. I’d like to see a better package emerge from this debate. But let’s not mistake the ultimate goal, nor the magnitude of the potential victory. Today, paying for health care is a problem for individuals. The day any of the proposed bills passes, it becomes a policy problem for the federal government. No current version of the bill comes close to solving that problem – but every one of them poses the right questions. When the Congress of the United States passes health reform into law, and the President signs the bill, it will be a watershed moment, and a signal political triumph for the Democratic Party. The conservative critics are right – these sorts of programs tend to expand inexorably. And that’s because they’re popular, and because voters reward their representatives for doing so.
The policy wonk in me wants to get this right, because the costs of half-way measures are crippling. But the political handicapper in me is whispering that a half-way measure will actually be better than an honest bill come the midterms. It’s a depressing thought, but with a silver lining.