Friday, October 29, 2010

Rorschach Test

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President Obama and the Democrats were never going to compromise and were going to jam health reform down the throats of the Republicans

OR

The Republicans were going to oppose anything and everything in the way of health reform and wouldn't compromise or negotiate, because they couldn't afford to allow President Obama to have a victory.
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Most people will believe one of these two versions is true, almost immediately; if you believe one, there is almost no way you will believe someone could believe the other. Welcome to our divided country.

There are a variety of folks writing stories this week along the lines of 'would the Democrats political standing (and therefore their presumed election results) be better' if health reform had been handled differently, or not addressed at all. Here is wonkroom nicely pulling together multiple progressive writers considering these questions. One of the main arguments seems to be that the President made an error by not being more centrally involved in driving the health reform train from the start of his administration and deferring too much to the Democrats in Congress. A few thoughts on all this:
  • one of the truisms coming out of the Clinton reform effort was that it was an error to have such an executive-branch driven process since it is the Congress that ultimately must pass legislation. Now, some say it was a big mistake to let the Congress have such a predominant role because the legislation got too watered down.
  • If you ascribe to the too watered down version (what passed wasn't progressive enough), think back to the snowy night in December, 2009. Which Republican was going to vote yea on the motion to proceed in the Senate of a more progressive bill? What more would Ben Nelson have required to stay a yea vote on a more progressive bill? Make Nebraska its own country and him the King....?
  • The health care system is unsustainable, and PPACA is a first step that gives us a chance to move towards a sustainable system. Doing nothing was and is a route to health care cost inflation bankrupting our nation as our perpetual cost inflation problem is joined with the retirement of the baby boomers in the next few years. In policy terms, health care is the biggest long term policy problem facing the nation. It was correct to address it because it is the biggest problem. If the Democratic party suffers large losses partly for addressing the biggest problem, then you just have to be ok with that.
  • Lets say the Republicans win massive victories next Tuesday, and actually move beyond hyperventilating about repealing this law and actually propose some coherent health care policies. If this happens, the passage of PPACA will be responsible for their engagement in health reform. Think back to the last time the Republicans were in power and they tried to drive a comprehensive health reform attempt....you are correct, there is no such example. The Republicans have no offense on health reform. This is not the same as having no ideas. They have many ideas, and are expert at employing strident ideological rhetoric in opposing any plan. Example A is that they used an individual mandate as the basis for their argument against the Clinton plan. 15 years later, an individual mandate is central to PPACA, and according to the Republicans, this now foretells the end of the republic. Such rhetoric is of limited use in trying to develop practical solutions in the messy arena of health care policy, but is great in being against something.
  • I believe that the passage of PPACA will viewed as a historic achievement, because it helped to break a log jam in the health care system and started in motion a process that can lead to a sustainable health care system. It has put the health system in play. Each Congress for the next 5 (maybe 10) will return to health care. It is the first step. The next steps are yet to be determined....but they would never have come about without the first one.

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