Whatever happens today in Massachusetts, congressional Democrats must pass a health care reform bill. There is a lot more at stake here than curbing medical costs and expanding coverage, though both are crucial. The fundamental challenge is proving that progressives can govern the country.
A win on health care would show that Obama and his party are serious about fixing our broken political system. A loss would make Democrats look feckless and deepen public anger and cynicism toward government.
It’s gut check time for Democrats. If Republican Scott Brown wins the Massachusetts Senate race, some nervous centrists may be tempted to overread the result as a “populist” revolt against health reform or “big government” solutions in general. Some liberals will claim that voters are punishing Democrats because Obama and his party haven’t been radical enough. If only the Democrats had included a public option, or embraced a straight-up single payer architecture, then voters would at last see change they can believe in.
Well, Massachusetts voters seem to have other things on their minds besides health care, like the economy and one-party dominance of state politics. But there’s no doubt that public support for health reform has steadily eroded over the past year. During the 2008 campaign, voters routinely listed health care as their top concern; now only 39 percent favor the President’s reform blueprint.
Although conservative disinformation has taken a toll, the main reason is that Americans are more worried about the economy than health care. And as ordinary families struggle with depleted retirement savings, home foreclosures and double-digit unemployment, they also stew over the billions Washington has spent to bail out overcompensated bankers and inept auto executives. Such “populism,” however, doesn’t fit neatly within any ideological template. People are mad at Wall Street greedheads, but they’re also increasingly anxious about government regulation and deficits, which makes them wary of liberal demands for bolder, costlier initiatives.
Another reason for growing disenchantment with health reform is the process itself. The health care debate has shown Washington at its polarized and parochial worst. It has taken too long and involved endless haggling by an ever-changing cast of negotiators. Too many interests have been accommodated, at the expense of both taxpayers and policy coherence. Win or lose, the coming after-action reports on health reform will surely focus on the wisdom of President Obama’s decision to articulate broad principles and let Congress sweat the details.
Still, in the end, all of us need relief from escalating health care costs, and millions of our fellow citizens need access to insurance. And more than anything else, Americans need to know that our democracy still works. That’s why progressives ought to fall in behind President Obama’s dogged efforts to pass a bill.
“The worst thing to do is nothing,” former President Bill Clinton advised Democrats at their recent retreat. He’s right. Should Democrats lose the Massachusetts seat, they will basically face three choices. One is to speed up efforts to reconcile House and Senate bills and push for floor votes before Scott is seated in the Senate. The second is for the House to pass the Senate bill intact and send it to the President’s desk for signature. The third is to give up. Option 2 is the quickest, simplest and most procedurally defensible course. It’s one pragmatic progressives should support on policy grounds as well, since the Senate bill, though far from perfect, is more fiscally responsible and contains stronger cost control measures than the House version.
Republicans will cry foul in any case, but their credibility is shot. The post-mortems also will show that, by taking an obstructionist stance from the beginning, Republicans foreclosed any possibility of a bipartisan bill. Worse, as health care analysts Bryan Dowd and Roger Feldman argued last week on Progressive Fix, they violated their their own beliefs (for example, by piously denouncing cuts to Medicare providers) and utterly failed to offer a principled alternative.
For House Democrats, especially liberals, having to approve the Senate bill unchanged would be a bitter pill. The bill’s subsidies for low-income workers aren’t as generous, its regulations on the insurance industry are less severe and, of course, it doesn’t include their cherished public option. But they should recognize that their party’s reputation for governing competently is on the line and take one for the team.
For the governing party, winning ugly beats losing ugly. Passing a bill, moreover, is the beginning, not the end, of improving health care quality and delivery in the United States. The government will have to issue new regulations to put the bill’s often vague provisions into force, and like any piece of landmark legislation, it will be tweaked and revised as we go along.
So on health care reform, progressives ought to hang together or – you know the rest.
