I’m with Steve Benen on this one: after listening to Republicans say all weekend that the president needs to surrender on health care reform and start embracing theirpolicy ideas, maybe it’s time to draw a lot more public attention to all that fine GOP thinking on the subject.

So where to begin? I guess that would be with the “plan” that drew 176 Republicans votes in the House in a test vote in November of last year, the so-called “Boehner plan.” Dissed by an official Congressional Budget Office analysis that suggested it would cover almost none of the uninsured, while controlling costs far less effectively than the House Democratic proposal, this plan followed the usual conservative template of focusing on tort “reform,” “interstate markets” for private heath insurance (e.g., elimination of state regulations), elimination of the entire employer-based system, and a two-pronged strategy of subsidizing high-deductible individual health plans for healthy people, and state-run risk pools for sick people. It was, as Matt Yglesias put it, an “un-insurance” plan that would take health policy, in some respects, back to the 1950s.

Another example of Republican “thinking” on health care policy is the idea of “voucherizing” Medicare, which was the central health policy element of the official House GOP “alternative budget” offered last April by Rep. Paul Ryan of WI. While “Medicare voucher” proposals vary, they all at the very least aim at transforming Medicare into a system of federal subsidies for purchasing private health insurance, while capping expenditures regardless of the impact on benefits. To put it simply, seniors would march through the streets with torches to protest any such plan if it were taken seriously.

And then there’s the most fully developed Republican health care plan, the one developed and implemented by the front-runner for the 2012 GOP presidential nomination, and recently promoted by the party’s maximum “new star”: the Massachusetts health reform plan. How about allowing a vote on that in Congress? Oh, yeah, sorry, that’s pretty much the plan already passed by the U.S. Senate without a single Republican vote! It’s socialist!

Suffice it to say that while Democrats have been materially hurt by endless scrutiny and confusion about the substance of their ideas on health care, Republicans have massively benefitted from a total lack of accountability for their own ideas. Best I can tell, Republicans would probably be politically destroyed if people truly paid attention to GOP health proposals. So Democrats should find ways to help their GOP colleagues publicize their ideas.

This item is cross-posted at The Democratic Strategist.

Everyone should read Matt Yglesias’s post,”How Close Were We, Really?” which makes a point that I’ve been mulling. The fact that health care reform blew up so quickly after the Brown win implies that whatever consensus had been achieved between the Senate and House, it was significantly incomplete, weak, or both. House liberals apparently were not prepared to pass anything coming out of conference that didn’t reverse the problems they have with the Senate bill. But it’s unclear whether moderate senators or representatives would have stayed on board in that event. If the last week shows nothing else it reveals that a whole lot of members of Congress were decidedly un-excited about supporting anything resembling either chamber’s bill.

This seems like a job for Keith Hennessey: knowing what we know now about the uneasiness of moderates and the stubbornness of liberals, what was the likelihood that reform would have passed if Coakley had won? (Keith had the probability of collapse given a narrow Coakley victory at 10 percent — and two percent with a big win — before the election.)

If this interpretation is right, it implies that many progressives haven’t given enough credit to how far out on the plank many moderates actually went (which isn’t that surprising given how many of them misread the polls). Pre-Brown, moderates were betting that antagonism toward reform wasn’t so strong that their job — their chance to work on all of their other legislative priorities — was in mortal danger. The Brown win provided new information that clearly affected the calculus (as did the initial freak-out by Massachusetts’s own Barney Frank).

Perhaps one big reason why the Obama team (and everyone else) was caught flat-footed after the election was that they were unaware of how much moderates already felt they had stuck their necks out.

All this said, I think the consensus that Democrats having second thoughts ought to accept that they have no choice but to vote for the final bill is correct. Actually, I think these Democrats have probably reached that conclusion too. But it’s important to note that that wouldn’t be enough to pass something — if House liberals won’t vote for the Senate bill, it doesn’t matter what moderates do. What progressive bloggers need to do is start working the liberal legislators in the House.

A problem that seems to be getting lost in the current confusion over the fate of health reform legislation is something that has little to do with party or ideology, much less with the details of health policy. It’s cameralism.

To put it simply, members of the U.S. House and the U.S. Senate have very different perspectives, mistrust each other’s motives, and rarely communicate. In general, they don’t much like each other. They live and work in two very different institutional cultures, and with the exception of House veterans serving in the Senate, they don’t go to much trouble to find out how the other chamber functions.

Much of the time this “cameralism” is background noise in the legislative process. But when it comes to the kind of highly complex, trust-based maneuvers that health care reformers are talking about this week–you know, House passes Senate bill with assurance that Senate passes bill “fixing” their own bill via budget reconciliation, somewhere down the road–it’s a real problem that can’t just be wished away. And that’s particularly true in an environment requiring almost total agreement among Democrats in both Houses. Maybe that’s one reason the White House is talking about a “cooling off” period on health care reform.

This item is cross-posted at The Democratic Strategist.

In the wake of Tuesday’s Republican victory in Massachusetts, Scott Winship wrote a post here that expressed hope that “liberal pundits” would finally get out of “denial” about the unpopularity of health care reform.

Now as Scott knows, there’s always peril involved in making generalizations about the views of large classes of people. I don’t know which “liberal pundits” he’s thinking about in making the suggestion that there’s a general unwillingness to accept public opinion data on health reform; the links he offers don’t really support the claim. But most of the “liberal pundits” I’ve read in recent months don’t dispute the fact that public support for the particular legislation being discussed in Congress at any given moment has been flagging (though given the very fluid nature of the legislative process, it’s difficult to identify which version the public is reacting to, which is why the variations in the wording of polling questions on health reform so often produce different results).

Scott goes on to mock particular arguments that he views as rationalizations for this alleged unwillingness to accept reality: voters are uninformed, Republicans have misled them, and in any event, a significant part of the opposition to health reform bills is “from the left.”

Are these really just rationalizations? I don’t think so. Poor public information on health reform and Republican lies about “ObamaCare” are germane for the simple reason that public opinion may well change if health reform is enacted, and lo and behold “death panels” aren’t convened, Medicare benefit cuts don’t happen, and “government” does not in fact “take over” health care. And the “opposition from the left” data point is relevant to nervous Democrats in Congress because voters unhappy with the absence of a public option, for example, are not terribly likely to vote for Republican candidates who favor voucherization of Medicare or oppose regulation of health insurers.

Scott also seems to assume that “liberals” who talk about the “will of the majority” being frustrated by the de facto 60-vote requirement in the Senate are talking about public opinion. But all the examples he cites are in fact discussing the “will of the majority” of senators, and the majority of the population they represent. The rules of the Senate, after all, cannot be adjusted daily based on tracking polls of the relative popularity of this or that piece of legislation.

Finally, there’s the apparent motivator of Scott’s post: the Massachusetts results. Should the strong opposition of Scott Brown voters to health care reform (at the federal level, at least) represent an “aha” moment for those with any doubts about public opinion on this issue? Again, I see no atmosphere of denial on the subject; yes, many observers, myself included, have noted that a lot of different things were going on in Massachusetts, and have argued that it was not all just one vast referendum on health reform in Congress. But more to the immediate point, the relevance of the Massachusetts results to public opinion nationally is significantly damaged by its unique status as a state that has already enacted reforms almost identical to those attempted by the pending legislation in Congress. And this, in fact, was Scott Brown’s number one talking point on health care reform: why should Bay State citizens pay taxes to give Nebraska the benefits Massachusetts already enjoys? That’s a pretty compelling argument, on the surface at least, but it’s not one that can be made elsewhere.

Ironically, Scott closes his piece by suggesting that perhaps congressional Democrats should put aside fears about public opinion and enact health reform legislation anyway. In doing so, he reflects the real debate I’ve been hearing among “liberal pundits” for many months now: when given a historic opportunity to achieve a long-held progressive goal which happens to represent an immediate national challenge, should Democrats defer action until public opinion is completely on their side? What’s the point of running for office as a progressive if you aren’t determined to achieve progressive policy goals when you can? Is there any other approach to health reform that might be more popular? Is there any time like the present for action?

These questions don’t automatically answer themselves, but I don’t think it’s fair to suggest that health reform advocates are in denial about the political risks involved in health care reform, particularly at a time when Republicans are absolutely refusing to cooperate, and when much of the beltway commentariat has been telling the president for months that he should abandon all goals other than agitating the air for more jobs and lower deficits.

Progressives need data-driven critics like Scott Winship who are willing to contribute to our debates with sometimes troubling information. But in this case, I suspect, to use an old southern expression, he’s just goosing a ghost.

There was a point yesterday when it sure looked like Scott Brown had managed to kill federal health care reform without setting foot in Washington. Senate Democrats were busily disclaiming any interest in further action on a potential House-Senate conference committee report before Brown could arrive to joyfully join a filibuster and impose the will of the minority. House Democrats were refusing to consider passage of the Senate bill (which could avoid the necessity of a conference committee report and another Senate vote) without iron-clad assurances of future action to change objectionable features (e.g., the “Cadillac tax” which unions hate, and language restricting abortion). Such assurances did not seem to be forthcoming from Senate Democrats. And no one knew where the White House was, though rumors abounded that the president had told a reporter it was time to go back to the drawing board and try to enact something less ambitious.

All this was happening as conservatives in effect snaked-danced through the streets hailing Brown’s victory as the largest political event since, maybe, World War II, and the effective end of the Obama presidency.

The general malaise among health-care-reform-minded progressives was probably best expressed by The New Republic‘s Jonathan Cohn, who has been an eternal optimist about prospects for eventually getting legislation done. He published a piece late yesterday bewailing the White House’s apparent drift, with the bitter title: “Where’s the Obama I voted for?”

As often happens, though, the panic subsided, and things look more hopeful today. Turns out the president’s comments were vague but resolute about pressing forward on health reform. Senate Democrats are not walking away from health reform, and House Democrats have stopped making angry comments about the impossibility of getting acceptable assurances from the Senate about future action in order to facilitate passage of the Senate bill. It still will be complicated to put together a “deal” that both progressives and moderates in both Houses can live with, but it seems to be sinking in that failure to enact anything, after so many Democrats have already cast votes for reform and made themselves targets for conservative attacks, is just not an acceptable outcome.

So the conservative exultation over “the death of ObamaCare” may be a bit premature. We’ll know soon enough.

This item is cross-posted at The Democratic Strategist.

As the entire political world looks to Massachusetts today to see what its voters (or at least those willing to vote in a special election) do about an open Senate seat, Republicans, of course, are excited by the possibility that they can kill health care reform by denying Democrats the 60th vote they need for final passage of the reform plan in the upper chamber. But it kinda makes you wonder why in all the obsessive coverage of the MA race, we aren’t seeing the last Republican to win a major statewide office in the Bay State: you know, Mitt Romney, supposedly the front-runner for the 2012 GOP presidential nomination.

Politico‘s Alex Isenstadt raises that question today, and the bottom line is that, well, Romney’s just not that popular in Massachusetts:

Romney’s White House run, said Jeffrey Berry, a Tufts University political scientist, left a sour taste in the mouths of state voters.“Mitt Romney is an unpopular former governor. He left the state to run for president and people feel he was insincere when he ran for governor in the first place,” said Berry. “He hasn’t really been a part of Massachusetts political culture since he left office. I think people thought he ran for office merely to run for president.”

Andrew Smith, director of the University of New Hampshire Survey Center, explained that voters in Massachusetts had recoiled after Romney took a sharp right turn on social issues during the presidential campaign — and the former Massachusetts governor went so far as to criticize his home state over its legalization of gay marriage.

“He sort of lost credibility among voters in the state,” said Smith.

This certainly helps explain why Republican candidate Scott Brown hasn’t been anxious to recruit Romney to run around the state with him, but there may be something else going on that is keeping Romney out of the picture: Brown’s support for the Massachusetts health system, which is by all accounts a major albatross for Mitt in his future presidential aspirations.

After all, Brown’s number one talking point in recent days has been that his state doesn’t need federal health care reform because it’s already enacted a strikingly similar set of reforms on its own. National action, he argues, will just mean Massachusetts taxpayers will have to help other states get up to speed in covering the uninsured.

This may be an effective argument in Massachusetts, but it’s not terribly appealing to Republicans elsewhere, who typically view the kind of reforms enacted under Romney’s leadership in the Bay State as rampant socialism. The last thing Romney needs is to put himself in the middle of that particular debate.

And so, irony of ironies, the most famous Massachusetts Republican is out of public sight on the day when Massachusetts could give the GOP a very famous victory. That doesn’t bode well for Mitt’s 2012 prospects, and for that matter, for Republican claims that a Brown victory can be exported elswewhere–say, to the 49 states who haven’t enacted a health care reform initiative much like the one they are trying to kill in Congress.

This item is cross-posted at The Democratic Strategist.

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.

As Congress makes sausage out of health care reform, Republicans have complained bitterly that they have been excluded from the process. As health economists whose work generally reflects a market-based perspective, it might be surprising to hear us say that exclusion is just what the Republicans deserve. There are three reasons why.

Private health insurance works best for Americans who get it in groups through their employers. But virtually all such Americans know they are only one layoff away from losing their health insurance. If they have a pre-existing medical condition, they will have to pay astronomical premiums for an individual insurance policy, if they are lucky enough to get coverage at all. Those who are turned down can face financial ruin from the cost of illness. Any rational person would want to insure against the risk of losing his or her health insurance, but that is virtually impossible to do in the current health insurance marketplace.

This is a clear case of market failure and it has persisted for decades, yet Republicans simply don’t recognize this as a problem that needs to be solved. The individual insurance market is the source of most of the horror stories that plague and sully the health insurance industry, yet Republicans, who say they want to preserve private insurance, have proposed nothing that would address the problem.

The obvious solution is to impose some type of structure (i.e. “insurance exchanges”) on the individual insurance market, including a guarantee that affordable coverage would be available to anyone who shops in the individual market. State governments would be the natural entities to manage this market, but government involvement, even in the face of clear market failure, is anathema to Republicans. In addition, the Democrats’ mandate requiring individuals to purchase insurance is too much for many libertarian-oriented conservatives to bear, especially if costly subsidies are tied to the mandate. But at least they’re attempting to solve a complex problem, something Republicans can’t seem to do.

The second Republican failure is their criticism of the Democrats’ proposed cuts to Medicare. Part A of Medicare (which pays for hospital care) is scheduled to run out of money in 2017, or sooner if the recession continues to depress federal tax revenues. Young Americans have not mismanaged the Medicare program and don’t deserve to pay the bill for that policy failure. Drastic cuts in the cost of Medicare (coupled with higher premiums and a dramatic increase in price competition at all levels) will be necessary to solve this problem, and the sooner the better. The cuts proposed by congressional Democrats – mainly in payments to hospitals, other providers, and private Medicare Advantage plans – are a tepid attempt to deal with this problem. Like many Democratic proposals, they go hand in hand with a misplaced distaste for private health insurance plans. But vilifying the Democrats on that score, without offering alternatives to shore up the program, is fiscally irresponsible.

The third Republican failure is their knee-jerk criticism of “comparative effectiveness” research. This research aims to discover which medical treatments work better than others. It’s perfectly acceptable to worry that comparative effectiveness research in the wrong hands (like the government’s) could lead to rationing. But blanket condemnation of comparative effectiveness research leaves the impression that the current level of ignorance regarding the effectiveness of medical treatments is an inconsequential feature of the health care system. This is an embarrassment to the party that claims to be a prudent steward of the public’s money.

Republicans need to start listening to their constituents and propose innovative, conservative remedies to the numerous problems that plague the U.S. health care system. People who truly are market-oriented should be able to see market failure when it exists and propose corrections, even when those corrections include a role for government. Since the insurance industry has failed to fix itself, Republicans should have proposed a new set of products that protect people from losing insurance coverage. They should have proposed remedies including regulatory constraints that would lead to more stable and affordable health insurance coverage without the need for government subsidies. Finally, Republicans should have promoted their own proposals to fix Medicare, instead of demagoguing the issue. The Republicans’ silence on these fronts has been deafening – and explains why they deserve to lose the health care debate.

Bryan Dowd and Roger Feldman are professors at the University of Minnesota. They split their votes between Barack Obama and John McCain in the 2008 presidential election.