If I can leap ahead a bit here, in anticipation of Harry Reid actually passing health care reform (something that is far from assured), the Democrats are going to have to defend their votes for this bill, while the Republicans will have to defend their votes against it. Because a lot of the provisions of this reform will not come to fruition until 2013 or 2014, the debate over this vote is going to be largely theoretical during the 2010 and 2012 election cycles. To be honest, most of the people who will eventually get health insurance (and the subsidies to pay for it) are more likely to vote for Democrats than Republicans anyway. They have lower income levels and pay little to no federal income tax. Once they have insurance in hand, they’ll probably be modestly more likely to vote, but we shouldn’t expect to see any immediate boon in the Democrats’ fortunes from this group.
The selling point for this reform is not going to be that it provides insurance to the uninsured. The popular parts of the bill are going to be the pieces that apply to everyone. The end of recissions, no more worries about preexisting conditions, caps on out of pocket expenses, and increased portability. The way to put Republicans on the defensive is to ask them why they wanted the insurance corporations to be able to continue to screw the consumer. The Republicans will try to talk about the cost of reform, but they’ll have a hard slog in the face of CBO estimates that the reform will actually improve the budget deficit and bend the cost-curve of providing health care to people.
The main tangible evidence that voters will have to assess this reform in the short-term will be the cost of their insurance. If it is still going up rapidly every year, they’re going to be pissed off and dubious that anything positive has been accomplished. This is the main risk of postponing many of the cost-cutting provisions through two election cycles. On the whole, Democrats should be able to win the short-term political argument over whether this reform was a good or a bad vote, but it won’t be a slam-dunk. As the Democrats put the finishing touches on this legislation during the Senate debate and the Conference Committee, they should keep an eye on the short-term political consequences as well as the long-term policy considerations. If the Republicans make any gains in the 2010 Senate elections, we’ll see very little positive reform in 2011 and 2012. So, passing the bill is the most important thing, but making sure it is possible to sell the bill politically in the short-term is also critical.
This is a good point, and one largely lost in the “public option” media hype. In all honesty, if health insurance reform legislation could accomplish these things, even without the public option (to be sure, a good thing IMO), does anyone think that this would not be worth doing? Are we willing to settle for absolutely zero, including worthwhile constraints on the behavior of insurance companies? Just asking…
Why should we settle for insurance reform? It’s only part of the health care reform to make it politically possible to pass it.
Yes, it’s worthy in its own right, but the name of the game is getting everyone access to health care without bankruptcy.
I agree with you in principle, but suppose that at the end of the day, the votes simply are not there to pass this with the public option? I also agree that Congressional leaders (Reid in particular) should use every tool available, including reconciliation, to make this happen with the public option. I simply don’t know if Reid has the sack to do this, if needed. My point is this: do we pass the the other parts, or do we leap off the cliff with the flag in our hands if the public option is not a part of this? As I have said many times, I believe doing nothing is political suicide for the Democrats.
doing nothing is political suicide … but so is passing a shitty bill … because whether it is now .. or later .. there will be blowback
The agonizing question is, Does passing a minimal bill lock it in as all the healthcare reform we’re ever going to get, or does it open the door to getting the real thing down the line?
The argument for the former is history: Social Security, Medicare, and other breakthrough social policy innovations took several rounds to get where they are today.
The other side is, if the bill that’s passed looks like just more phony bullshit, the view that government can’t do anything good with healthcare will prevail.
The outcome will be a test of whether a cautious, incremental approach (which I would call this bill even with a good public option) can produce something long-term worth the bother.
So, passing the bill is the most important thing, but making sure it is possible to sell the bill politically in the short-term is also critical.
When have Democrats on The Hill ever been good at selling anything(besides Obama selling himself)? When did they even care enough to sell it? Do you really think Evan Bayh wants to sit in the Senate for another 35 years? Or Blanche Lincoln? They don’t want to tick off their corporate masters(or in Bayh’s case .. his wife) for fear of losing that present or future version of wingnut welfare
well, most politicians vote defensively. Their biggest fault is a failure of imagination. They don’t anticipate the things that get them defeated.
Is to too tinfoil-hat to imagine the insurancecos doing everything they can to make insurance worse and costlier and blaming it on “reform”? And you’re not factoring in Beck and the other fascist clowns hammering away on how the Dems forced socialism down our throats so they could keep darkish terrorists healthy.
I absolutely agree that “The way to put Republicans on the defensive is to ask them why they wanted the insurance corporations to be able to continue to screw the consumer.” But will Dems have the integrity to tell that truth and out the corporate toadies among them? Hope so, but not betting on it.
The way to sell the bill in the short term is to get ahead of the criticism of the real weaknesses in the bill. And to foreclose any movement to repeal it.
The 2010 Congressional session could (if the Democrats recover sanity), focus on removing the anti-trust exemption for insurance companies (which is missing from the Senate bill), changing the definition of the basic plan to cover dental and vision, and breaking the micro-managed fee-for-service payment accounting. All of these measures would be popular (except with insurance companies). They could be done as separate bills, or as amendments to the HHS appropriations. And fix the items that ordinary folks (not the teabaggers) are having difficulty with–medical loss ratios are likely to be one. Make passing the popular parts a litmus test in the 2010 Congressional election. And watch what happens to the Party of No.
If there is a 2013 or 2014 beginning date on the exchanges and public option, there are two to three years to make legislative tweaks to it to ensure that it works–or if it looks good, accelerate its implementation.
Both of these are going to be essential pressure if the opt-out begins upon passage and the Republican governors go for grandstanding.