Health-Care Reform Stopped Being About Policy a Long Time Ago

Patrick Caddell and Doug Schoen, a former pollster and a pollster, respectively, have written an op-ed in today's Washington Post about arguing that Democrats need to change their approach on health-care reform. They say the public is so overwhelmingly opposed to the reform package that Democrats would be better off if they broke the piece up into small, less ambitious policy initiatives that could achieve bipartisan support. But that misses the point. This debate stopped being about policy long ago.

Here's a paragraph from their op-ed that will help me explain what I mean:

For Democrats to begin turning around their political fortunes there has to be a frank acknowledgment that the comprehensive health-care initiative is a failure, regardless of whether it passes. There are enough Republican and Democratic proposals—such as purchasing insurance across state lines, malpractice reform, incrementally increasing coverage, initiatives to hold down costs, covering preexisting conditions and ensuring portability—that can win bipartisan support. It is not a question of starting over but of taking the best of both parties and presenting that as representative of what we need to do to achieve meaningful reform.

The problem with this statement is that it essentially describes what Obama wants to do. Caddell and Schoen say a proposal allowing the purchase of insurance across state lines would receive bipartisan support. But that's exactly what a national insurance exchange would allow people to do. People participating in a national exchange could buy whatever plan they wanted regardless of what state the insurer was based in. But Republicans in the Senate railed against that idea, so we're now looking at a bill with state exchanges. Even so, section 1333 of the Senate bill does encourage states to get together and form "compacts" that would allow insurers based in any one of the states that form the compact to offer insurance to residents in all of the states.

Medical-malpractice reform is another of Caddell and Schoen's bipartisan ideas. The president has said repeatedly that he supports reforming medical negligence laws, and at the recent health-care summit he even instructed Democrats to work with Republicans on their ideas for reform. Not only that but the Senate bill includes a provision that encourages states to come up with innovative malpractice-reform mechanisms that Congress could then grant funds to. But Republicans don't see these ideas as aggressive enough for their liking.

Similarly, the initiatives to hold down costs in the plan the president presented before the health-care summit were all ripped directly from Republican ideas. Covering preexisting conditions has been a central demand of the president's since Day 1. Need I go on?

The point is the debate over this bill ceased to be about policy in August last year, when Sarah Palin et al. whipped the public into a frenzy about death panels and killing Grandma. If it were about policy, Caddell and Schoen would have a point, but it would be moot because there actually is bipartisan support for the central ideas of the bill. Instead, thanks largely to misleading pundits and dissembling Republicans, a large segment of the public (which incidentally overwhelming supports nearly every major provision in the bill) mistakenly believes that the bill is an ultraliberal monster that will raise their premiums and allow the government to tell them when they can see a doctor. If you don't believe me, take a look at both Paul Krugman and David Brooks today.

Even if Democrats did break the bill up into component parts (which in my view is a mistake—the parts don't work without each other) that notionally have Republican support, there's simply no evidence that they'd get any more GOP votes than they have now. This debate is purely, savagely political. Arguing that abandoning reform now in order to seek Republican support for policies will help Democrats in November misunderstands the fundamental nature of the opposition.