Ezra Klein: How To Pass Health Reform

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October 15, 2007

How To Pass Health Reform

John Boehner is promising that the Republicans will soon produce a health care plan "that will provide access to all Americans to high quality health insurance." Atrios replies, "Given the quality of media coverage of policy debates they're probably making the right move. There are different plans, and, hey, who can tell which will work. It's all so confusing and boring. Hillary cackled!"

That's exactly right. These plans exist to toss static into the discussion and make it seem as if there are two viable, existent options, one of which costs a lot of money and is really scary, and one of which involves no money, changes, or actual improvements, but will still solve everything, forever.

That said, the reason the Republicans are jumping into this debate is that they're scared. The Democrats need to viscerally recognize that this issue is moving in their direction, get the Republicans on the record supporting reform, and then brutally attack them until they actually vote for reform. We know which plans will work and which won't. We know which plans are proportionate to the problem and which aren't. The question won't be how good our policies are, but how good our political strategy is. And what the Right is showing here isn't that they want to have a serious conversation about the issue, but that they sense their own weakness on the issue. Democrats have to be prepared to capitalize, and if the Republican plan is nothing more than a pathetic tax exemption, Democrats have to be willing to say so, and use that puny, cruel, cynical policy offering to force Republicans to the table.

Health care reform will pass when obstruction ceases to be politically safe. It's up to the Democrats to make that the case.

October 15, 2007 in Health Care | Permalink

Comments

I don't want all Americans to have access to high-quality health insurance. I want all Americans to have high-quality health insurance (or really, high-quality health care). Anything less than that doesn't solve the problem.

Posted by: KCinDC | Oct 15, 2007 4:12:46 PM

But that would be mean to the GOP. And require courage as well.

You're correct, of course, but Steny Hoyer doesn't have you in his Iphone address bood, I suspect.

Posted by: JimPortlandOR | Oct 15, 2007 4:13:05 PM

Also, replay the Fala speech, beat a whole bunch of them during elections, and then enact your own plan.

Posted by: Nicholas Beaudrot | Oct 15, 2007 4:29:19 PM

We know which plans will work and which won't. We know which plans are proportionate to the problem and which aren't.

Now *that* is the part of this post that really scares the bejeezus out of me!

Posted by: El Viajero | Oct 15, 2007 4:48:59 PM

We do know which plans work (single payer) and which ones don't (plans that are designed to ensure that insurance companies continue to take a big chunk of health care spending, rather than simply to deliver care to those who need it). The problem is, the Democrats are supporting the latter.

Posted by: Dilan Esper | Oct 15, 2007 5:13:39 PM

Exactly. This is the time when you push the plan that you know would be actually best, that is easiest to explain, that is very clearly different from anything any Republican could ever claim to be advocating. Medicare for All.

Posted by: tatere | Oct 15, 2007 5:52:48 PM

except that you ignore the static produced by clinton herself without regard to motive. as i said, i find it funny that you do this here. you accept a "its a top priority' from clinton without much proof, but here you dont believe a word the GOP says. I get it. my team versus theirs. but its not exactly objective since neither the GOP or clinton is to be believed with regard to comprehensive plans on their face.

Posted by: akaison | Oct 15, 2007 7:11:38 PM

Nonsense. The Republicans are going to offer tax credits. The proposal will be ludicrous on its face. If they were serious about challenging, or supporting, any of what Democrats have proposed, we wouldn't be having any discussions, we'd be passing legislation. Single payer is an option that needs more fleshing out to be a realistic proposal. At present, no one has a good answer for how we would transition a wide variety of health care arrangements into a single plan that could reasonably be expected to deal with vastly different scenarios. Don't get me wrong - I'm all for massive reform; but the public isn't there, and certainly the half that takes their cues from the GOP and conservative talkers isn't remotely there. Tax credits won't look like anything Democrtas are proposing and almost anyone who looks at healthcare seriously will call them a decidedly unserious proposal. If Boehner had more than that, we'd have heard it by now, because they need to seriously explain their thinking if they're planning something else.

Posted by: weboy | Oct 15, 2007 7:12:01 PM

Actually, the most telling sentence from this post, that succinctly exposes the Democrat strategy in all this, is:
The question won't be how good our policies are, but how good our political strategy is.

Posted by: Bill B | Oct 15, 2007 7:13:06 PM

At present, no one has a good answer for how we would transition a wide variety of health care arrangements into a single plan that could reasonably be expected to deal with vastly different scenarios.

All you need to do is set up the mechanism-- some sort of tax measure-- and set up the payer (by expanding Medicare to cover everyone). You don't have to get rid of anything-- the market will then adjust to the new reality that all Americans have a baseline of health coverage provided by the government.

Really, its much much harder to transition to a plan that achieves universal coverage while maintaining roles for insurance companies, because you have to create a bunch of artificial regulatory structures to do that.

Posted by: Dilan Esper | Oct 15, 2007 7:22:45 PM

The simplest program to implement, as well as to explain politically, would be Medicare For All. Instead of constant references to the complexity of the program, leading voters to throw up their hands at the problem, these three words would resonate in the understanding of our citizens. Everyone has seen the effectiveness of Medicare, and it is a program people are comfortable with. I am convinced that we will have universal health care only when the Democrats realize that this is the political play to make.

Posted by: The_Question | Oct 15, 2007 7:34:23 PM

Once more I must say that I have no idea what the best program is for dealing with the healthcare crisis in this country. I am just engaging my bullshitometer when it comes to the character of the players involved in the debate. Clinton's plan could be the best or worse for a ll Iknow- my problem is the trust issue. She has yet to shown she can be trusted and what people say here just reinforces why that is the case.

Posted by: akaison | Oct 15, 2007 8:02:34 PM

Exactly right, Mr. Klein. And here's the kicker: this is what has been largely absent from the left for, oh, some thirty years now, in that such a turn to power politics would be backed by a fundamentally moral and overwhelmingly popular policy of which the left holds the torch of knowledge, B. Clinton's famously implied "right and strong." Let a desperate and sinking modern conservatism and it's media marionettes screech all they want (and they will, as the Frost family can attest); this one has the potential to be a turning point in American history, and they know it. A thoughtful but no holds barred approach from the Dems on this would be a moment for the history books, and let's hope Congress pays attention to deeply informed voices who are, so to speak, "rrready to rrrumble."

Posted by: Conrad's Ghost | Oct 15, 2007 8:26:51 PM

Dilan - I'm not arguing for or against a particular plan; I think Hillary Clinton's proposal is interesting, but also problematic, for a number of reasons. I am not as opposed, as you are, to the role of private insurance in the mix, at least as a way to get from where we are to where we want to be; and I think people need to be realistic about the fact that many professional white collar workers consider their insurance just fine and don't necessarily want a change; their opposition to a "universal payer" plan would be a big derailing factor. That's why I point to the need to think through what a transition looks like; it's easy to talk about how "Medicare for all" would work for a lot of people; the people facing the biggest changes in that scenario are people (healthy people, I'd point out) with good health insurance who believe they will sacrifice choice and quality. Those are not small matters. I'm not saying I agree with the perceptions, I am pointing out that they exist. We are not at a point yet where a lot of people understand all the ins and out that many of us here, who care about this and study it closely, do. My larger point was that there's a notion expressed here that what Republicans proposal will look, somehow, like Clinton's proposal (or even, say Romney's in Mass), leading to some difficulty in differentiation between right and left. And that's not what's going to happen here. What the right will propose - which will largely be built around tax credits (and probably their tort reform hobbyhorse, not to mention HSAs) - is stuff we've already seen, and for which we already, as Ezra notes, have answers. If they've got something else, believe me, we'd know about it. And they don't. But once they join this discussion - something I've seen as a key development for some time - the realty is we're that much closer to the bigger changes we've been advocating. I agree we should be forceful. But I don't think we should be especially afraid of what they'll come up with. Everything - including Boehner's pre sell - looks half-assed.

Posted by: weboy | Oct 15, 2007 8:58:37 PM

Medicare is hugely expensive and on current projections will be bankrupt in about a decade. "Medicare for All" would cost at least an additional $1 trillion a year in federal spending. It would be the most fiscally irresponsible program ever created. That's one reason why it's never gonna happen.

Posted by: JasonR | Oct 15, 2007 9:06:37 PM

You know what works, do you? Then how come all I hear from you is Hilary's compulsory insurance is a good idea? Why is no-one in america looking at the French model? (As far as I can tell no-one in America realises that the french model is different from the English NHS).

It sounds to me like you're ready for a political career - you're now sure that you understand the economics that economists don't.

Posted by: Marcin Tustin | Oct 16, 2007 4:10:32 AM

We know which plans will work and which won't.

I see no evidence of that. All the major Dem contenders, and even you, Ezra, refuse to confront the problems with linking health insurance to employment. And please don't give me that nonsense that some tax credit after you get laid off is going to help you pick up the slack.

Until I see this addressed, I have no confidence that any of the plans being floated about will meet the goal of 100% coverage, or even close.

Posted by: Brautigan | Oct 16, 2007 10:32:19 AM

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