The Magazine

The Inevitability Myth

Health care reform is not a fait accompli

Nov 2, 2009, Vol. 15, No. 07 • By MATTHEW CONTINETTI
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Did the Democrats become Calvinists when we weren't looking? Lately they've been talking an awful lot about predestination. They want to claim that Obamacare's victory is foreordained, that the health care debate is over and--surprise, surprise--the liberals won.

So: Paul Krugman wrote on his blog that an "aura of inevitability" surrounds Obamacare. The Washington Post's health care blogger wrote that this month's pro-Obama vote in the Senate Finance Committee "convinced many that health care reform was more of an inevitability than a possibility." A blogger for the Atlantic Monthly wrote that health care reform is a "fait accompli."

Pas encore. Yes, the chances of some sort of health bill passing, at some point, are by no means negligible--unfortunately. But there are many reasons to be skeptical of the future of Obamacare. Here are three:

The Landscape. "Our government rests in public opinion," Abraham Lincoln said in 1856. "Whoever can change public opinion, can change the government."

Public opinion is not on the Dem-ocrats' side. Most Americans remain satisfied with their health care. It's true that certain elements of the proposed reform, when isolated from others, poll well. But Congress isn't going to hold separate votes on each piece. Congress will be voting for the whole package. And the fact is that, ever since Congress began to assemble that package, more people have opposed the health care plan than favored it. The polls are striking. Since September 9, President Obama has campaigned strenuously for his plan, and it continues to lose support. And the Gallup poll says that Obama's ratings plunge over the last three months is the largest quarterly drop for an elected president since 1953.

In other words, a polarizing chief executive is asking Congress to enact a $1 trillion entitlement and tax hike against the public's wishes. Won't Democrats whose seats are up in 2010 think twice before acceding to his demands?

The Money. A glance at the polls reveals the alarm at our ballooning national debt. The Congressional Budget Office concluded that the Senate Finance Committee's health care bill would pay for itself in its first 10 years, but only by imposing taxes and cutting Medicare. There is no reason to believe that the reform that comes to a floor vote will resemble the Finance bill. This bill is far too stingy for liberals. They are ready to add to the debt in order to achieve their social vision. They want universal coverage. They want more generous subsidies.

But a left-liberal health care reform is a dicey proposition. Consider what happened last week in the Senate. Medicare is scheduled to reduce doctor's payments by more than 20 percent in 2010. The Democrats wanted to restore those cuts at a cost of $247 billion in unfunded liabilities. But, when Harry Reid tried to end debate on the measure last week, he failed. Joe Lieberman and 12 Democrats voted against the Senate Democratic leadership and for fiscal responsibility. Reid can't get 60 votes for a payoff to the American Medical Association. What makes the White House think he can get 60 for Obamacare?

The Calendar. Obama originally wanted a bill before summer's end. Didn't happen. Back in September, lawmakers expected Pelosi to hold a vote by the end of that month. No go. Then the deadline was the end of October. Another fantasy. Now we're told the vote won't come before early November.

But November features off-year gubernatorial elections that look favorable for Republicans. In Virginia, Republican Bob McDonnell holds a commanding lead over Democrat Creigh Deeds. When Obama won the state last year, the reigning opinion was that his coalition was strong enough to move the Old Dominion firmly into the Democratic column. A McDonnell victory would shatter this illusion. It would give pause to the center-right Democrats about to tie their fortunes to the president. It would show that the enthusiasm in American politics is all on the right.
Southern and Western Democrats may begin to ask, What's the rush? And then the longer the health care debate goes on, the more the momentum for grand reform will fade. Big schemes will be abandoned.

The health-reform Calvinists are wrong. Politics isn't physics. Legislative logrolling isn't gravity. Nothing is inevitable.

--Matthew Continetti