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Health Care Lessons

Learned and lost.

9:21 AM, Jan 27, 2010 • By JEAN KAUFMAN
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The old saw about generals who err by fighting the last war instead of the present one may offer the best explanation for the peculiar inability of a surprising number of Democrats—including, it seems, President Obama and his top advisors—to heed the message that the people don’t want them to continue to push for health care reform.

A great many liberal pundits (who, conveniently, don’t have to run for reelection) are in agreement that the health care reform bills should not be allowed to die a quiet death. The New Yorker’s Hendrik Hertzberg calls for passage, and Paul Krugman makes the argument that dropping the push for the bills at this point would be to “fail the test of history.”

That last phrase indicates what might be driving these Democrats over the cliff (or the precipice, as Obama might say): Their long-held conviction that there is an upward historical trajectory which cannot be denied, a trend from less governmental control to more, and towards ever-expanding and newly-found guaranteed “rights” for citizens. Anyone who opposes this process is impeding the proper course of progress.

But a funny thing happened on the way to destiny: The people had the insolence to reject the idea. Well, say these Democrats condescendingly, then the people will just have to be ignored. Once the bill is somehow passed, and they see how much it helps their lives, they’ll come around and thank us.

Paul Begala gets to the very heart of the matter:

…[F]ailure is not an option and surrender is not a strategy. I am convinced that Democrats lost the Congress in 1994 because we failed to pass health care…. This is our last, best shot. After our failure in 1994 it took 16 years before another president and Congress were bold enough to take on the challenge. I doubt anyone old enough to read this column will live long enough to see universal health insurance.

Democrats such as Begala seem convinced that it was their loss of the last “war”—the 1993 fight for health care reform during the Clinton administration—rather than the dubious merits of the Clinton proposal itself that caused them to lose control of Congress subsequently. And so, much like those clichéd generals, they are determined not to make that error again. However, in the process they have made other (and perhaps greater) mistakes.

But the Clinton bill of 1993 was not the only health care war the Democrats previously lost, just the most recent and most bitter. History is littered with examples of earlier attempts that came to naught, although there have been major wins in related areas, such as the passage of Social Security during FDR’s administration, and Medicare during LBJ’s. 

FDR had originally thought that some form of universal health care might become part of the Social Security bill, but figured the nation wasn’t ready for it yet. Truman failed as well. A Nixon-Ted Kennedy compromise proposal for health care insurance reform that would involve the private sector and businesses was foiled by Watergate, and Nixon’s successor Ford didn’t think pursuing it was a good idea in the sinking economic climate that followed. Likewise, Jimmy Carter would have preferred to tackle universal health insurance, but didn’t because the country was in such dire economic straits during his tenure.

Clinton’s push was the biggest, and it came closest to success. But he lacked the magic sixty votes for cloture, and was forced to appeal to Republicans. The Democrats felt that the bill was defeated mostly by a combination of Republican recalcitrance plus misleading insurance company ads that frightened the public and turned them against it.

Here are some of the lessons Democratic “generals” feel they have learned from these past skirmishes:

(1) It might be decades before Democrats get another chance to control both Congress and the presidency. This time such a rare opportunity must not be wasted. 

(2) Health care reform was stopped by a bad economy on several occasions. This time a bad economy must not be used as an excuse. 

(3) The Clintons are believed to have annoyed members of Congress in 1993 by dictating too many of the details and not letting the House and Senate have enough input. This time Obama must hang back and let Congress handle it.

(4) Special interest groups such as insurance companies had sabotaged the 1993 effort (as doctors had the FDR effort). This time they must be brought on board early and bought off if necessary.

(5) Republicans are ornery obstructionists who derailed the 1993 effort. This time they must not be allowed to have any input.

(6) Americans turned on the 1993 bill because the information they got though misleading ads scared them with lies. This time as little information as possible should be divulged; speed and secrecy are of the essence.

But the Democrats forgot that remedies often have unintended consequences. When the requisite speed of passage turned out to be unattainable, the public not only began to learn (and be frightened by) many of the bills’ details, but detested much of the process by which the Democrats were driving them—the speed, secrecy, and buyoffs; the incoherent patchwork nature of the bills; and the lack of leadership by President Obama, who left the sausage-making to an openly corrupt Congress.

The greater the public distaste, the more it seems that many Democratic leaders are determined to bitterly cling to the flawed bills and do their best to pass them, whatever it may take—be it reconciliation, House approval of the Senate bill, more vigorous arm-twisting, or some combination of them all. They rightly fear that the votes Democrats have already taken, as well as the corruption in which they’ve already participated, have alienated so many voters that they are on course to lose the House no matter what they do now, much as they’ve already lost their 60th seat in the Senate. So if they must go down, why not depart in a blaze of glory, with the passage of health care reform as their swan song?

Forget the fact that both bills satisfy no one, not even their supporters. Forget that many objections made by opponents of the bills concern substantive issues reflecting differences in the basic philosophy of government that separates the two parties. Forget that the bills have been arrived at through processes so obviously corrupt, with secrecy so great, and accompanied by so many broken promises, that they have deeply and perhaps irrevocably tarnished the Obama administration. 

And forget the most fundamental fact of all: There might be something inherently difficult and even contradictory about the notion of universal health care that is comprehensive, affordable, high quality, and yet comes without a huge price; that there may be no way to slice the available pie into enough large and tasty pieces to satisfy everyone without resulting in national near-bankruptcy, as well as substantial and unacceptable loss of liberty. 

Dismissing such concerns with the sanguine reassurance that “all will be well, just trust us” is not enough. Maybe the problem with passing these bills is not merely strategic, and maybe most Americans will never approve. Maybe they would prefer more minimalist and gradual change, or even (gasp!) the implementation of some of the more modest proposals Republicans have suggested, such as interstate transportability of private health insurance, and tort reform. Maybe voters’ very real concerns are based on reality, not a reaction to scary rhetoric designed to frustrate the wishes of Democrats and halt the inevitable progressive sweep of history. 

But it is much too threatening to the Democrats’ long-held vision of universal health care at last to actually look at these facts. It might mean they would have to admit that they could be chasing a pipe dream, albeit one they’ve held close to their hearts for the better part of a century. 

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