Obamacare: Act II

Published January 25, 2010

National Review

Journalists all over Washington, D.C., have already written the big story for February. The headline will be “Democrats Score Major Win on Health Care.” The lead: “After a bruising battle, President Obama has accomplished what Harry Truman and Bill Clinton couldn't. His friends and foes alike see comprehensive health-care reform as the most significant change in American government in decades. . . . White House sources say that while the president is of course pleased by the historic achievement, he intends to continue his recent focus on the economy and jobs in the months ahead, and signs of economic recovery will soon result in a political recovery for the Democrats.”

Passage of health legislation is probable, though not nearly as certain as the Washington consensus would have it. But the extensive debate over the legislation has revealed more opportunities for conservatives than anyone imagined possible a year ago. Moreover, that debate will not end if the Democrats' bill passes — and in fact, the opportunities may increase.

The resilience of conservative attitudes on the part of the public is the chief reason those opportunities exist. The reigning assumptions a year ago were that the financial crisis had made the public much more favorable toward government activism than it had been during the age of Reagan, and that the new president's eloquence would allow him to rally the public behind his agenda. Neither assumption proved true.

The polls show a public that is skeptical, even resistant, toward big government in general and this health legislation in particular. President Obama's statements on health care have failed to arrest, let alone reverse, the growth of opposition. As the new year began, the chief political argument impelling congressional Democrats to enact the legislation was no longer that it would be popular, but that passing the bill would let them change the subject. Passage would indeed be historic: There is no modern precedent for such sweeping legislation's becoming law without a public consensus in its favor.

Republicans were supposed to be powerless over health legislation, marginalized in the House and unable to sustain a filibuster in the Senate. They were nonetheless able to drive much of the public debate. They did so by resisting the temptation to accept the inevitability of a liberal health-care overhaul and make a deal that would have merely tinkered with it around the edges — the only sort of deal that could have been on offer, given the balance of forces in Washington. The Democrats were not even willing to meet the Republicans halfway on tort reform, which would not have required them to abandon any of their bill's core elements.

The Left, upset about the Senate's abandonment of its cherished dream of a health-care system run directly by the government, has taken to complaining about that body's unrepresentative nature. And they're right; the Senate does not reflect the public's views. It is well to the left of them. In retrospect, we can see the 2006 and 2008 elections as repudiations of Republican performance rather than as affirmations of contemporary liberalism. The financial crisis, in particular, gave the Democrats their large majorities in Congress, so it's no surprise that they are finding it hard to use those majorities to advance an agenda completely unrelated to that crisis. If the Senate were a truly representative body, it would have voted down the health-care bill.

Some liberal hotheads, frustrated by the bill's slow progress and many compromises, urge the abolition of the filibuster, or even of the Senate. But for the rest of us, solutions to the problem of unrepresentative legislation lie closer to hand. The first is for the public to reduce the power of organized liberalism in the 2010 and subsequent elections. The second is for Congress to reject (or, if it passes, for a future Congress to repeal and replace) the terribly flawed health-care legislation liberals are now championing.

Repeal is commonly judged impossible. Conservatives have long worried, and liberals have hoped, that nationalized health insurance would permanently shift our politics to the left: Americans would grow accustomed to depending on the federal government for their health coverage, and would attribute the system's failures to underfunding rather than structural flaws. But Democrats have designed this year's legislation in a way that makes this scenario unlikely to unfold anytime soon.

They wanted the Congressional Budget Office to report that their plan would spend less than $1 trillion over the next ten years, so they rigged the bill to generate such a report. They achieved that goal in part by making tax increases and Medicare cuts go into effect several years before the bill's benefits do. This sequence is likely to create years of political vulnerability for the new scheme. Voters will see mostly pain, not gain, from the legislation in its first four years – and four years is a very long time in politics. Conservative politicians will not have to threaten existing benefits in order to press for repeal, and they will be able to point to the bill as an example of the Democrats' misplaced priorities while championing their own version of health-care reform.

In recent months, many Democrats have operated from the assumption that they have to pass this bill to avoid political disaster, while Republicans have operated from the assumption that if the bill passes, they have lost the health-care fight permanently. Both assumptions now appear to be wrong. Instead of moving off the stage, health care, along with the economy, looks likely to remain atop the domestic agenda throughout this congressional-election year, especially if the Democrats pass a bill that the public hates and that will also put a drag on the economy.

Most voters still want what they have always wanted on health care: lower costs, higher take-home pay, and greater security — all accomplished with the least possible disruption to their current insurance arrangements. The Democrats are poised to pass a massively expensive bill that achieves essentially none of this. Republicans have tried to argue (as they should do much more forcefully over the next ten months) that a few changes to tax law and regulation could address these concerns much better, by fostering the development of a market in individually owned insurance policies. Those reforms would also increase the number of people with insurance. This modest and constructive agenda would not require fines on people who opt out of insurance, federal boards to decide what constitutes appropriate medical practice, or huge new taxes that stifle economic growth.

Such an argument, which can serve as a means of opposing Obamacare now and of calling for its replacement with actual health-care reform if it passes, is the obvious path for Republicans in 2010, since it will connect public unease with Obamacare to the case for economic growth through fiscal restraint. The Democrats' economic platform is of a piece with the party's assumptions that it can run Americans' health care from Washington and that the appropriate response to public doubts is to hunker down. Passing the misbegotten bill will not remove the albatross from around the Democrats' necks as long as Republicans persist in highlighting its many flaws. We have already seen this type of strategy work with a massively expensive bill that delivered very little in practice: Obama's stimulus package has grown less and less popular since it passed, the opposite of what its backers thought would happen.

In their rush to pass something quickly, and their desire to mask the costs of their plan behind a moderate CBO score, the Democrats have created a bill that just might turn health care into a Republican issue. If Republicans embrace the opportunity by refusing to change the subject, by pressin
g the kinds of gradual concrete reforms they have been talking about all year, and by understanding how making a persistent case for conservative health-care reform can play to their strengths, they may find themselves with a great opportunity in 2010.

We stand at the end of the beginning of the health-care fight, not the beginning of the end. And more than ever, it's a fight the Right can win.

Yuval Levin is Hertog Fellow at the Ethics and Public Policy Center in Washington, D.C. and editor of National Affairs. Ramesh Ponnuru is a senior editor for National Review.

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