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Passing Health Reform Isn't Enough

PH2009061502075.jpgOver at The New Republic, Jacob Hacker and Rajul Rajkumar consider our future in a "World Without The Public Plan" (cue ominous music). But I'm not really convinced that the simple presence of a public plan would ensure success as they define it. So I'm taking their article as a "World In Which We Get Health Reform Wrong" (cue louder ominous music). And I think they don't go quite far enough (cue really, really loud ominous music, and maybe a siren wailing).

Hacker and Rajkumar simply consider the policy consequences of a failed attempt at health reform. I think people should consider the political consequences of a failed attempt at health reform. People talk about Colin Powell's Pottery Barn Rule: If you break it, you own it. But there's a partner to that law: Call it the Plumber's Principle. If you hired a plumber to fix your toilet and a week later the problem returned, you'd stop trusting that plumber. If you say you've fixed it, in other words, you own that fix.

If Harry Reid and Nancy Pelosi muscle health reform through Congress, if President Barack Obama signs a bill in the Rose Garden and hands the pen to an ailing Sen. Ted Kennedy, if health reform, in other words, passes with fanfare and attention, Democrats own it. This will not be a quiet accomplishment. They will have told the American people that on this historic day, under this historic administration, they have begun to bend the curve and and tame the insurers and guarantee coverage and generally fix this huge problem that so many before have promised action on but so few have succeeded in tackling.

And if, 10 years down the road, the plight of the middle class has worsened and cost growth hasn't slowed and the only real difference is that more tax dollars go towards low-income subsidies, Democrats will be blamed for that. Their arguments will have less credibility. Republicans will run ads about "the last time a Democrat told you he could reform American health care."

This happens all the time in politics. No one would trust Republicans to respond to a hurricane or invade a small country in the Middle East. Conversely, many people would trust Bill Clinton to balance the budget. Voters judge the success of major policy initiatives. And the success of health reform will be even more obvious than most, as they'll feel it in their weekly paychecks. If Democrats pass a bill that gets the policy wrong, they run a real risk of losing trust on what's arguably their core issue. This is high-stakes stuff.

Photo credit: AP Photo/Pablo Martinez Monsivais.

By Ezra Klein  |  July 1, 2009; 11:26 AM ET
Categories:  Health Reform  
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Do Pelosi and Reid understand this? Because my sense is they don't. Otherwise they'd be fighting a lot harder for the best outcomes(meaning public option and single payer).

Posted by: Calvin_Jones_and_the_13th_Apostle | July 1, 2009 11:38 AM | Report abuse

the only thing that appears absolutely certain about whatever bill will be signed, is that at the end of the day, everyone will still be complaining.
like the two women in the woody allen film complaining about their meal in a hotel...
"the food is terrible, and the portions are too small."

it will not be enough for those who will accept nothing less than public option and single payer, and others will rant bitterly against the triumph of socialism under the obama administration.

no matter what compromise is finally reached, there wont be a complaint department large enough for the day after.

Posted by: jkaren | July 1, 2009 12:09 PM | Report abuse

Horrors! The link goes to page 2!

Posted by: MrGoodKnight | July 1, 2009 12:27 PM | Report abuse

Needless worrying, Ezra.

Look at what public education has done for schools. Look at what welfare has done for the family. Look at what affordable housing has done for the homelessness. Look at what the stimulus has done for unemployment. Look at what Social Security has done for retirement saving. Or how the Affimative Action has defeated racial inequality.

Of course it will work. If you didn't absolutely know it was going to succeed, you wouldn't be here writing about it all day, would you?

On a less sarcastic note, Ez, I won't gloat when the right inherits this mess back from you guys in a few years. Yes, I'll be relieved that maybe we'll still have a chance of stopping the hemmorhaging. But I'll always mourn for what will have been lost.

But don't worry, that won't affect you. Because it what will have been lost is something that you obviously cannot see.

Posted by: whoisjohngaltcom | July 1, 2009 1:38 PM | Report abuse

Well, Ezra, as you know I am a strong supporter of a government run plan, preferably single payer. I have quoted from a letter to the President from PNHP which explains why a public option is terrible idea in another of your postings. Part of the problem is what you talk about here. It will fail and that will be the end of health care reform.

I want a system that has been proved to work in one form or another in every other industrialized country. If we can't achieve that, I hope nothing will get done. The situation will worsen and then maybe the public will can overcome the special interests.

Posted by: lensch | July 1, 2009 2:21 PM | Report abuse

"Because it what will have been lost is something that you obviously cannot see."

Oh, do shut up, you silly child. Wherever you got your education, it failed miserably.

Posted by: pseudonymousinnc | July 1, 2009 4:07 PM | Report abuse

Sadly, I'm not sure politics and policy follow that nicely here. The political position of many of our elected officials would be enhanced by health care reform that was not comprehensive that kicked the can down the road a few years. You get to benefit of having done something and you still get to use the issue. With comprehensive health care reform that works, the issue is now lost. Even better if Republicans blocked it.

The worse outcome is a comprehensive reform that doesn't work. As a politician with a 6 year timeframe, doesn't that make the comprehensive part the risk and not the details of the reform. Hey, I'm a Democrat and I believe we can design good programs that will work, but I can't be sure.

Many of those who now benefit from Medicare voted against the party that created the program almost as soon as it was possible to do so. If, say, single payer was enacted, I can see Republicans making gains on the transition. Even if this were a better system than what we have, there would still be problems in execution that Democrats would entirely own. All Republicans would be able to find a sick person who is ill served by the system and tell the sad story. Meanwhile, those with newly secure health insurance would worry about other issues which the Democrats may not own.

Posted by: windshouter | July 2, 2009 12:49 AM | Report abuse

Republicans, conservatives and moderate alike, are intent on blocking any initiative of the Obama Administration. Healthcare is the latest rallying point for a Party that labels government as a lousy administrator, only capable of promoting bureaucracy and inefficiency. How paradoxical, though, that same Party is skittish about a public option on healthcare! One would have thought they would welcome such an option, as they consider themselves fierce advocates of the free market system, which by its very nature promotes choice and competition. They contend that the public option will eventually drive private insurers out of business. How does that tie into their premise that Uncle Sam can manage nothing?

In furtherance of their argument, they predict that the public option is only one step away from a single-payer system, under which healthcare will be rationed. But we already ARE in a rationing health care regime. Self-imposed. Facing high premiums, ever-increasing co-payments, exorbitant drug prices, and unaffordable deductibles, we are self-rationing our healthcare. Many Americans simply AVOID going to the doctor and, sadly enough, take a gamble on life. This should never be. Not in America!

Etzer Cantave

Posted by: ecantave01 | July 3, 2009 2:59 AM | Report abuse

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