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The Long-Term Politics of Health-Care Reform


Irving Kristol once defined a neoconservative as "a liberal who got mugged." Maybe. But there's a not insignificant number of liberals out there who could be defined as "a conservative who got sick." Take this e-mail I received yesterday:

As a life-long Republican who voted Democrat in the last election and has lived under single payer healthcare in Canada for the last years, I thank you for your article. I pay $96. a month as a premium which covers both me and my wife. The personal family care we have received is really good. We go to our own Doctors when we wish, get all the tests we need and hospital care has been good at no extra cost. To be sure there are problems as with any system but this one is affordable and accessible. That more than I can say for the US systems and I still have relatives and friends living there.

Or this, from a wonderfully interesting Prospect article about the Swedish soul:

Yet in spite of this, the rich in Sweden do stay rich. I asked one friend, Rikard Uddenberg, a prosperous businessman, how this was. "The tax system was very harsh 30 years ago. If you had a good idea it was difficult to expand. But there have been many changes since then, starting with Olof Palme's government and gathering speed since then. Now Sweden's corporate tax is lower than many other countries."

He admits that when he grew up the prevailing ethos among the rich was to secretly put their money in Liechtenstein. "That's how I thought too." But he had had a road to Damascus event in his life. Four years ago his first born baby was diagnosed with a dangerous heart ailment. She was treated by a Libyan doctor in one of the world's top children's heart clinics in Sweden and has now recovered, a happy little girl. "Then I realised what went on inside the system I had rather derided. I saw what the tax system did with our money and how effective it was. The treatment did not cost me a kronor. More than anything this changed my attitude."

This is not, incidentally, a particularly controversial point. In the 1990s, Newt Gingrich and others exhorted Republicans to vote against Clinton's health-care reform proposal by arguing that it would reknit the connection between Democrats and the middle class by clarifying the benefits of government action. As Bill Kristol wrote in his famous memo, "it will revive the reputation of the party that spends and regulates, the Democrats, as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle-class by restraining the growth of government."

As a matter of long-term politics, this is something worth watching in the health-care reform bill. Which pieces could lead a middle-class taxpayer to decide that the Democrats had helped them in a very direct way? As opposed to the Clinton bill, which remade the whole health-care system in an obvious and undeniable way, there's relatively little in this reform effort that the middle class will interact with down the road. The flip side to letting everyone keep what they have is that they don't notice what you've done. The exceptions are things like the public plan and the health insurance exchanges that give them options they haven't had before. Remove or weaken those elements, however, and it's unlikely that health-care reform will come anywhere near to fulfilling Kristol's fears.

Photo credit: Chris Kleponis -- Getty Images Photo.

By Ezra Klein  |  July 8, 2009; 12:21 PM ET
Categories:  Health Reform  
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Any system's a great system to be healthy in. When you're sick, you'll want coverage in a system like the one we have today.

Posted by: whoisjohngaltcom | July 8, 2009 12:43 PM | Report abuse

What are you implying, Ezra? That taxes pay for services? Why do you hate America?

Posted by: ajw_93 | July 8, 2009 12:46 PM | Report abuse

i would say the opposite - this system is a good one in which to be healthy and/or well off... not at all a good one in which to get sick unless you have the means to just do whatever you want...

anyway - on Ezra's post - this is exactly why a robust exchange with significant consumer protections and a good public plan or co-op that provides real options to folks is so important to make the bond with the middle class so that they see that health reform was good for them.

the medicaid expansions and pre-existing condition limitations are great for those who really need the help, but not as much for endearing the reform to much of the country...

Posted by: tsweeney1 | July 8, 2009 1:36 PM | Report abuse

If you would like to help pressure Congress to pass single payer health care please join our voting bloc at:

Posted by: letsgobuffalo | July 8, 2009 2:51 PM | Report abuse

"When you're sick, you'll want coverage in a system like the one we have today."

If you have coverage. Though when you're sick again, you might not.

Do you have anything but facile, untrue sloganeering, Galtroid?

Posted by: pseudonymousinnc | July 8, 2009 3:07 PM | Report abuse

Brilliant post, Ezra, and not surprising to see a moment of curtain-pulling-back truth from Kristol. It's all about controlling the Village.

Reconnecting the Democrats with the middle class. What a concept.

Posted by: PoliticalPragmatist | July 8, 2009 3:10 PM | Report abuse

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