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Reform begets reform

This is a good point from Fred Hiatt:

[M]aybe the country isn't all that divided -- most of us would welcome common-sense improvements in health-care delivery and insurance -- but the system feeds on and exacerbates our differences. The advent of the 60-vote rule in the Senate has magnified the already formidable checks and balances built into the Constitution, with the disproportionate blocking power it awards small and rural states. Cable television and the Internet have empowered those with the greatest intensity of feeling. The self-serving redistricting habits of the political elite, designed to protect incumbents, have left most legislators vulnerable only to primary challenges from the extremes of their respective parties.

Whichever explanation appeals to you -- and no doubt they all contain some truth -- the perception of paralysis increases the urgency of passing health-care reform. Failure would damage the Obama presidency, and it would also deepen the fear, here and abroad, that America is stuck.

To put this slightly differently, the failure of this health-care reform bill will not be taken as evidence that people should try other health-care reform bills with much more severe -- and thus unpopular -- cost-cutting measures. It will be that even a popular president backed by the largest Senate majority since the 1970s couldn't pass a fairly modest health-care bill. If you don't believe me, just ask the Republican presidential candidates if any of them are preparing detailed plans to privatize Social Security.

"Doing" health-care reform proves something important: Health-care reform can be done. That's not an argument for a bad bill, as Hiatt is careful to say, but it's an argument for recognizing that an imperfect bill is the beginning of a necessary process, while a damaging defeat ends any hope of one.

By Ezra Klein  |  November 23, 2009; 11:09 AM ET
Categories:  Health Reform  
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All very true, but what too many in Congress and among opinion makers want is precisely "a damaging defeat [that] ends any hope of" reform.

America may well have lost the ability to solve problems because too many people have a vested interest in their continuation.

Posted by: Mimikatz | November 23, 2009 11:22 AM | Report abuse

Hiatt's point is well taken, but I wonder if "doing" a version of health care reform that has been mutilated beyond all reason in order to reach a 60 vote majority would in effect permanetly enshrine this ridculous requirement of 60 votes as the minimum threshold for ever accomplishing anything in the Senate. In hindshight, the really gutsy move would have been to change the rules by majority vote on the first day of the current session (when the Dems had, I believe, 58 votes) to restore the filibuster to the old "Mr. Smith Goes to Washington" principle of being able to block a bill only if you were willing to go to the floor and actually hold the floor against passage, not by simply refusing to let the bill be debated. I doubt Republicans would have been able to gin up outrage about Dem 'tyranny', since they still would have had the ability to block bills, but they would have had to do it in plain sight. As it stands now, the Dems are really worse off with 60 (nominal) votes in their caucus than they would have been with 55 or so, since they will bear the full blame for failure on any issue which the leadership supports but which cannot hold every single member of the caucus, which is a bar few, if any, meaningful bills can ever reach.

Posted by: exgovgirl | November 23, 2009 11:33 AM | Report abuse

Robert Reich, TPN:

"Upbeat policy wonks and political spinners who tend to see only portions of cups that are full will point out some good things: no pre-existing conditions, insurance exchanges, 30 million more Americans covered. But in reality, the cup is 90 percent empty. Most of us will remain stuck with little or no choice -- dependent on private insurers who care only about the bottom line, who deny our claims, who charge us more and more for co-payments and deductibles, who bury us in forms, who don't take our calls."

Posted by: scarlota | November 23, 2009 11:34 AM | Report abuse

i'm of two minds on this.

on the one hand, no liberal today would support the original social security legislation: that should be a chastening thought to the likes of robert reich quoted by scarlota.

on the other hand, any time i'm arguing a similar line to fred hiatt, i have to assume i'm wrong, because when is fred hiatt correct about anything?

Posted by: howard16 | November 23, 2009 11:38 AM | Report abuse

I agree with Mimikatz. The combination of an opposition party that refuses to participate in seeking solutions for our problems in any sentient way, a legislative process that gives too much power to the obstructing minority, a media that refuses to ask the relevant questions that would expose lawmaker's lies, and powerful interests with a large stake in keeping things just as they are by whatever means possible, makes real problem solving virtually impossible. It is deeply depressing.

Posted by: wvng | November 23, 2009 11:39 AM | Report abuse

The bottom line is this- when just 15% of the country is getting free healthcare the situation is so politically untouchable that for decades no one has been able to do meaningful reform. Now you think that by giving more people free healthcare money that you think it will be EASIER to reform? Ridiculous.

Posted by: spotatl | November 23, 2009 11:40 AM | Report abuse

Very few people get "free" health care. All working people pay into Medicare, and today's seniors paid years of Medicare and income taxdes. People who get Medicaid pay into state and local governments through sales and other taxes. Armed services people paid with their service for whatever gov't health care they get.

Sure, there are subsidies in the reform bill, but there is also great income inequality in this country as well as insurance discrimination which prevent many people from being able to acquire insurance coverage. Beasides, insurance, especially for-profit insurance, is a stupid way to pay for all but catastrophic health care.

Posted by: Mimikatz | November 23, 2009 11:48 AM | Report abuse

I have to disagree with this assessment. I do think that this process highlights the terrible state of our legislative process.

However, as to the potential despair of health care reform, I would first point to civil rights legislation of the '60s that took many, frequent attempts before succeeding. I would also point out that one of the best benefits of this process that we've experienced has been the long, detailed discussion of what is wrong and what our options are. This benefit was largely absent from the last attempt to address this issue 15 years ago because of the poor strategy and quick death of the movement.

Defeat of this bill should be no reason to give up the fight, especially while the Democrats maintain control of both houses of Congress. We must keep the issue in the public mind.

Posted by: bcbulger | November 23, 2009 12:04 PM | Report abuse

"...with the disproportionate blocking power it awards small and rural states."

Translation: It's frustrating that we can't steamroller those Yokels.

"Cable television and the Internet have empowered those with the greatest intensity of feeling."

Well, that's no longer an issue for the government of Venezuela anymore.

Posted by: WrongfulDeath | November 23, 2009 12:21 PM | Report abuse

I've been reading here for months that without health care cost controls the US will go bankrupt in twenty years. If nothing is done, if the bill just dies in the Senate, it will still be true that runaway health care costs will bankrupt the country over the next twenty years. In short, if the problem isn't solved by passing the bill(s) under consideration, the problem isn't going to go away. Congress is going to have revisit health care reform sooner rather than later. They have no choice.

Health care reform will remain at the top of the agenda every Congress until the Senate delivers legislation that works.

Posted by: NealB1 | November 23, 2009 1:02 PM | Report abuse

That all makes sense, but that doesn't mean we should be putting lipstick on a pig. Calling the bill "imperfect" is something I'd expect to hear from the Obama press shop, not from an independent assessment.

Let's call the reform bill what it is: its a "C+" bill. They get a "B+" in understanding the problem, but a "D" in failing to solve any Washington politics whatsoever. That B+ understanding got watered down by buying off industry groups and an inability to have any real tough talk with the American people.

I agree that this bill is clearly better than failure-- both for the process reasons mentioned here, along with the important insurance reforms and subsidies. But again-- let's call it what it is. "Imperfect" is hardly the correct depiction.

Posted by: wisewon | November 23, 2009 1:33 PM | Report abuse

I agree with wisewon except to the extent that he assumes that Ezra provides an independent assessment rather than whatever he thinks the administration needs at any given time. At the moment, liberals recognize that this is a crap bill and are disappointed by it, so Ezra rides to the rescue with a stirring pep talk. Well, for me it wasn't too effective, since it seems to amount to, "Buck up, sunshine! Things will (magically) get better...." Oh, bonus points for throwing praise to Fred Hiatt, one of his Post overlords, who views spending money on any social program as a frivolous distraction from more important business, ie, fightint all the wars we possibly can.

Posted by: redscott | November 23, 2009 2:31 PM | Report abuse

Good reform begets reform. This bill begets a furious electorate and President Romney in 2012.

Posted by: bmull | November 23, 2009 10:31 PM | Report abuse

Where is my comment? are you displaying? Please let me know

Posted by: jwalavanam | November 24, 2009 1:04 PM | Report abuse

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