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What if?

Imagine that John McCain had won the 2008 election. Confronted with a Democratic majority and interested in recapturing his reputation as a politician far above partisan politics, he decided to co-opt a longtime Democratic priority and reform the health-care system. After a series of long and grueling meetings with Democratic leadership, he settled on a plan they felt able to support. The plan looked like the Senate plan. Not exactly, but enough for the purposes of this hypothetical. Remember that Joe Lieberman and Lindsey Graham, McCain's main Senate allies, were both Wyden-Bennett sponsors. Compromise that plan down a bit and you're left with something a lot like the Senate bill: private insurance, government regulation, public subsidies, some taxation of benefits, individual mandate, state exchanges and all the other major features.

Put aside whether you think that proposal would've been the likely outcome. What would the vote be? How many Republicans would support the bill if it were their party that looked likely to benefit? How many House Democrats would stick with the plan if it was taxing some benefits and had no public option and a Republican president had his name on it? And if you think that the differences in vote composition would be dramatic -- and I do -- then what does that say about the usefulness of evaluating legislative fights on grounds of policy disagreements?

By Ezra Klein  |  February 26, 2010; 10:39 AM ET
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The GOP fought HCR since FDR.

They would never support it.

Posted by: Lomillialor | February 26, 2010 10:44 AM | Report abuse

If Hypothetical President John McCain proposed the exact same 11-Page Plan as Actual President Obama, the GOP would overwhelmingly support it, like they did when it was first written by the GOP in 1993.

The GOP doesn't care about reforming health care, they only care about The President and Congressional Democrats failing so they can win more seats in November. That's literally all they care about - the failure of any and every Dem initiative. This much is obvious.

Posted by: VTDuffman | February 26, 2010 10:45 AM | Report abuse

Ezra, just want to repost my question for you from yesterday, in case you missed it and have a chance to answer. Would love to see more interaction in your comments section! Here it is:

Two questions for Ezra:

1) Did today's proceedings change your mind at all about making 'negotiations' (or summits, whatever) televised? Earlier today it seemed as if it had not. But maybe at the end of the day you see things differently. I personally feel that today was some vindication for those of us who wanted this on TV. I don't see how private negotiations have done any good, or how they have changed anything, whereas at least the televised event put the wonky arguments out there and for posterity. Even if Republicans are unchanged, we are better off having their policy arguments in the light of day. Moreover, any time you get a Member of Congress and a President arguing, face to face, on policy (e.g. Alexander and Obama on premiums/CBO), and you get a moment where facts matter, we all benefit.

Of course, I understand the counterpoint - that the only people watching are media types or political junkies who have, like the summit participants, made up their minds. But I think there are more casual viewers who will see clips of an exchange like Obama-Alexander, which will hopefully be fact-checked on mainstream news (like Brian Williams or Couric, etc.).

2) Do you think this sort of event would have been useful at the beginning of the process? Sure, there were negotiations/talks w/ Republicans earlier. But to have a major, televised summit, where both parties have to lay out their views on what is negotiable, what the goals are, etc., the debate would have been framed better from the start. We wouldn't have had to wait until September for a clear view of what the president wanted. Instead, he could have been very clear on things like coverage, cost, etc. Thoughts?

By the way, I don't know what is more of a sign that you have "made it": Skype with Diane Sawyer or setup for a Jon Stewart punchline?

Posted by: gocowboys | February 26, 2010 10:57 AM | Report abuse

Yeah except that you gotta dance with the one that brung you.

Posted by: luko | February 26, 2010 10:59 AM | Report abuse

Maybe in this scenario, Snowe or Collins might be brought on board. I don't see any other GOP members of Congress going for it though because it would increase regulation and taxes which Jesus Reagan commanded Republicans to oppose when he brought the Bible down from the mountain. I doubt McCain would really seek to do this any case. There would be a better chance of him making common cause with Democrats on stuff like immigration, climate change, and tax reform.

Posted by: redwards95 | February 26, 2010 10:59 AM | Report abuse

There has to be a role for the news media in holding politicians accountable for policy positions. Imagine if Fox News was truly non-partisan, and was equally tough on everyone. Engaged journalists, going beyond "he said, she said" reporting, could really make our public debate more productive. The media can't transform politics, but they can make a difference, and they would likely be rewarded with better ratings, as fair-minded people who currently turn to Fox News and MSNBC would likely embrace a robustly challenging non-partisan news source.

Posted by: jduptonma | February 26, 2010 11:01 AM | Report abuse

It's an interesting idea, but we would be too busy invading Iran to take up health care.

Posted by: rpy1 | February 26, 2010 11:12 AM | Report abuse

"Confronted with a Democratic majority and interested in recapturing his reputation as a politician far above partisan politics,....."

Look out below!!

There's where the McCain express goes off the tracks. Because upon finally at long last achieving his goal of becoming President, its my firm conviction McCain would have been every bit the right wing partisan that Bushie was and more. This media-created myth that McCain was some "above partisan" figure is and always was baloney.

Putting McCain in the White House would have gotten u scolded about how we cant afford some costly, government run health care package when we have an invasion of Iran to prepare for.

Posted by: zeppelin003 | February 26, 2010 11:16 AM | Report abuse

"The GOP fought HCR since FDR.

They would never support it."

Not buying it. I recall a certain Medicare Prescription Drug plan that passed in Congress under a certain Republican president. Republicans' only restriction on socialized medicine appears to be that we can do it as long as we don't pay for it at the time we do it. Simple Reaganomics.

Posted by: slag | February 26, 2010 11:16 AM | Report abuse

Ezra is right. Many more Republicans would be on board for the John McCain healthcare plan because Captain Queeg--I mean, John McCain, has an (R) next to his name. The Republicans let the Commander in Chief set the agenda, when he's a Republican. If this were a top-down effort, then we'd get it. I'd wager a lot of the Republicans support this healthcare plan, but they don't want the Democrats to pull it off.

To dismissively say "The GOP fought HCR since FDR" may be accurate, but misses the point. They went along with Medicare Part D under Bush. How many would have signed on for something like that under Obama?

They'd go along with the McCain bipartisan plan, and such a thing probably would have passed as I don't think the Democrats, even though in the majority, would have been in lockstep against it.

@Ezra: "then what does that say about the usefulness of evaluating legislative fights on grounds of policy disagreements?"

Well, what does it say? More importantly, what are the alternatives? Evaluate all legislative fights on whose got the biggest salami in the meat drawer? Hair cuts and mustache grooming?

Posted by: Kevin_Willis | February 26, 2010 11:20 AM | Report abuse


It's long been obvious that the modern Congress is not equipped for actual governance and that policy is, at most, a pivot for political charades. The question is whether a competent executive can bully it just enough to achieve a few basic, critical reforms on behalf of the citizenry. If not, we can just throw up our hands and wait for the rest of the world to pass us by.

Posted by: jwellington1 | February 26, 2010 11:21 AM | Report abuse

I doubt McCain would have endorsed anything like the Senate bill. McCain's plan was to offer a tax credit of $5,000 for individuals to purchase insurance (maybe along the lines of Wyden-Bennet).

The more likely scenario would go something like this I think.

--McCain announces he'd like to implement his campaign health plan, with expansion of HSAs and elimination of employer and a tax credit given to consumers instead, and sale of insurance across state lines. Oh, and TORT REFORM is repeated over and over again as the greatest driver of costs so becomes a centerpiece of the bill.
--Dems try to propose more subsidies for the uninsured, and some other progressive policies. McCain dismisses them and sticks with his plan.
--After some "troublesome" Senate Dems try to work in more regulation, McCain threatens to veto legislation that included "onerous" regulation and taxes. Democrats like Baucus, Lieberman and Nelson run for the hills and endorse McCain's plan. McCain claims bipartisan support.
--These same Dems try to convince the others that something is better than nothing and even if only 3 million more people are uninsured.
--Joe Lieberman goes on the Sunday talk shows and blasts Democrats for being obstructionist and smirks ever so annoyingly.
--The rest of the Democrats cave and vote for McCain's plan which probably is deficit financed and doesn't do anything to contain cost.
--Republicans start to push the idea that they are the "party of the people" and have brought health care to millions of Americans.
--Joe Lieberman goes back on the Sunday talk shows to blast the Democratic leadership.
--McCain gives a thumbs up at his press conference to announce the signing.

And the dramatic conclusion!

--More Americans are sick without insurance or underinsured because every health insurer moves to North Dakota, with no regulation. The middle class is squeezed with even higher premiums. To control costs, Congress starts slowly implementing Paul Ryan's plan of privatizing Medicare. Ben Nelson is a co-sponsor.

Posted by: kmani1 | February 26, 2010 11:22 AM | Report abuse

"And if you think that the differences in vote composition would be dramatic -- and I do -- then what does that say about the usefulness of evaluating legislative fights on grounds of policy disagreements?"

Congratulations Ezra Klein, you're becoming a cynic, which means you're paying attention!!

Its always been at once a tremendous source of comedy and frustration how Democrats act as if their policy preferences are being judged by some Harvard debating society, in as much as they keep deep diving into these arcane details over and over and over, as if somehow if they keep wonking us to death we'll all surrender under the weight of their 800 lb proposals, while Republicans go for the jugular and make visceral arguments in 10 seconds that any idiot can understand.

The political scene is like watching a one-legged man at an arse-kicking contest. Of course building some long, boring argument around the strength of these wonkish details isnt going to work, for one, because most people arent government obsessives. Secondly, the political scene in America is a lot more like a football game than it is two sides working toward trying to fix problems. This has to be a source of despair for idealistic types, but such is life.

Posted by: zeppelin003 | February 26, 2010 11:24 AM | Report abuse

As the Medicare part D plan showed us the Republicans would vote for it, but only if it was unpaid for. If the cost of it went straight to the deficit: Cool. If, however, it entails any kind of tax increase, forget about it.

Posted by: nisleib | February 26, 2010 11:28 AM | Report abuse


The summit showed the fundamental difference between the two parties. And that is best captured in the last speech of Hubert Humphrey:

It was once said that the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life, the sick, the needy and the handicapped.

It is clear how the republicans view it. Why is this not talked about oftener?

Posted by: anil_malhotra1 | February 26, 2010 11:28 AM | Report abuse

I have to say that kmani1's suggestion is a lot more believable than Ezra's.

Posted by: rpy1 | February 26, 2010 11:33 AM | Report abuse

McCain wouldn't have made it a priority to pass health care legislation. Odds are he would be a largely ineffective president given that he would have faced an opposition Congress and given that he's out of step with a number of members within his own party.

There's a pretty good chance that we would be in the middle of an economic depression right now too. An ill-advised, treasury draining war with Iran isn't out of the question either.

Posted by: JPRS | February 26, 2010 11:35 AM | Report abuse

Highly implausible that Democrats would have allowed McCain to raid Medicare - even to expand insurance coverage.

Posted by: tbass1 | February 26, 2010 11:48 AM | Report abuse

"Highly implausible that Democrats would have allowed McCain to raid Medicare - even to expand insurance coverage."

Yes. It is highly implausible that Democrats would have allowed McCain to "raid" Medicare. Just as it is highly implausible that Democrats would allow anyone--even the Democrats themselves--to "raid" Medicare.

Posted by: slag | February 26, 2010 11:52 AM | Report abuse

I think Ezra is absolutely right, and McCain might well have supported health care reform. I never supported McCain as anything more than the lesser of two evils. If it turns out that the Republicans succeed in blocking the barbarians at the pass, I'll be glad that Obama won. The current Tea Party movement is a reaction to the Democratic party's attempt to overplay its hand. Doesn't mean that Americans or Republicans are hypocrites (not too sure about the latter). A lot of Americans were rudely awakened, and it may cost the Democrats dearly.

Posted by: MikeR4 | February 26, 2010 11:52 AM | Report abuse

This whole plan is about raiding medicare. If McCain had tried such a stunt he would have been opposed in the party. Republicans are far less in line than the democrats are at this point. Sidelight: Did anyone notice the rudeness with which Obama treated McCain? He seems to lack the ordinary sense of respect for the elderly that prevails in all cultures.

Posted by: truck1 | February 26, 2010 12:34 PM | Report abuse

"Did anyone notice the rudeness with which Obama treated McCain?" He is actually being rude to all of them. Dennis Prager pointed out that they all must call him Mr. President. Once that is a given, it is only common courtesy for him to call them Mr. Congressman or Senator Ryan, etc. Instead he calls them all by first name.

Posted by: MikeR4 | February 26, 2010 12:56 PM | Report abuse

There were quite a number of instances of rudeness. His glaring,(now going viral as "death glare") when his plan was criticized, his informing all speakers whether their arguments were "legitimate" -- or not, just talking points. This from the person whose first point was about bringing his daughter to an emergency room. That's a legitimate argument, as opposed to talking point? I would call it an anecdote more appropriate to Oprah or a woman's magazine than a policy summit. This was a very bad forum for the president, one in which his more negative personal qualities were on full display.

Posted by: truck1 | February 26, 2010 1:19 PM | Report abuse

Well, truck1, you want to talk about "negative personal qualities [on] full display"?

I think it was the GOP that came up with the great talking point yesterday that "we just don't live in a perfect world and can't have all we want--so thank you, taxpayers, for the great health insurance coverage you provide to Members of Congress; as for those of you with pre-existing conditions or low income, looks like the trickle-down from the plutocrats who only pay 15% in taxes hasn't happened fast enough: [expletive] you."

I'm paraphrasing, of course, but more accurately than you are when you describe the POTUS, telling someone an idea is "legitimate" even!, as "rude."

Posted by: Bertilak | February 26, 2010 5:15 PM | Report abuse


Just as Ezra thinks McCain might have plumped for the Senate bill had it not been authored by the Democrats, I think the Democrats would not abide any redirection of Medicare dollars if it were it incorporated into a bill authored by Republicans. Republicans hardly have a monopoly on partisanship.

Posted by: tbass1 | February 26, 2010 6:07 PM | Report abuse

If McCain had been elected, what would have happened with health care?

McCain would have announced that he was suspending his Presidency, and he would have brought out Joe The Plumber to be his guru on health care and other vital issues.

Posted by: Patrick_M | February 26, 2010 10:03 PM | Report abuse

& VP Palin would have warned us that sick people pal around with terrorists.

Posted by: Patrick_M | February 26, 2010 11:16 PM | Report abuse

As I told you some time ago, Patrick_M, had you elected John McCain, you would have had HCR by now.

Posted by: bgmma50 | February 27, 2010 7:07 PM | Report abuse

...yes, and then, after passing health care reform, the great John McCain would climb on to the back of his winged unicorn, and he would ride the magical beast into the stars.

I don't get to elect the President. It is a group effort.

Posted by: Patrick_M | February 27, 2010 8:28 PM | Report abuse

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