Are we done talking about big government?
Jon Chait and Matt Yglesias are kicking around the idea that the passage of the Affordable Care Act fills the final major hole in the American safety net and means, as Matt says, that "the era of big government liberalism" is over and "future public policy has to be about ways to maximize sustainable economic growth, and ways to maximize the efficiency with which services are delivered."
I'd rephrase that slightly: I think the era in which the government's major commitments are the dominant issue is (largely) over. The Affordable Care Act doesn't make the government much larger as a share of GDP. Rather, it commits the government to guaranteeing something close to universal health care, even if the relevant transactions occur between individuals and private insurance companies. The reason the GOP talks about "repeal and replace" is that they don't think they can persuade Americans to undo that underlying commitment. If they did, they'd just go for repeal.
But the fights over how government should look will be as fierce as the battles over what it should do -- and may, rather oddly, fall much more cleanly across big government/small government lines. Social Security, Medicare, Medicaid and the Affordable Care Act will all require substantial changes in the years to come. Most of those changes have less to do with the programs themselves than with underlying cost growth in the sectors of the economy they encompass -- health-care provision and pensions, both of which will harm private firms and paychecks as surely as they'll wound government budgets. But as both parties struggle to find answers for that cost growth, they'll likely end up adding longtime ideological commitments actual answers -- or substituting them for actual answers: Conservatives will look to fully or partially privatize Social Security, Medicare and Medicaid, while liberals will look to empower the government to add a federally sponsored insurer and bargain down costs in the Affordable Care Act.
This might actually mean more arguments over "big government liberalism" than we've seen in recent decades. Democrats were so focused on the question of the government's commitments that they ended up making a lot of compromises on how those commitments got carried out. The Medicare Prescription Drug Benefit, the Affordable Care Act and the tendency to disguise social programs disguised as tax credits all fit this pattern. But with the commitments established, I wouldn't be surprised to see Democrats become much less willing to make those compromises going forward. And if the GOP can't roll back the commitments, a lot of their energy will turn toward privatization.
This is the fundamental reality underneath Paul Ryan's Roadmap, for instance, which uses the need for long-term cost control as a justification for eventual privatization (even though the privatization schemes are not how his plan saves money). His Roadmap is the most radical salvo in the big government/small government debate that any politician has launched in some time, but it's framed as an exercise in cost control, and it makes a point to avoid questioning any of the government's underlying commitments.
Photo credit: Melina Mara/The Washington Post.
| January 24, 2011; 9:52 AM ET
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