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Posted at 11:14 AM ET, 03/10/2011

Republicans oppose Democrats, not health-care reform

By Ezra Klein

I think I’m pretty cynical about the way American politicians approach policy questions, and so there’s little I love more than an opportunity to argue against excessive cynicism. So thank you, Jonathan Bernstein:

I think opposition to any sort of government-initiated universal health care is the most natural movement conservative position. Yes, conservative politicians (not just Mitt!) have in the past supported things that looked like Obama’s health care plan, but I think in almost all cases that was just about playing defense in a situation in which the true movement conservative position (that is, it’s not the government’s concern) is wildly unpopular.

I disagree. I think health-care policy is not a priority for most Republicans, so when they’re in office, it’s not the thing they naturally choose to spend political capital on. But that doesn’t mean that, all else being equal, they wouldn’t be glad to pass one of their policies on the subject and say they were the folks who solved the country’s health-care problem. You saw that impulse in Mitt Romney, in George W. Bush’s campaign to pass the Medicare prescription drug benefit (though that had a lot to do with winning Florida in 2004), in Bob Bennett’s decision to co-sponsor a comprehensive reform bill alongside Ron Wyden.

The problem is, the thing that really is a priority for most Republicans is defeating Democratic presidents. And Democratic presidents often attempt health-care reform, because they care about it a lot, and they often appropriate Republican ideas, because they overestimate how much Republicans are interested in health-care policy and underestimate how much Republicans really want to make them fail. And then the policy they’re pushing becomes their policy, not a policy the Republicans originally offered up, and the process of polarization begins.

I believe as strongly now as I did a year ago that President Mitt Romney or President John McCain could’ve offered a bill quite similar to the Affordable Care Act and gotten a lot more than zero Senate Republicans to vote for it, though I think it’s an open question whether they would’ve bothered to do anything about health-care reform at all. But I don’t think Republicans have strong and consistent views against health-care reform. I think they have strong and consistent views against Democratic presidents.

By Ezra Klein  | March 10, 2011; 11:14 AM ET
 
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Comments

EXACTLY!

Posted by: sligowoman | March 10, 2011 11:38 AM | Report abuse

So that's the less cynical perspective? Wow!

Posted by: JohnRose | March 10, 2011 11:43 AM | Report abuse

I could not agree more. But what's more notable, however, is how many times Democrats have fallen for the trap and try over and over again for bipartisanship when not one Republican was interested. Think about how much time was wasted on the "gang of six," with the end result just being that the bill got delayed into the summer, and set the stage for the massive Koch brothers-funded "grass-roots" protests.

Obama is a smart guy, but there was no better opportunity than early 2009. He should have rounded up his troops and 60 senators (yes, including Lieberman) and figured out a way to convince them to break any filibuster. Then pledge to the American people that everything will get an up-or-down majority vote. And allow every Republican bill and amendment to get debated and voted on. It would have forced Republicans to come to the table with something plausible (and no, Paul Ryan's road map does not solve our health care problems). And many of those ideas could have been incorporated, making the bill truly bipartisan. If the Republicans knew a bill was going to pass regardless, they would, in theory, have had more incentive to work towards a solution.

Instead Obama lost the public debate on it because the process was so drawn out and could be painted as a sinister partisan plot. We heard protest after protest, mostly from people with insurance, claiming that people worse off than them shouldn't have access to insurance. We heard about "government takeovers" and "death panels," some of it supported by sitting senators. The media line became that "people are angry" about the bill, but I suspect most people that will reap its benefits (like individuals and small businesses) were hoping it would pass. We never heard from those families on the mainstream media that had lost their insurance, we heard from people not wanting the bill "rammed down our throats."

At the very least, a bill was passed that improves access to care. As a medical student, I feel that this is a huge, landmark achievement. But it came at a very high cost politically and policy-wise. Here's hoping we continue to work towards improving our health care system.

Posted by: kmani1 | March 10, 2011 11:55 AM | Report abuse

Dems would have certainly opposed Pres Mitt Romney or Pres John McCain. They would have opposed it on grounds of not going far enough.

We get politics when we need solutions. Oh well.

Posted by: will12 | March 10, 2011 11:56 AM | Report abuse

Ezra -

"But I don’t think Republicans have strong and consistent views against health-care reform. I think they have strong and consistent views against Democratic presidents."

I think you could replace "health-care reform" in that passage with almost anything. This is one reason I've always been skeptical of the "tea-party is racist" views of many. What I think people don't consider is that a nearly-crazy fringe of extremist Republicans would form a Tea-Party-like movement even if the President were Zell Miller instead of Barack Obama.

Posted by: willows1 | March 10, 2011 12:13 PM | Report abuse

Mr. Klein:

Just keep telling yourself there's nothing wrong with ObamaCare. Still waiting for a coherent explanation how that $500 billion in Medicare "savings" can be spent twice. Kathleen Sebelious finally admitted last week that's what was going on.

We must need someone of your fantastic moral standing and genius to explain to us rubes how this double-counting works in the real world, outside of Beltway budget gimmicks.

Posted by: ElmerStoup | March 10, 2011 12:16 PM | Report abuse

kmani1, keep in mind that they didn't have 60 votes until many months later, when Al Franken was finally seated. There really wasn't a long period of time when they actually had 60 seated.

Still, you're right that President Obama should have been out in public talking about an up or down vote for all legislation and appointees right from the start. After the stimulus and the lack of Republican votes, they should have said, "Now we're going to debate a healthcare/insurance overhaul. Here is the procedure we're going to use. Here's how many Republican members and how many Democratic members will be participating at every stage of the game. Here's how much time we're going to devote to the process, though we will allow votes on whether to extend time. We believe this process is fair and expect both parties will allow the final bill to have an up or down vote."

Posted by: MosBen | March 10, 2011 12:21 PM | Report abuse

Of course Republicans and conservatives have a health care policy. Alan Grayson laid it out succinctly: "Get sick? If you are poor, just die."

The only real content of conservatism is "I've got mine and screw you." This works okay for some people under conditions of extreme bounty, but historically has killed off societies if followed to its logical conclusion. Some concern for social cohesion is needed -- the novelty in our current situation is that dark skin and female gender have been excluded as markers for extracting the pain of cohesion and we are renegotiating who gets hurt in the context of losing an empire. It's messy.

Conservative ascendancy will merely make it more ugly and vicious for many.

Posted by: janinsanfran | March 10, 2011 12:24 PM | Report abuse

MosBen - But that strategy would almost certainly have ended with either no HCR bill or the Democrats basically abandoning the process and using reconciliation as they did. The Republicans were entirely recalcitrant to the idea of compromise. The could have compressed the timeline significantly, but I bet the calculus would have been basically the same in the end.

Posted by: willows1 | March 10, 2011 12:27 PM | Report abuse

-------------------Mr. Klein:
Still waiting for a coherent explanation how that $500 billion in Medicare "savings" can be spent twice.
------------------
ElmerStoup

There is no double counting, Ezra has explained this time and time again to rubes like you. The thing is is that you're a clueless partisan hack to stupid to even read.

Posted by: mynameisblehbleh | March 10, 2011 12:31 PM | Report abuse

MosBen, you're right. Even after Franken was seated, Kennedy had already withdrawn from public service due to health issues. So the only period of time when Democrats had 60 effective votes was 9/25/2009-2/4/2010, between when Kirk was seated to replace Kennedy and when Brown replaced Kirk. (http://en.wikipedia.org/wiki/111th_United_States_Congress#Changes_in_membership)

Posted by: JohnRose | March 10, 2011 12:33 PM | Report abuse

WOW, EZRA, ARE YOU ACCUSING REPUBLICANS OF PLAYING POLITICS??? HARD HITTING STUFF!!! YOU THINK POSSIBLY THAT MORE DEMOCRATS VOTED FOR FREE TRADE AGREEMENTS AND CAPITAL GAINS TAX CUTS UNDER CLINTON THEN WHEN PROPOSED UNDER GWB????? THE POST HASN'T HAD CUTTING ANALYSIS LIKE THIS SINCE DAVE WEIGEL LEFT... (who am I kidding, he was fired because he has no integrity).

Posted by: cdosquared5 | March 10, 2011 12:38 PM | Report abuse

willows1, I think you're right that the ultimate calculation would have been the same, but a shorter time frame would have been much better politics, but even without that I think we'd have all been better off with some more time in the Senate to consider other things (like appointees).

While I understand the impulse for the Dems to really try to get bipartisan support for the ACA, I think we can all agree at this point that it quickly became readily aparant that they were going to get Lucy-ed. Having a shorter amount of time would have still given them time to try to get Republicans on board while not allowing the process to drift, which it clearly did.

Posted by: MosBen | March 10, 2011 12:50 PM | Report abuse

Ezra opined: "I think opposition to any sort of government-initiated universal health care is the most natural movement conservative position. "
-------------------------------------------
ACTUALLY, it is the ONLY position for someone who wants the Constitution to be followed...

Those who don't take that position, don't want it followed.

Posted by: illogicbuster | March 10, 2011 1:30 PM | Report abuse

cdosquared5, give it a rest. Both parties play politics. Both parties have been guilty at various points in history of political contradictions and hypocrascy. When the traditional media spends so much time giving the benefit of the doubt to people who don't deserve, is it really such an offense when someone like Ezra finally throws up his hands and says you're just playing politics?

People been searching in vain for some coherence in the GOP position on health care. Ezra, for one, has provided numerous interviews and opportunities to people like Paul Ryan, Mitch Daniels, and countless others to outline their alternative policy proposals. The fact that there hasn't been a legitimate, rational, or plausible GOP proposal to date suggests that "something else" is going on here. It should come as no surprise that that "something else" is "playing politics."

You can point finger at Dems., and pretend to be "outraged," insult "liberal bloggers" and write in ALL CAPS all day, it doesn't change the analysis.

My trouble is that the health care reform
"debate" has been one big farce from the beginning. Whether Dems. felt they had to indulge the GOP as long as they did or not, I believe health care reform could have been substantively much stronger and more palatable from the public if the Dems. hadn't spent as much time pretending the GOP had a "serious" position. They should have been called out on their nonsense from the start. I've got my fingers crossed that Schumer's speech yesterday on the deficit might short-circuit some of the same nonense on the deficit "debate."

Posted by: pbasso_khan | March 10, 2011 2:10 PM | Report abuse

mynameisblehbleh and pbasso_khan:

Give it a rest yourselves. When your main argument is to question the good faith of people who have a genuine policy disagreement with you, you should be smart enough to realize that you have a personal problem and, maybe, just maybe, your policy arguments aren't really all that great.

Posted by: ElmerStoup | March 10, 2011 3:09 PM | Report abuse

Ezra's reading of the situation seems a bit generous. These days, Republicans seem to be against both health reform AND the Democratic party. And rabidly so.

Medicare Part D contained a lot of provisions the Dems didn't like. But the Dems didn't attempt to sabotage the bill, post-hoc.

Posted by: weiwentg | March 10, 2011 3:35 PM | Report abuse

@MosBen - you're right that they only got 60 seats at the time Franken and Kirk were present in the Senate (my use of "early" 2009 was probably a bit misleading). That being said, I still stand by my argument that the process was far too drawn out, and when they had 60, they should have pounced on the opportunity for a more exhaustive health care debate with the premise that a bill was going to be passed at the end (in reality, this was never the case, as everyone kept wondering about whether there were 60 votes).

If they had pushed finance reform first, immediately after/around the stimulus, they could have tackled health care in the fall. Finance reform would have been popular then and could have been contrasted with the TARP bailout, etc. Obama might have gone into the fall a stronger president.

Of course hindsight is 20/20, and again, while I'm proud something was passed, I am troubled by the process and hope we continue to improve the system.

Posted by: kmani1 | March 10, 2011 3:56 PM | Report abuse

ElmerStoup, proponents of health care reform have given the other side ample opportunity to justify their position with data, plausible budget numbers, and various other evidentiary support. They have not done so.

The GOP has yet to come back with a-n-y-t-h-i-n-g that passes the laugh test. And, when they don't like the statistics (for example, the nonpartisan Congressional Budget Office's measure of impact on the deficit), they attack the source as biased, unfair, flawed or irrational. Why is it biased? Doesn't matter. Why is it unfair? Because they say so. Why is it flawed? Because it was written on a Monday instead of a Tuesday . . . That's not a "genuine policy disagreement." It's nonsense.

When all the other side comes back with after 2 years of debate are cries of "death panels" and "pull the plug on Grandma" and "liberty is under attack!" we're not having a "genuine policy debate." We're engaging in a dishonest, cut-throat public relations campaign to scare the public. On those grounds alone, the good faith of the GOP position is highly suspect.

You don't get to falsely and spuriously claim -- over and over and over again --- that health care reform is "socialized medicine" and that the bill imposes "death panels" and then get angry when people doubt your sincerity.

Posted by: pbasso_khan | March 10, 2011 5:50 PM | Report abuse

I have been debating Health Care mostly on Canadian Blogs as our Conservatives are poised to push us into a US system with ways and means tests etc.

Canadian Universal, one payer health care costs us 10% of our GDP and covers 100% of our citizens.

The US system costs you 16.5% of your GDP and leaves millions with no coverage at all.

When debating Conservatives I asked if he did not understand the implication of the numbers.

He replied "Government should not be involved in health care in any way, shape or form" and there you have the crux of the Conservative/Republican policy. There is really no thinking for them at all!

Posted by: cyberclark | March 10, 2011 8:20 PM | Report abuse

That the Democrats spent more than 10 seconds whether they'd have 60 votes just shows they were doomed from the start. As soon as they saw how the GOP voted against the stimulus bill in lockstep, that was their clue to get their first term agenda packed into a reconciliation bill that could be whipped through by August recess. Oh well, he who can't take the hint, must take the consequences.

Posted by: beowulf_ | March 10, 2011 8:53 PM | Report abuse

pbasso_khan: Opponents don't have data??

Please! Your guys count $500 billion twice and your opponents are the ones with the funny numbers? Your guys ignore the "Doc Fix" and it just goes poof!

The Medicare actuary has questioned the rosy scenario projections and all we get from your guys is a bunch of hand-waving.

The "nonpartisan" CBO numbers are only as "good" as they are because of the phony assumptions they were forced to make by the Democratic leadership, a fact that is disclosed in the fine print.

And yes, ObamaCare imposes major restrictions on our liberties as citizens, a fact 26 AGs and two federal district court judge concur with.

Posted by: ElmerStoup | March 10, 2011 10:58 PM | Report abuse

pbasso_khan: Opponents don't have data??

Please! Your guys count $500 billion twice and your opponents are the ones with the funny numbers? Your guys ignore the "Doc Fix" and it just goes poof!

The Medicare actuary has questioned the rosy scenario projections and all we get from your guys is a bunch of hand-waving.

The "nonpartisan" CBO numbers are only as "good" as they are because of the phony assumptions they were forced to make by the Democratic leadership, a fact that is disclosed in the fine print.

And yes, ObamaCare imposes major restrictions on our liberties as citizens, a fact 26 AGs and two federal district court judge concur with.

Posted by: ElmerStoup | March 10, 2011 11:01 PM | Report abuse

ElmerStoup: did you really just say, "Please!"? Might I suggest, "P-leeeze!" That's even sassier.

Opponents don't have data, and opponents don't have an alternative plan. Why? Because fundamentally, you don't believe in universal health care coverage. Or, at the very least, you don't believe the haves should play any role in ensuring coverage for the have-nots --- irrespective of how the economics break down (i.e. putting a dent in rising health care costs and paying down the deficit while dramatically decreasing the ranks of the uninsured). And so --- since the economics add up, what do you do? You choose to discredit the economists by putting words like "nonpartisan" in air quotes and coming up with pretend issues like the "Doc Fix" and double counting. Be honest, you could care less.

Because it has nothing to do with the "liberties as citizens." It has everything to do with selfishness.

Posted by: pbasso_khan | March 11, 2011 12:10 AM | Report abuse

A republican president would not have spent an entire year of recession pushing for state controlled healthcare. So there would have been no republican, comprehensive bill with its myriad income tax implications and new squad of IRS enforcers. Now let us all say: win the future.

Posted by: truck1 | March 11, 2011 6:26 AM | Report abuse

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