Ezra Klein and Health Care Vision

Posted: Feb 03, 2010 7:39 AM
Health care reform has been on life support for weeks now (and if you're as tired of the fight as many are, you might want to ignore this post). The Washington Post's Ezra Klein postulates that political compromise on health care is impossible due to intransigence by the GOP and that there would be no way to write a bill that could attain a reasonably bipartisan outcome.

"The policies that Republicans are willing to compromise on are meaningless, and arguably already included in the bill. Beyond that, the GOP's leadership is against further compromises because total opposition fits better with the electoral ground game... In fact, the bill is a substantive compromise. It's a deficit-neutral, universal-coverage scheme that relies on the private insurance market and looks like one of the Republican alternatives from 1994."

Dr. Klein has misdiagnosed the problem. He claims that the Senate bill has integrated Republican ideas and, despite this, attained no GOP support. The problem with this idea is that the health care fight isn't about individual ideas here or there. It's about competing visions for what a workable American health care system looks like. [# More #]

The Senate bill combines the trident of mandate, community rating and guaranteed issue with subsidies to focus on expanding coverage. This approach further entrenches the employment-based group health management system in place today and, as Klein notes, hopes for cost control while further shrinking the individual market. The mainstream conservative vision for where health care reform should go is to fundamentally disentangle employment from insurance while prioritizing cost control over expanding coverage. The Senate bill's vision is irreconcilable with this conservative vision.

So while Klein thinks that the small Democratic concessions to Republican ideas should be enough to win bipartisan support and remove roadblock intransigence, he refuses to give credit to his ideological opponents. The Republican ideas (that Klein says are only 'debatably' integrated into the Senate bill) would likely harm the overall Democratic vision for health care reform. The hodgepodge of disparate and incompatible ideas is how we got to the messed-up health system we currently have.

There's the left-behind Democratic Wyden-Bennett proposal that focuses on the individual mandate, state exchanges and an increased individual marketplace that is far more compatible with this competing vision. Working with this proposal is essentially waving the white flag and going back to the drawing board on health care, something the Democrats are unwilling and politically unable to do this year due to such an exhaustion of political capital on the current Senate bill.

Klein's underlying point that the GOP stands to gain and the Democrats stand to lose with the failure of any Democrat-shepherded health legislation through Congress is true. And it's true that Republicans in Congress have unwisely refused to budge on necessary components like Medicare reform as well. But what's missing in this analysis is the court of public opinion. Public opinion is massively against the existing health care reform bill at this point. Centrist and vulnerable Republicans might actually have something to gain if public opinion was in favor of a Democratic reform plan. It does, for the time being, make sense for the Republicans to play politics when the American people are behind them and against this reform package.