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Tuesday, June 9, 2009

Sweeping Health Care Reform...Not So Fast

Today's Politico carries a discussion among pundits and academics about the possibility or even probability that President Obama will pass sweeping health care reform. For my own two cents, I think the chances are very slim. I can't think of any bill that actually became law that was anywhere near as complicated, with so many moving parts, as the framework for President Obama's health care reform package.

President Obama faces both a numbers problem and a problem of political dynamics. In order to form a coalition big enough to form a majority, he would need to bring together legislators of varying ideologies from states and regions of competing interests.

Let's take the issue of a public insurance option. This is a non negotiable issue as far as almost all Democrats are concerned. It's also non negotiable, the other way, for almost all Republicans. As such, one way or the other President Obama loses 40% of the legislators right away. Now, it goes without saying that he will keep the public option, so that means any hope of bi partisanship goes away.

Then, there are issues like whether or not the plan will mandate that every single person be covered. This is also non negotiable for most liberal Democrats. Moderates aren't necessarily against this however most moderates are already squimish about the exploding deficits.

So, if health care reform is to cover every single American, we next come to the issue of how to pay for it. Right now, President Obama is already $90 billion yearly short. The Congress has rejected such ideas as decreasing the write off for charitable giving and mortgage interest. He's trying to pass cap and trade but that is moving extremely slowly through Congress. If President Obama doesn't pay for universal health care, he will likely lose a great deal of moderates, Blue Dogs mainly, who are already quite worried about the bursting budget deficit.

If, on the other hand, President Obama tries to pay for it with something like a tax on employer funded health insurance, he is likely to face a populist revolt from those that get their health care through their employers. It will also mean that he would be breaking his promise not to raise taxes on 95% of Americans.

The Republicans would use such a tax as a bludgeon to sway public opinion against the plan. The problem with health care reform is that you are trying to combine folks of very different ideologies to get on board with one plan. Often, their ideologies conflict to such a degree that pleasing one means losing the other.

So, this brings me back to the president. To pass health care reform in the vision that President Obama wants takes a politician of unique skills. I don't believe that President Obama has these skills at all. He's never built any sorts of coalition to advance any sort of legislation. He's certainly never taken the lead on legislation this complicated. This is the sort of political skill that Lydon B. Johnson was legendary for having. LBJ was legendary for being able to cajole when that was necessary and strong arm when that was necessary. That's one reason why LBJ was able to pass the very complicated Great Society. President Obama is a great orator, with outstanding charisma, but he has absolutely no experience in crafting complicated legislation and building a breadth of legislative support for them.


waltc said...

All of this is dependent on Congress actually reading the bill before voting on it.

There is a precedence for them not reading a very complicated and costly bill prior to passing it.

Anonymous said...

It is pretty huge. He has to get his party to agree on the type of plan, the people it will cover, and how to pay for it. On top of that, he's fighting the Republicans who either think the health care system is fine the way it is or want to take advantage of the situation to pass another tax cut, the insurance industry lobbyists trying to pick off conservative democrats, and a skeptical media who thinks it can't be done.

And on top of that, he's surrounded himself with people whose answer to every question seems to be "give Wall Street more bailout money."