Along lines similar to my post from earlier today, E. J. Dionne has a column at TruthDig1 that expands on the basic nthemes that I was discussing: Why Democrats Are Fighting for a Republican Health Plan.
His basic thesis:
Here is the ultimate paradox of the Great Health Care Showdown: Congress will divide along partisan lines to pass a Republican version of health care reform, and Republicans will vote against it.
Yes, Democrats have rallied behind a bill that Republicans—or at least large numbers of them—should love. It is built on a series of principles that Republicans espoused for years.
Meaning?
Republicans have said that they do not want to destroy the private insurance market. This bill not only preserves that market but strengthens it by bringing in millions of new customers. The plan before Congress does not call for a government “takeover” of health care. It provides subsidies so more people can buy private insurance.
Republicans always say they are against “socialized medicine.” Not only is this bill nothing like a “single-payer” health system along Canadian or British lines. It doesn’t even include the “public option” that would have allowed people voluntarily to buy their insurance from the government. The single-payer idea fell by the wayside long ago…
This is what I was getting at below: on the overall spectrum of policy options, the one on the table today is nowhere as far left (or as intrusive) as its critics have made it out to be. It is one that still focuses very heavily on keeping the providing of health care itself in private hands. Indeed, while I fully understands why the insurance industry would oppose certain provisions of the bill, it is difficult to look at this and see a process that will ultimately harm insurance companies. They remain the central figures in financing health care. Indeed, forcing a large number of healthy young-ish people into buying insurance will help the bottom line for these companies.
And, I continue to find the fact that this program is pretty much the same as the one pushed by Mitt Romney in Massachusetts to be of interest (as I noted here), especially since Romney is arguably the early front-runner for the GOP nomination at the moment. Along those lines, Dionne notes:
Republicans now say they hate the mandate that requires everyone to buy insurance. But an individual mandate was hailed as a form of “personal responsibility” by no less a conservative Republican than Mitt Romney. He was proud of the mandate, and also proud of the insurance exchange idea, known in Massachusetts as “The Health Connector” (the idea itself came from the conservative Heritage Foundation).
Romney has described the Massachusetts plan as “the ultimate conservative plan”2 although he does not support such a plan on the federal level. Of course, as a WSJ column this week makes clear, Romney is going to have some political problems in the primaries because of the health care issue.
The irony here, regardless of the rhetoric, is that the health package that may pass today is, in many ways, more bipartisan (in terms of the long-term evolution of the ideas not in terms of votes) than it is being made out to be. It certainly is much, much more centrist than the opposition rhetoric suggests.
It was argued after the 2024 elections that the US is a “center-right nation.” And, indeed, there is evidence in this debate that there is something to that assertion. At a minimum, despite what the base of the Democratic Party may have wanted from this process, the bill has clearly been pulled in the center-right direction. Easy examples of this fact: no public option and the fact that pro-life Democrats have been placed in a key strategic position in this process. This is hardly the reign of the hard left.
- The piece has a WaPo copyright, but I can’t figure out if it was first published there or nor. [↩]
- Source: Fox News Sunday, March 8, 2024. [↩]
March 21st, 2024 at 2:08 pm
This is hardly the reign of the hard left.
This is precisely why it is hard to take Republican rationale for their opposition to the bill seriously.
It is pretty clear that the Republicans are dedicated to nothing other than obstructionism as an opposition party. Example A; House Republicans arguing on the principle of an “up-and-down vote” on the reconciliation package while their Senate counterparts block “up and down” votes in the upper chamber.
What is interesting to me is to figure out why did the Dems actually start out so far “right” in their negotiations on HCR.
Obama claims to be a pragmatist, but the one health care model used by most of the industrialized world (regardless of ideology) is a single-payer system.
The reason that you have conservative and liberal governments endorse single-payer in other countries is simply because it is the most efficient and effective mode of pooling risk and providing care.
Obama and the Dems never even considered this type of model. The only one who would be “hurt” by single payer is the health insurance industry. So the fact that the Dems decided to protect the health insurance industry as the basis of their negoitations should disabuse any notion that they are “leftist.”
March 21st, 2024 at 2:09 pm
It is a good piece, but EJD makes one very common error: eliding the very large differences between the British and Canadian models.
The British system has undergone reforms in recent decades that have introduced some more market competition, but the core of the system remains what might be called “single-provider.” Most hospitals and doctors are in the public sector.
In Canada, on the other hand, there is a “single payer” (a public insurance system, similar to US Medicare) but provision of health services is mostly in the private sector (again, as with US Medicare).
It is also worth noting that there are many models around the world that are not “single payer” yet are also not predominantly private. The Israeli, Swiss, and French systems, for example, are built on a series of state-supported non-profit networks. Those are also not “single payer” because the service-provider is not billing a government insurance agency.
March 21st, 2024 at 2:14 pm
@MSS: Yes, I noticed the conflation of the British and Canadian systems in the piece, but lazily did not address it.
It is true that, in general, there has been no especially good discussion, even in elite opinion circles, of the variation of systems around the world.
March 21st, 2024 at 3:07 pm
As I have written about consistently the problem is the costs. If you look at McCain’s proposal during the election campaign he paid for his plan by taxing employer paid plans. There is nothing, I repeat nothing that will pay for 40 million more people. We will need more taxes, and I believe the Democrats are already planning a VAT, to pay for this monster. No combination of Medicare cuts, and the taxes already in the bill will pay for this bill.
March 21st, 2024 at 3:24 pm
@Mark: I agree that the most significant criticism that can be leveled at the bill is the cost question. The bill does allege a means for paying for itself, although one can certainly argue over whether it will work as it suggests that it will. This CSM article details where the money is supposed to come from: click.
I would note, btw, that your assertion about a VAT in the wings is pure speculation.
I would also note that that 7 year coast of the Iraq war has been over $700 billion and the estimated cost of this bill is just over $900 over 10. As such, the estimated cost of HCR is actually cheaper than the Iraq war on an average cost per year basis. That’s not an argument for or against, just a comparative figure.
March 21st, 2024 at 4:07 pm
Vat is speculation but I am pretty sure as I have written on my blog that the numbers don’t add up without a lot more money. I have heard two people including Rahm Emmanuel talk about it. I don’t think they have the votes but when the crisis hits they will turn to it. I have never seen an entitlement that does not run a lot more in the long run.
I totally agree that war costs are high and are good basis for comparison.