Wednesday, June 24, 2009

The strategic political stakes in health care reform

If Obama fails to get a solid, workable health care plan in place that moves relatively quickly to universal coverage, the "democratic moment" that came into being with his Presidential campaign as a focus may well be over. Theda Skocpol puts it in even starker terms (Robust Health Care Reform is the Moment of Truth for Obama and the Democrats TPM Cafe 06/24/09):

Obama and the Democrats are coming off a historic, landslide election. They have all the popular support for robust reform they will ever have. Good policy design as well public desire for change and considerations of social justice and economic efficiency insist that they enact health care reform with a strong public plan in the mix. That is the only way to move toward cost control and guaranteed access with quality to all -- especially for Americans in lower economic strata or in rural states where one or two private insurers call the tune. There is no need for "bipartisanship" and the calls for it from some weak-kneed Democrats are merely excuses for doing the business of the medical-insurance establishment. Senators Baucus, Conrad, Feinstein, Nelson, Landrieu, Bayh -- this means you. All of you come from states where people really need robust reform and you should step up. ...

Because let's not kid ourselves: WHATEVER passes this year will make the Democrats owners of the health care mess going forward. If they just throw more subsidies and piecemeal regulations into the current system, they will ensure galloping public costs for residual arrangements and for subsidies to private insurers who will easily find ways to avoid sick or costly patients. Businesses and citizens will grow more and more irritated as time passes, and will blame the Democrats. Rightly so. [my emphasis in bold]
The Democratic Party is at a high tide not seen since 1965. And then, a substantial portion of the Democratic Congressional delegation was from conservative, segregated Deep South states. If the Democratic Party as it is now constituted cannot pass this health care reform now, this year, then it will never be able to without a fundamental change in the Party. If it fails, the first step toward that change should be deposing "Give-'Em-Whine-Harry" Reid as Senate Majority Leader.

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