Monday, March 22, 2010

the health care bill (again)

Well the bill is close to being law, which is a surprise compared to where we stood a few months ago, although less so when the large Democratic majorities--and the fact that they are almost certain to disappear this fall--are taken into account. I must confess to having mixed feelings about this development. I have always thought that the harsh Republican response to health care was misplaced: there's a pretty good case for market failure here, and conservatives have learned to live with one form or another of national health care in other developed countries. But I think the contrary sense--that this is some kind of defining moment that marks the high point of the anti-Obama conservative reaction--is equally misplaced. Here's why:

1. The attention span factor.--Democrats are trying to play this as a 21st century version of Medicare, Medicaid, and Social Security all rolled into one. This is an odd parallel, since the Democrats got creamed in 1966 and lost the Presidency in 1968, after the first two were passed. But I think it's exaggerated, anyway. Most people saw this for what it was: a liberal President, forced on the defensive, trying to salvage something of his agenda by pressuring his own party into supporting a bill many were plainly unenthusiastic about. He deserves some credit for political courage--he is certainly ahead of Bill Clinton on this score (although that isn't hard). But more people were talking about the Cornell basketball team today than the health care bill: I just don't think most people are nearly as focused on it as the Washington elite, and the gap is likely to grow rather than shrink in the coming months.

2. The need for further legislation.--Many in the media have played this as a yes or no issue: either there would be reform now or the issue would go away for another generation. In fact, the rapid growth of health care spending would have sooner or later required legislation anyway, and the current bill will likely need a series of amendments to meet revenue and other targets. Health care, in other words, is an ongoing issue: and Republicans may be better positioned attacking the budgetary and other excesses of this than attempting to defend a status quo that most knew deep down was indefensible.

3. The "the more they see it, the more they'll like it" fallacy.--Faced with largely negative polling data, Democrats have resorted to a transparency argument: the more people see of the actual legislation, the more they'll grow to like it. This almost never happens. The essential newspaper headline today was, "Congress passes bill that extends health care, saves money, and doesn't take anything away from anyone." Whatever happens, that won't, and--as people learn the actual costs of the bill--they are much more likely to turn against it than in favor of it. This is especially true given the workings of entitlement theory, which suggests that people become more angry at losing something they already have than grateful for getting something new: an unfair result, perhaps, but usually pretty dependable.

The biggest problem with health care, I think, is not so much the bill itself but that it has taken up a year of time that might have been spent addressing issues--jobs, economic growth, the war on terrorism--that most people seem to think are more important. In this sense, its closest parallel may be the Camp David peace accords, with President Jimmy Carter (like Obama with health care) became more or less obsessed with in the second year of his Presidency. Carter got an accord, and thirty years later it remains a signature achievement. But most Americans simply shrugged and wondered why he was spending so much time on the issue while the economy fell apart. The rest is history.


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