June 07, 2005

Let's See The Plan!

Over at Tapped, Matt Yglesias makes a good point about the politics of health care. It's a bit self-defeating for liberals to try and design a health care plan in the hopes that maybe, just maybe Republicans and other business interests will hop aboard and agree to this or that particular proposal. The onus should be on them to say what they'd agree to; in the meantime, it never hurts for liberals to start thinking up their ideal health care system and use that as a starting point for discussion. Single-payer, say. Of course, it's quite fun—and edifying, mustn't forget edifying—to discuss the whole gamut of health care plans, put them out in the public sphere, and even try to guess at what different interest groups might actually agree to. Insofar as that's the sort of stuff that should be thought about and debated, at least among policy nerds, I'm all for it.

But Democrats, given that they're out of power and all, shouldn't be in the business of proposing these sorts of things, in the hopes of coming up with some "workable" plan of action. On the other hand, proposing some pie-in-the-sky single-payer health care plan isn't going to help Democrats win elections anytime soon either. Over the long haul it would be nice to build up broader public support for this sort of thing. But in the immediate future, it's sort of a loser.

In fact, it seems faintly ridiculous for any Democrat to make any sort of concrete health care proposal right now. During the 2004 primaries, nothing was more faintly ridiculous than watching the different Democratic candidates unveil their "health care plans" and jab elbows over the details. What was the point of all this, besides satisfying some weird media demand for "a plan"? At a very broad level, sure, the different proposals gave us a decent sense of what the candidates were about: we could see that Dennis Kucinich wanted a broad government takeover of health care, and that John Edwards didn't really feel like spending all that much on the uninsured. Fine. But when it came down to it, it wasn't as if any of these plans were ever going to pass intact, and pointing out that Wesley Clark's plan would cover a few million more people than Howard Dean's was mostly an academic exercise in futility. Who cares, really.

Same with the general election: Kerry's reinsurance proposal was treated like it was going to be signed into law the second he took office, even though it was obvious it would be hacked up—or blocked altogether—by a Republican Congress, or altered by budget realities, just like it was obvious that Bush's "health savings accounts" would be expanded into a tax shelter for the rich, and his subsidies for the uninsured would probably be peeled back altogether. These proposals weren't even starting points for negotiations, necessarily, they were just... arbitrary policy papers. Now I loved the little Washington Post articles tallying up the costs and possible weird side-effects each health care proposal would have, but they certainly didn't tell me anything all that useful about each candidate, besides the very general fact that Kerry would try to spend more to help the uninsured and Bush could care less. But no one needed a white paper to see that.

What I'd like to see the Democrats do is rally behind a set of principles for health care reform, and use that as the basis for both campaigning and negotiation, rather than some semi-specific proposal that can be picked apart and anyway, would never survive first contact with House and Senate Republicans. For instance, liberals can probably agree that we ought to cover all uninsured Americans. There are a variety of ways to get to that point, but if that's something people think is important, then it's going to cost about $100 billion a year—it would be great if we could do it for less, but odds are anything cheaper is just unserious. Likewise, in a modern economy where people switch jobs frequently, and businesses are being rendered uncompetitive by spending billions on health care administration, it makes a lot of sense to decouple coverage from employment. Again, lots of ways to do that, but that should be an endpoint. And so on.

So yeah. I'd rather see the party agree on a broad set of health care goals before wonking itself out with an endless slew of competing policy proposals. I don't know if this is at all politically feasible; maybe not, I can imagine The Note would piss itself if any Democrat, especially in the 2008 presidential race, tried to run on a health care platform that didn't include "a plan". But I just don't see the point in the whole charade.
-- Brad Plumer 10:27 PM || ||