Democrats To Pass Significant Health Care Reform

I know.  You can’t, won’t, don’t believe it.   You just know that the Democrats are going to let an opportunity of the century slip through their collective fingers.  Fear not.  This time they have a secret weapon.  The Republican Party.

Far be it from me to defend the two party system, but it does have its virtues.  One of its virtues is that its vices–patronage, the seniority system, pork, and assorted perks, etc.–can actually work to help unify a party when the stakes are especially high.  And the stakes are extremely high in the case of health care.  The Republicans are unified against it.  (Olympia Snowe is the outlier who proves the point.)  The Democrats must unify against their unified adversaries to remain the dominant party.  Self-interest, in all likelihood, will win the day this time around, although unity will require some intense horse trading between Democrats.

The unity of the Republicans is not accidental.  It has two basic grounds: ideological and  tactical.   On the ideological front, as divided as Republicans are over how far to carry the culture wars, the party remains committed, more so than ever, to the notion that government is fundamentally a threat to individual freedom.  Various wings of the party still define freedom in negative terms, that is, individuals should be allowed to satisfy their own preferences, primarily through the market, without government interference.  It’s not the government’s place to help protect and nurture individual growth and development.  This is a private matter.  (There are, of course, exceptions, for example, prayer in classroom.)  On the tactical front, the Republicans have little choice but to continue to appeal to an increasingly strident anti-government base, because they cannot afford to lose it.  The vast majority of Republicans in Congress could not survive if the base were to desert them in even modest numbers.  They must remain united for the foreseeable future as the anti-government party if they aren’t to disappear.  And the best way to do this is to select causes or issues and rally around them.

Turning to health care:  it’s clear to most Americans that the market is not working.  It cannot satisfy individual preferences, or even when it does, there is a legitimate fear that it will not continue to do so.  (Everyone has heard of someone who was denied coverage arbitrarily by a health insurance company.)  Individual preferences simply cannot hold out against the power of the insurance industry.  The industry has itself become a quasi-tyrannical government, deciding on who lives or dies, and it does so often based on its bottom line.  There is a palpable sense of vulnerability in the land, and for most Americans it’s not being caused by the government.

Enter the Democrats.  Since the 1930’s they have been more committed than Republicans to the notion that the government has a role to play in the self-development of individuals.  Self-determination requires not only a society in which tyranny is absent (the right’s position), but one in which the government helps nurture the well-being and education of its citizens.  And the government must at times defend citizens against corporate forces that the little guy simply cannot fight.  The Democrats are positioned to be on the winning side of the health care debate.

“But wait,” you say, “this is not a matter of which party has the majority of Americans behind it.  It’s a matter of lobbyists, and they have bought not only the Republicans but many Democrats.  These Democrats will continue to cater to the health insurance industry.”  Here is where the party system will come into play.  There is a point at which the self-interest of members of the Democratic Party will shift from the bucks that they have gotten from the lobbyists to the necessity of preserving party unity.  Why should this be true now when it hasn’t been in the past?  The stakes are simply higher and things have moved along too far.  For a Democrat to be responsible for the defeat of significant health care legislation at this stage would not only gravely injure the party, it would open the door to retribution from other party members in terms of patronage, pork, etc.

The Democrats who are indebted to the insurance industry will hold out as long as they can to cut the best deal they can for their clients.  And there indeed are some Democrats who are ideologically closer to the Republicans and would prefer less government involvement.  But unless they plan to change parties, at some point, push will come to shove.  The Democrats will have to fall in line.  They will have to unite. (For example, Democratic Senators would have to vote to support a Republican filibuster in the Senate in order to hold up health care reform.  Politicians, however, don’t vote with the opposition party to support its filibusters.  Could this happen with Lieberman?  Yes.  Likely?  No, unless he decides to become a Republican.)

Will the reform be substantial?  It will not satisfy those who want national health care insurance.  Yet it will have to be substantial enough to start cutting costs, cover most of those who do not have insurance, and gut the power of the insurance companies to decide who has  insurance.  To fail at these basics would seriously undermine the Democrats with their most vocal supporters, and it would run the risk of creating turmoil in the Democratic Party as politicians have to explain a weak plan after all of the hype.  There would be some serious finger pointing.  And the unified Republicans would be waiting in the wings to gobble up pockets of isolated Democrats.

Of course, predictions are dangerous.   However, if I were a betting man, I would bet on this one.  And so is Obama, a man who has always understood the place of self-interest in “community organizing.”

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The analysis in this piece draws on insights from J. David Greenstone’s The Lincoln Persuasion.  Greenstone was a professor of political science at the University of Chicago during the time that David Axelrod was an undergraduate political science major.  It seems that others in Obama’s circle were acquainted with Greenstone’s work, for example, Cass Sunstein.