Chicken little was wrong: Republican strategy after health reform passes

Once the health bill passes, Republicans have to choose between calling for its repeal and not calling for its repeal. Neither choice is attractive. My heart bleeds for them.

One theme Republican and Democratic opponents of health care reform share is the argument that, if a bill passes, it will be an albatross around the necks of the Democrats. But as Colombo liked to say, there’s just one thing: what are the Republicans going to say about it? Turns out there’s no good answer to that question, from the Republican viewpoint.

The Tea Party crowd wants Republican candidates to promise to repeal the whole thing. And of course if it’s an unconstitutional law that will put future generations in tax slavery while stifling medical innovation and sending Granny to the death camps – which is what Republicans have been saying about it – it certainly ought to be repealed.

But as Democrats have been finding in trying to pass the bill, inertia-of-rest is is a powerful force in politics.  Every change hurts someone – in part because every cost is someone’s revenue – and the people who get hurt tend to react a lot more strongly than people who might be helped.  Once the bill is law, the rights it confers are part of the status quo.  Susan Collins can get away with voting against cloture on a proposed law still vague in voters’ minds.  But could she get away with voting to allow insurance companies to exclude people with pre-existing conditions?  To re-expand the “doughnut hole” in Medicare drug coverage?   To deprive small businesses of tax credits for providing health insurance to workers?  I don’t think so.

After all, the Democrats didn’t include the unpopular parts of the bill – the individual mandate stands out – because they’re masochists;  those provisions are in there because they’re necessary conditions for the popular parts of the bill.  Once the bill passes, the Republicans face the same problem, in reverse.  So they’re going to have to choose between not calling for repeal, and alienating their base or calling for repeal and guaranteeing that they can’t get any votes outside their base.

Sucks to be them, doesn’t it?   The Democratic campaign committees have already started advertising campaigns charging that targeted Republicans will repeal health care reform.

Of course it never stood to reason that Obama (and Axelrod, Plouffe, and Emmanuel) Reid, and Pelosi were pushing hard for something that was gong to be an electoral catastrophe for Democrats, while Republicans were fighting tooth and nail to keep that catastrophe from happening.  But neither John Boehner nor Ralph Nader has ever allowed the fact that a claim is nonsensical to stand in the way of making it.

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact: Markarkleiman-at-gmail.com

18 thoughts on “Chicken little was wrong: Republican strategy after health reform passes”

  1. Perhaps people won't like the limp cost controls causing premiums to skyrocket? I wouldn't be so hasty in assuming this legislation won't hurt Democrats. The compromise bill (and all its unknowns) could come just in time to charge up the people who don't like it, regardless of political affiliation. I'm already voting against these people because this bill doesn't do enough, so if they want my vote back they are very likely going to have to sacrifice someone else's vote.

  2. Perhaps people won’t like the limp cost controls causing premiums to skyrocket?

    Feature, not bug. Or thin end of the wedge The failure of the Massachusetts mandate plan to adequately control costs — they're rising there no faster than other high-cost states, but that's not 'bending the curve' — has triggered the first steps in a major overhaul of how medicine is paid for, to wit, bailing on fee-for-service and switching to capitation payments.

  3. I assume they're recalling the image of angry old ladies crawling up onto the hood of Dan Rostenkowski's car: PL 101-234, the Medicare Catastrophic Coverage Repeal Act, which may have been nonsensical, but was no less real. Politicians do sometimes resist what will help or enact what will hurt them. Still, the odds of a repeat of 1989 seem remote.

  4. "Of course it never stood to reason that Obama (and Axelrod, Plouffe, and Emmanuel) Reid, and Pelosi were pushing hard for something that was gong to be an electoral catastrophe for Democrats"

    Nevertheless, I think it will be. I don't foresee that those who would have voted for a Democrat will vote Republican instead but rather those voters will not vote at all. I left the Republican party in 2008 and voted for Obama based on the changes I believed he would bring about. The Bush-era policies that the Obama administration has embraced and extended have already cost him my vote in the next election; he didn't change what he said he would, even when it was demonstrably within his power to do so. The failure of the Democrats in congress to bring about reform without capitulating to special interests on health care, financial regulation, etc. have sapped my motivation to help any of them in the next cycle.

    Right now I'm inclined to vote for primary challengers or no one at all.

  5. A couple of thoughts:

    –The Iraq war was a political catastrophe for the Bush administration, and a political bonanza for liberal anti-war Democrats. And yet when we look at the period before the war, anti-war Democrats were fighting to keep it from happening. What conclusions should we have drawn from those facts?

    –The political ramifications of the Democratic health care approach may not be the same in the long run as they are in the short run.

    –The Tea Party approach is the right one politically: scrap the whole thing–the good and the bad is the way to phrase it–and start over, with a clean and transparent process, like Obama promised but didn't deliver.

    –Someone's right here, and someone wrong. We'll find out soon enough. Or not soon enough, but soon.

  6. "“Of course it never stood to reason that Obama (and Axelrod, Plouffe, and Emmanuel) Reid, and Pelosi were pushing hard for something that was gong to be an electoral catastrophe for Democrats”"

    Sure it does. The leadership of both parties are from safe seats, they stay in office no matter what catastrophe they cook up for their parties. And they've got enough power to keep from being kicked out of their leadership positions, too. And Obama? He gets either two terms, or one, then he's retired. Why should he care?

    But they're not being stupid. A short term catastrophe can set the stage for a long term comeback. And putting another sixth of the economy under the government's thumb is bound to help the long term prospects of the party of big government. Every increment of government growth makes the Democratic party stronger relative to the Republican. It might take a few election cycles to ride out the storm, but then they'll come back stronger than ever.

  7. Davis X. Machina said:

    "Feature, not bug. Or thin end of the wedge The failure of the Massachusetts mandate plan to adequately control costs — they’re rising there no faster than other high-cost states, but that’s not ‘bending the curve’ — has triggered the first steps in a major overhaul of how medicine is paid for, to wit, bailing on fee-for-service and switching to capitation payments."

    So the goal is to get people so upset about how medical care works in this country that they institute a fundamental change? Please elaborate on your statement of 'feature, not bug.'

  8. After all, the Democrats didn’t include the unpopular parts of the bill – the individual mandate stands out – because they’re masochists; those provisions are in there because they’re necessary conditions for the popular parts of the bill.

    How very nice of you to answer your own question!

    The Republicans will repeal the unpopular parts of "reform" and allow the rest to fail of its own accord. So long as people don't generally understand exactly how and why various unpopular parts of "reform" are necessary elements–and people most certainly don't generally understand it–the unpopular parts can be repealed and the resulting failure blamed on the Democrats.

    This, of course, is why delaying implementation of most of the "reform" legislation until 2014 is so profoundly stupid. Unless and until people see the program as a whole working for them, unpopular elements that have not yet been implemented are very easily repealed.

  9. Robert, I don't see how that works. The only potentially unpopular part–let me say that again, the only potentially unpopular part–is the individual mandate. Everyone likes making insurance companies insure everyone and charge them the same. Most people are fine with subsidies for participants of modest means. Those are the major aspects, definitely the do-or-die ones.

    If you take away the individual mandate, but leave the rest, you simply make it impossible for insurance companies to do business: rates high enough to cover sick people who don't have to buy until they get sick, but can't be turned away once they do, will be far too high for healthy people to pay, so their customer base gets sicker and more expensive to care for, etc. That's great if you hate insurance companies and are trying to usher in single payer, but probably not what the Republicans have in mind.

  10. The Bill creates a situation where MegaCorporations can gouge the

    American People to their hearts' content, and since no GOPers voted for it,

    ALL GOPers can plead "Not guilty", while they pelt Democrats for pushing it through.

    It could be an extended period of agony for Democrats. But deserved.

    That's what you get when your the Democratic Party and you lose your

    grasp of Liberal/Progressive values.

    The lack of cost-controls is what, ironically, the GOP will skewer the Democratic party with.

    The very thing that the GOP stonewalled for, and the "blue-dog" (i,e,traitor) Dems just HAD to have.

    In the long run, it may purge the Democratic party of the vile corporatist "centrists" who

    have polluted the party–People like Lieberman,

    Rahm and The Clintons, once and for all.

    This is ipecac for the Dems.

  11. Mark: "But could she get away with voting to allow insurance companies to exclude people with pre-existing conditions? To re-expand the “doughnut hole” in Medicare drug coverage? To deprive small businesses of tax credits for providing health insurance to workers? I don’t think so."

    I'd expect a fair number of things to be repealed in a GOP adminstration. Remember, Mark, that these don't have to be put in a bill titled 'The Gut Healthcare Reform and Convert Americans into Soylent Green Act of 2017'. They can be individual sentences in other bills, and even the sentences could be difficult to understand.

  12. Everyone likes making insurance companies insure everyone and charge them the same.

    I don't think so; I think that's likely to be the most explosive aspect of the bill, since it means that for most people who currently have individual insurance, premiums will increase by several times. (That's what the fact that an identifiable 20% of people have about 80% of the costs means.)

    It's going to be basically COBRA for all; most people who currently have individual insurance have cheaper-than-COBRA coverage.

  13. Robert, I don’t see how that works. The only potentially unpopular part–let me say that again, the only potentially unpopular part–is the individual mandate. Everyone likes making insurance companies insure everyone and charge them the same. Most people are fine with subsidies for participants of modest means. Those are the major aspects, definitely the do-or-die ones.

    Republicans take control of Congress in 2012. Republicans repeal the mandate because they can and because it's politically popular to do so. Obama, who won reelection because there was no legitimate Republican candidate running against him, signs the repeal because it's attacked to the budget bill which he's unwilling to veto. Then premiums, which must be community rated, with some allowance for age variation, very quickly spiral upwards once the remaining bulk of "reform" is instituted. Insurance becomes unaffordable for people of modest means, even with subsidies, and there's no way that subsidies can be sufficiently increased to change this. The Republicans blame the Democrats, saying this was an inevitable element of the program, and the press, in full he-said-she-said mode, plays along. The Republicans demagogue–truthfully!–that for the vast majority of people insurance would be more affordable on the individual market after full repeal. With this truth and with people not understanding how Republican repeal of the mandate is what made actually insurance completely unaffordable on the individual market, Republicans lay the political groundwork for full repeal. In the 2016 elections they campaign and win on a full repeal platform, increasing their congressional majorities and taking the Presidency at the same time.

  14. I thought Yglesias made a good point this morning: which of the lies and half-truths will republicans be able to repeal, as you can't repeal something that doesn't exist?

    Yes, the individual mandate is an easy sell, but I think most of their public traction is notional. Kind of a hand-waving about socialism, czar, death panels, etc. Republicans seem rarely very good at the wonkish details required in hen-pecking.

  15. Robert Johnston: Clinton was willing to shut down the Federal government rather than make budget cuts that the Republicans wanted. If Obama had to choose between that kind of standoff and signing a bill that unraveled health care reform, I’m sure he would follow Clinton’s example.

  16. "The Republicans demagogue–truthfully!–that for the vast majority of people insurance would be more affordable on the individual market after full repeal. With this truth and with people not understanding how Republican repeal"

    Robert, I am actually very sympathetic to this analysis.

    The one thing that I think complicates it is that 2016 means 6 more years of insurance costs rising faster than inflation, plus (I strongly suspect) a population the bulk of which feels poorer than it does now — more expensive gasoline, energy, and other resources for one, higher taxes one way or another for two (something is going to have to happen between now and then to start paying down our current bills, and if it's not income tax, it's going to be nickel-and-dime poll taxes — higher excise taxes, "user fees" etc).

    So come 2016 all the above doesn't change the fact that the problems of today still exist, just as badly as before. Could a charismatic (and aggressive) Dem leader campaign on the opposite platform — "We tried to involve the insurance companies, it was a disaster, so screw them, we're expanding Medicare down to 35 yrs old"? This is, of course, what's in the minds of the leftist critics of this bill.

    Of course campaigning this way, and even getting the country behind you, doesn't change the structural factors Yglesias is always mentioning. So, another way to state this is that, in the absence of knowledge regarding the Dem plan for the filibuster, it seems foolish to prognosticate further. If the Dems seriously work to throttle down the filibuster, predictions made on the balance of what is popular become reasonable. If the Dems refuse to deal with the filibuster, predictions based on who was the wealth seem like a more sensible choice.

  17. Eli says:

    December 29, 2009 at 8:39 am

    "I thought Yglesias made a good point this morning: which of the lies and half-truths will republicans be able to repeal, as you can’t repeal something that doesn’t exist?"

    G-d-D-mn but that boy can be sorta dumb 🙂

    The things that are being demagogued against don't have to be the things that are being repealed. We've seen that before, and will see it again.

  18. Seems fair enough, since the things that are promised don't have to be the things that are enacted. I don't recall anybody running on limiting HSAs and FSAs to prescription drugs. In fact, I remember the guy who's going to sign this monstrosity that outlaws my high deductable health insurance plan campaigning on everybody being able to KEEP their current coverage.

    Sure, you knew that was a lie the moment it left his mouth, but he DID say it.

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