I wrote a column this week for Kaiser Health News on both the necessity and the difficulty of making some changes to the CLASS provisions of health reform. There’s reason to believe that some program provisions must be tightened to ensure the program’s actuarial soundness. There will be other glitches and issues that must be addressed as states and the federal government implement health reform. Unfortunately, our currently polarized politics makes it hard to address or even to acknowledge this basic reality. The fact that Republicans negotiated in bad faith on the path to health reform doesn’t help…
My conclusion reads as follows:
On CLASS, and surely on other matters, there is just too little political space to implement midcourse corrections or enact programmatic improvements. That’s a price Democrats paid by achieving their dream of near-universal coverage on a party-line vote. That was a price Republicans paid, too, through their implacable opposition to just about everything Democrats proposed, including many ideas Republicans traditionally supported.
Each side had plausible strategic and ideological reasons to pay that price. For now, anyway, our politics give us the choice between health reform that is less flexible and less carefully crafted than it really needs to be, and no reform at all. If this is the political choice presented to us, I strongly prefer the first option. I still wish we had a better way.
Bill, a Democratic commenter over at the Incidental Economist, took umbrage. He believes that I am too evenhanded:
These two quotes just don’t make sense….
Democrats didn’t want a party-line vote, they tried desperately to make the bill bipartisan. Pollack’s second quote tells us that he too is aware of this fact. If Democrats hadn’t accepted a partisan vote we wouldn’t have had health care reform at all.
He has a good point. I’m an emphatic partisan Democrat. In fact, I’m on record opposing fetishizing bipartisanship in the negotiations over health care reform. I’m so aware of what Bill is talking about. The fact remains that health reform can’t be implemented properly without midcourse correction, which will require some good-faith bipartisan negotiation.
That will be hard to do. It is an inherent challenge to fix such a massive bill that was passed on a party-line vote. Moreover, Republicans have so poisoned the well that many Democrats are understandably suspicious of any effort that might open vulnerable provisions to revision or repeal.
If you believe Democrats are being paranoid or inflexible, consider what happened during the gang of six negotiations. Republicans made Max Baucus look foolish. As far as I can tell–and as most Democrats will tell you publicly or privately–Republicans made a basic strategic decision to oppose the new law. The gang of six talks merely provided a vehicle to delay and obstruct what Democrats were trying to do. So when Mitch Daniels or others come along with proposed revisions, it’s understandable that many Democrats aren’t so interested in talking.
In my view, Republican governors such as Daniels are more sincere than Republican senators were 18 months ago. It’s important to to talk. Yet once people have been burned in a bad-faith negotiation, it’s asking a lot to recommend that they proceed as if this never occurred.