[Posted by Karl]
We now have reason to believe that Pres. Obama ultimately expects that Congress will settle on a healthcare reform bill that lacks a government-run health insurer, but includes an individual mandate, community rating, guaranteed issue, and a minimum required package. But will Congress settle on it?
TNR’s Jonathan Cohn writes of scaled-back healthcare reform:
Under such a plan, the Center on Budget [and Policy Priorities] concluded, “families with modest incomes who buy the lowest-cost coverage could face significant challenges if they experience a serious illness or injury, because their plans could leave them subject to steep out-of-pocket costs.”
Put aside, for a moment, whether this makes sense substantively. It makes absolutely no sense politically. Scaling down legislation basically means gutting the benefits that would go to the working and middle class. In other words, it would help fulfill the fear many of these voters already have and that opponents of reform have tried hard to stoke: That reform doesn’t have much to offer the typical middle-income American.
You also have blogger-activists like Jane Hamsher considering campaigning against Obama’s seemingly desired bill. But it’s not just the Left, either. Keith Hennessey has noted that the individual mandate could leave millions on middle-class Amercians worse off. Perhaps most important, from a political perspective, Barack Obama made a similar point when he was a candidate.
In this environment, it might be useful to review a 1995 post-mortem of HillaryCare from a lefty like Paul Starr. Although the Obama administration has tried to do everything differently than the Clintons on this issue, ObamaCare’s downward trajectory makes Starr’s description of the final efforts at HillaryCare all the more striking:
In fact, the only conceivable scenario for legislation by the summer was that the House would finally defer to a more conservative bill developed in the Senate. The unwillingness of House Democrats to acknowledge this reality was a premonition of coming disaster.
The final act was played out in the Senate and starred the “mainstream group,” a bipartisan coalition of roughly 18 Senators, led by Chafee and Breaux… The proposal… included insurance market reforms and voluntary purchasing alliances along the lines of the Jackson Hole Group’s version of managed competition. For all its flaws, the bill would have been a historic advance.
There was only one problem: It didn’t have much public support. It was too big for conservatives, too little for liberals. Democrats in Congress who genuinely wanted a compromise found that hardly any organized constituencies would swallow the bitter pill the mainstream group was offering. The elderly saw the proposal as cutting Medicare without providing anything in return; unions saw it as taxing high-cost health plans–the kind some union members still enjoy–without the guarantee of coverage “that can’t be taken away.” The mainstream group and Mitchell might have overcome these problems and in a different political season secured a majority, but the clock ran out.
From the beginning, the proposals in the center had failed to generate any public excitement. Economists and conservative intellectuals may like the individual mandate in the Chafee plan and the cap on tax benefits that both the Chafee and Cooper plans originally included, but no one has built public support for these measures. Most of the initial business backing for the Cooper plan seems to have been expedient. Business interests backed Cooper when they feared worse; they lost interest when the feared alternatives evaporated.
Years later, we again find the chambers of Congress at odds. The bipartisan group working the issue in the Senate is one-third the size of the pool in 1994. Pres. Obama aims for an individual mandate that has shaky public support at best, seniors are against the effort in general, small businesses are joining Big Business against it, and the Democrats’ left-wing base would be greatly demoralized or actively antagonistic. Can the “center” hold? When it comes to attempting government-run healthcare, maybe not.