Fight or Flight Response to Health Reform

Circumstances that disappoint or enrage offer the opportunity for a form of fight or flight response that is at least metaphorically, if not physiologically, related to that provoked by a mortal threat. I face such situations from time to time, and I’m sure you do too: your religious or social group heads in a direction you dislike, a new policy at work disrupts a comfortable equilibrium, a neighbor disturbs the peace. How do you respond?

One choice is to disengage, to walk away. To do so would seem to offer the hope of escape, but very often it does not. It guarantees that the situation will evolve without your influence. You’ve taken away your own power, ceded it to those who are willing to do the work of improvement. Sometimes you pay a heavy price.

Take health reform. Republicans walked away relatively early and a few vocal liberals/progressives threatened to do so at the end. Ultimately, it seems many (but not all) of the latter will be on board but the former will not. (Even Olympia Snowe, one of the only Republicans who seemed to engage in good faith, wishes to kill the bill with delay.) The difference between the the left and the Republicans has been one of fight or flight. The left engaged in a fight to improve the bill. Republicans turned away.

In terms of shaping policy, the cost of Republican flight will be high. As Jonathan Chait wrote this weekend,

The Republicans eschewed a halfway compromise and put all their chips on an all or nothing campaign to defeat health care and Obama’s presidency. It was an audacious gamble. They lost. In the end, they’ll walk away with nothing. The Republicans may gain some more seats in 2010 by their total obstruction, but the substantive policy defeat they’ve been dealt will last for decades.

More galling still, the legislation the Republicans wish to defeat will provide tremendous assistance to many residents of their states. After all, uninsurance rates are highest in the South, and lack of insurance is relevant to mortality and morbidity. Republican flight has been disappointing, even insulting. It is one thing to disagree with the opposition; it is another to refuse to participate in the solution to a collective (fiscal) threat.

Meanwhile, though they did not get everything they wanted (no public option, for example), the participation of the left in the health reform debate has been laudable and significant. Ezra Klein provides one concrete example, among many:

The original Senate bill barred insurers from imposing “unreasonable” annual caps on spending. This [latest Senate] bill bars them from imposing any annual caps on spending. That’s thanks, in large part, to the left, which attacked that weakness ferociously.

Looking forward, the outcomes of future debates over the evolution of health policy will be shaped in large part by those who choose to participate. There will be much work to do, even after health reform 2009/2010 becomes law. Republicans appear unwilling to do that work. They seem committed to the political expedient of flight and will likely continue to campaign against reform. That strategy may yet work politically and for a time. The extent to and duration for which it does is up to those who’ve engaged substantively in debate so far.

As the spotlight on health reform fades, will the left fade too or keep up the fight? I hope they fight, and I hope the right joints them. Compared to flight, it’s the courageous and mature response. It’s also optimistic and necessary.

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