Moderate health reform beats no health reform

Ezra Klein read my mind. Earlier tonight a tweet went through my brain but never came out because I don’t tweet, and nobody in my household would have appreciated it. It was, “One reason I favor the ACA to just about any other health reform proposal is because it passed.”

A lot of other health reform ideas are fine, though some are not. And I could have and would have supported many of them last year, if only they could have passed. They couldn’t then and they can’t now. It’s a strong reason to reject repeal (as if it were possible). It is not likely anything could really replace the ACA. The politics just don’t work. Heck, they barely worked for the ACA, but they did work.

It’s hard to understand how anyone paying the slightest bit of attention to politics during 2009 can imagine another comprehensive health reform bill passing. It’s an exceedingly fine needle to thread and many Presidents and Congresses tried and failed before Obama and the 111th. Why should we believe it could happen again and soon? It can’t and it won’t.

And that’s why it’s worth making our peace with the ACA. Is it really that bad? Really? Is it worth risking coverage for tens of millions of people over? It is, after all, a moderate bill, which was Klein’s point. That’s both why it passed and why we should accept it and move on.

People tend to form their impressions of how liberal or conservative something is by looking at how much partisan activity there is around it. And there was, of course, a lot of partisan activity around Obama’s signature legislative effort. But if you believe “liberal” and “conservative” refer to coherent schools of ideological thought, the health-care bill was the most moderate universal health-care proposal offered by any president, of any party, in the last century.

It was far more modest than what Harry TrumanRichard Nixon, or Bill Clinton proposed, relying more on the private sector and tampering less with existing insurance arrangements than any of those plans. It was even more moderate than what George H.W. Bush proposed. As I rarely tire of pointing out, it was a dead-ringer for the bill Republicans rallied around as a conservative alternative to the big-goverment overreach of ClintonCare, not to mention the bill Mitt Romney passed in Massachusetts. The individual mandate, now the most controversial element of the law, began life as a Republican idea.

It was a good idea. Republicans won! Yet they’ve assigned themselves the impossible task of repeal. I guess politics ceased being the art of the possible a long time ago.

See also: Klein’s follow-up. I wish he’d stop reading my mind. It’s getting spooky.

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