This post has been cited in the 4 February 2010 Health Wonk Review.
From time to time someone approaches me and asserts that another, very different approach to health reform would be better. Then they direct me to some website or a paper or just start explaining it to me. Then they want me to either agree with them or enter a debate.
One of the first things I look for is political feasibility. My would-be rival often charges that I’m only interested in what is possible and not what ought to be. The assertion, “Just because it passes doesn’t make it good,” is standard fare. I couldn’t agree more.
But that’s not my point. My point is that that which is clearly not politically feasible is not going to happen. It might be theoretically brilliant, but so is time travel through worm holes (if that is actually possible). It can’t survive the limitations of reality. Anybody pursuing it would be torn to shreds.
The point of bringing in political feasibility is that it is a relevant constraint. That which can pass isn’t necessarily good. But only that which can pass will ever happen. Ideas that are laughed out of the realm of political feasibility aren’t, broadly speaking, good ideas.
Does that mean the House and/or Senate bills are good? Well, I think they are at least good first steps toward solving many of the problems with our health care system. I don’t think they are the final bills on health reform. I do know if some variation of them does not pass we won’t see another for a long time. That they are (nearly) politically feasible is a huge plus! Moreover, that fact is not obvious from examining the bills themselves.
That’s the strange beauty of our legislative process. It certainly does weed out the political duds doesn’t it? In fact, if anything it has a high false negative rate. Whatever survives is extremely politically robust. It has to satisfy a myriad of special interest concerns and those of hundreds of legislators. It has to survive unbelievable distortions and attacks borne of insanely devious creativity. That’s not a defense of our system. That’s just the way it is.
So the next time a great new health reform idea pops into your head, ask yourself, “Would this survive a year of political scrutiny?” That’s not an easy question to answer. Few could begin to address it. But remember this, we have tried and failed at health reform many times. Very smart people were involved each time, folks that really know politics and policy. It is an exceedingly narrow needle to thread. Few ideas can make it. The current bills have made it further than any other, ever. That means a great deal.
In general anything we can conjure up that is radically different from the House or Senate bill is almost surely a dud. The sausage factory can only produce so many variations of sausage. Political feasibility is highly relevant. To ignore it is to invite fantasy. That’s just not worthwhile.