• Political Feasibility is Relevant!

    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.

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    • So what makes a bill politically feasible? Looking at both HCR and Waxman-Markey, I suspect that one required feature is daunting complexity, in which any number of special considerations (like Nelson’s federal buyout of Nebraska’s Medicaid costs) can be hidden. I tend to prefer simpler proposals — they’re harder to game and easier to analyze, and in the end I think they lead to less voter mistrust because of that. But for all the polling and focus groups, the object isn’t to make the bill feasible for voters, but to make it feasible for politicians — and that means embedding something specific for everyone to point to at election time and say “See what I got for you in the big health-care bill?”

      • @bluntobject – Of course it is art, not science (dark art maybe). And it isn’t by chance that what is politically feasible is complicated. The result of so many conflicting interests has got to be. But mostly, there are things that get proposed that one can immediately see won’t fly with one major interest group or another. Or, if you need 60 votes in the Senate for a left-leaning ambition but a senator or two is facing a tough fight in his state and vulnerable on the right you can’t count on his vote, at least not without some substantial gift or cover.

        That’s just a start. I’m not even very good at discerning the boundaries of the politically possible, but I think I’m better than most. I do, however, have access to some very good political minds, one of whom has, lately, predicted every political news item on health reform hours or days before it occurred. If only there were big money in blogging he’d be making it. Fortunately for me (and readers here) he tells me everything he thinks.

    • Sounds like your friend could make some money on Intrade and/or iPredict. 🙂

      • @bluntobject – We talked about Intrade on health reform. If we were the speculating type we’d be doing that. On the other hand, there are some ethical considerations. But really, it’s not that tempting.

    • pastor Chris says to say it is impossible suggests your knowledge is limited because no impossible dream has entered into the heart of man. if you can think it you can do it.
      that may sound spiritual but think of it; most great products started as just an idea, great businesses today started as just dreams now they are reality. my encouragement is keep dreaming possibility is subject to strong determination + passion. if you thought it through and you’ve a burning desire to make it happen and strong determination t then go for it. .dont limit yourself- throw away political feasibility. go for it because reality is what you make it.. keep dreaming