• What I really worry about

    What I worry most about is the same thing that most concerns Harold Pollack:

    [O]ne thing is certain. The new [health reform] law will need repairs and fixes along the way. There will be glitches. Specific legislative and regulatory provisions will require adjustment once they are tested. […]

    [But,] there is just too little political space to implement midcourse corrections or enact programmatic improvements. That’s a price Democrats paid by achieving their dream of near-universal coverage on a party-line vote. That was a price Republicans paid, too, through their implacable opposition to just about everything Democrats proposed, including many ideas Republicans traditionally supported.

    Each side had plausible strategic and ideological reasons to pay that price. For now, anyway, our politics give us the choice between health reform that is less flexible and less carefully crafted than it really needs to be, and no reform at all. If this is the political choice presented to us, I strongly prefer the first option. I still wish we had a better way.

    Health (and other types of) reform are technically hard. But, more and more, I see political obstacles as the real barriers.

    Pollack’s piece, a KHN column, is worth a full read. The vast majority of it is about the CLASS provisions. I think he summarized the issues fairly. It’s about as good a brief overview as you’re likely to find.

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    • These two quotes just don’t make sense:

      “That’s a price Democrats paid by achieving their dream of near-universal coverage on a party-line vote.”

      “That was a price Republicans paid, too, through their implacable opposition to just about everything Democrats proposed, including many ideas Republicans traditionally supported.”

      Democrats didn’t want a party-line vote, they tried desperately to make the bill bipartisan. Pollack’s second quote tells us that he too is aware of this fact. If Democrats hadn’t accepted a partisan vote we wouldn’t have had health care reform at all.

      • @bill – I gave those lines some thought too, at first thinking just as you did. But I don’t think Pollack is saying Democrats wanted it that way, nor is he unaware (or denying) they struggled for bipartisanship. (I would argue the bill is bipartisan in that it does include many concepts once endorsed by conservatives).

        What he’s conveying is more a reflection of reality. It was a party-line vote and that is both a reflection of and continues to contribute to the polarization over health reform.

        Having said all that, Pollack could have phrased it differently, but my guess is he didn’t want to invite a fight. In a column, sometimes it is best to tone it down on one or two points so the main message comes through. It’s really a column about the CLASS act, with a secondary theme on the political challenges going forward.

    • I agree with your take on the article but still disagree with the premise as presented by Dr. Pollack.

      Looking at the closing paragraph we have this line:

      “Each side had plausible strategic and ideological reasons to pay that price.”

      This suggests (as does the rest of the article) that Democrats had credible alternatives to their major initiatives of the last two years. Given the political environment, I don’t see what other choice Democrats could have made. In 2009 the Republican leadership stated publicly that they would oppose any legislative agenda put forward by Democrats. The alternative to monotonously centrist bills like ACA, Dodd-Frank, and ARRA would have been not to govern at all. The “strategic and ideological reasons” behind Democrats actions are true for literally every political party in history and thus contribute little to explaining the current impasse.

      I can understand why Pollack would want to avoid a fight (especially in a venue like Kaiser Health News) but I think this aversion leads him to misinform the reader. If the issue he seeks to raise is primarily political then I think he has to be willing to actually discuss the politics.

      • @bill – Sure. And, for the record, I agree with your interpretation of history. You should take it up with Dr. Pollack. (It is possible it was an editorial decision by KHN that led to the wording.)

    • Bill–I am very sympathetic to your position. (I have been offline and thus unable to directly respond.) My wording was a bit too evenhanded there-which is funny since I am generally considered a very partisan figure at least among the people who know me.

      FTR, I was one of those emphatic supporters of health reform who wanted to see this thing passed,, by reconciliation if necessary. I am on record lambasting efforts such as the gang of six negotiations, which I saw as mere devices to delay and obstruct a bill Republicans had made a basic strategic decision not to support.

      My point there is not that the blame is equally shared, but that we are now in a position in which it’s very hard to make programmatic fixes and midcourse corrections. Republicans have poisoned the well with their implacable opposition and delaying tactics. And Democrats have no incentive to risk opening up politically vulnerable provisions that require long-term adjustment.

      There was no real alternative to passing health reform on a straight party vote. Yet that was indeed a genuine cost of doing so.

    • Why am I suddenly reminded of this scene from Annie Hall?

      http://www.youtube.com/watch?v=bBtXfBdEXEs

      I certainly appreciate the response and admit I may have been hung up on a point which wasn’t really central to the article. I do have something I’d like to ask Dr. Pollack but I will think it through and post it in comments over at samefacts if it still seems relevant in the morning.

    • Bill it’s all good. But I do hide behind a large floor poster here at Incidental Economist.