Health Care Reform Still Matters

M. Scott over at Frum Forum reminds Republicans in the wake of the Scott Brown win that health care reform still matters to many Americans including many Republicans:

I work full-time. I volunteer. I was mildly overweight for several years, and cleaned up my act after I got a bad lipid panel result, so I have exercised for 10 hours a week for the past six years to keep my BMI at 20. I have seen a doctor just three times in the last 18 months. I cost the healthcare system very little. Right now, my health premiums are pretty affordable (Kaiser offered through the university where I work) but if I lose my job, I could be in dire straits. If I wind up working for a small employer, as I have in the past, my premiums could be exorbitant. And God help me if I develop a preexisting condition. In short, as a working American, I’ve got no guarantee of affordable health insurance in the long run...

Right now, convincing the system that you’ve got a disability and dropping out of the workforce is a surer path to long-term health insurance than getting up and going to work every day. Maybe that weird numbness in my hip or my past-their-prime knees or that stubborn case of tennis elbow or the gnawing anxiety about what the future holds qualifies me for disability, too. Maybe I’m a fool to keep working. Maybe I deserve to sleep in every day, recline in front of the TV when I do drag it out of bed, complain about “all those illegal aliens taking advantage of this country,” and let some other sucker rise before dawn each morning and help keep the country afloat. You and I both know that, in today’s political climate, nobody in either party is going to touch Medicare.

And in the crowing over Massachusetts, I don’t hear a single Republican addressing this. Maybe I have missed it. But isn’t the GOP the party of responsibility and rewarding honest, hard work? Republicans frequently talk about responsibility, but talk is cheap. At the end of the day, you get the behavior you reward.

It's a worthwhile reminder to the GOP that even though this particular health care reform deal might be dead, that doesn't mean that health care reform should not take place. Like M. Scott, I fear that Brown's victory might be misinterpeted as a way to just support the status quo.

That said, I've also been wondering if there is a reason that Republicans have not always been so passionate on health care reform as Democrats. I have a theory that one of the reasons Republicans have been active in trying to defeat health care is not simply because they are mean-spirited people as some on the left might think, but because they know there is nothing in it for them- no incentive to work for change. This is what Mark Thompson over at the League of Ordinary Gentlemen has to say about how the GOP views health care in response to fellow Leaguer Jamelle:

Certainly, health care reform is a very low priority for the GOP and to the extent it’s a priority at all, it’s only because it’s so front and center an issue for Dems and liberals.

It's not that it's the issue for Dems, but that the general public has tended to view health care as a Democratic issue. Republicans have put forth proposals and while I think they were weak tea, they were positions and yet they got very little press. Even the truly bipartisan Wyden-Bennett bill gave more focus to the Democrat Wyden over the Republican Bennett.

Contra Jamelle, I do think there are a good number of Republicans that do care about health care reform, but at this point, there is no incentive for them to put forth meaningful proposals. Democrats will shoot them down, the base will accuse them of being "Democrat-lite" and the press will ignore them.

I think what has to change is to give the GOP an incentive/threat. There has to be something in it for the GOP to want to support health care. Reihan Salam has an idea that just might do that: focus on Republican leaning voters instead of Republican politicians:

At the start of health reform, the White House seemed strangely focused on winning over center-right policy wonks by selling health reform as entitlement reform. The idea, I suppose, was to craft a proposal that moderate Republicans could embrace. This was exactly backwards. Conservative-leaning independents had abandoned President Bush for a variety of reasons, from the war in Iraq to — and this is important — Social Security reform. Of course, some conservative voters loved the idea of voluntary personal accounts. Older white voters who've seen their private pensions perform poorly, or go from defined benefit to defined contribution, felt otherwise. Many were Republicans, and that was an early source of discontent on the right in 2005 and 2006.

Rather than focus on Republican legislators, Obama should have focused on Republican voters, particularly older voters. The president performed relatively poorly with older white voters in 2008, and blunting the Republican advantage here was vitally important. Talking at length about trimming Medicare was not the way to do it. Instead, he should have advanced a Medicare buy-in from the beginning, plus an expansion of Medicaid. This was easy to understand and it would put Republican legislators in the same difficult position they found themselves in during the S-CHIP debate. Personally, I think Medicaid expansion should only happen if we federalize the program. But we're not talking about what should happen in the abstract.

Of course, there will always be some Republicans who want to no reform ever. But I think there are a good number that do want change. But to do that, Democrats need to appeal to Republican leaning voters in ways that bring them in and force the hands of GOP legislators. In essence, you don't go after Olympia Snowe, but the people who vote for her.

Health care reform matters. To pass major legislation means finding ways to get the opposition on board and make it within their self-interest to do so. Democrats should heed this lesson.