It’s chastening to think back to the predictions being made last summer about health care reform, and the assumptions that were widely shared in Washington at the time (certainly by me). Reform would face challenges, and it would never go as far or be as comprehensive as liberals wanted it to be. But some new law would pass by Thanksgiving or sooner. The stars that had defied alignment since the early attempts to pass national health legislation under Teddy Roosevelt were now fully in place.
Something may yet pass. But the price of reform has escalated considerably since last June. Barack Obama has lost about fifteen points in approval ratings, hovering at or just below 50 percent. In all polls, independent voters are more disapproving of Obama and of the Democrats’ health legislation than not. Citizens quite reasonably asked themselves why Obama and the Democrats have been spending so much time on health care while unemployment soared to 10 percent. Republicans have acquired momentum from the public opposition and now stand to make significant gains in the mid-term elections. The Democrats lost their supposedly “bullet-proof” Senate supermajority and, according to polls, came to look to many average voters as if they couldn’t govern. And even if health reform does pass, its putative benefits—insuring 30 million more people, lowering premiums, controlling costs—won’t go into effect until 2014. And the risk is still substantial that the effort will end in defeat.
What happened? It’s still too early to be sure, but broadly speaking, we can divide the chaotic details of the past several months into two categories: the political and the institutional. Obama and his administration certainly made their share of political errors, many stemming from the President’s having learned the wrong lessons from history, specifically the 1994 defeat of the Clinton effort. Whereas Bill and Hillary Clinton presented a plan to Congress that gave the key legislators comparatively little opportunity to collaborate on health policy or to take credit for it, Obama did the opposite to a fault. He gave the House and Senate too much time and leeway to develop their own plans. The administration finally announced its own reform principles on February 22, long after both houses of Congress had passed different versions of a bill.
There were arguably even bigger miscalculations than that. In my view, attempting comprehensive health care reform during Obama’s first year with a very bad (and weakening) economy was asking a lot of the American people. The 2008 election was a rejection of conservatism, but it was not an embrace of liberalism. Any chance of a new liberal era, I wrote…
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