Health Care Reform a Policy Victory for Moderates

The health care reform debate of the past year has highlighted a growing gap between our politics and actual policy-making, and the misplaced emphasis on the former. Politically, health care reform sparked one of the most partisan and radical legislative debates we’ve seen in years. But paradoxically the resulting policy is about as centrist and moderate as you can get while actually achieving substantial reform.

It completely retains the market-based insurance system and expands coverage by simply beefing up an already-existing program (Medicaid) and helping families with tax credits. There is no new government-run insurance program or even an entirely new entitlement, and it even will reduce the deficit over the long haul. The most radical change in the legislation—the mandate to purchase health insurance—is a Republican idea from the 1990s. In fact, the current legislation is almost identical to the Health Equity and Access Reform Act of 1993, a Republican bill proposed as an alternative to Bill Clinton’s reform plan.

So why didn’t a single Republican vote for the legislation?

Because after a year of rhetoric and wrangling this vote had little to do with actual policy and everything to do with politics. Jim DeMint famously quipped last summer that a defeat for healthcare reform would become Obama’s Waterloo, and David Frum followed up today by declaring the passage a Waterloo for Republicans. Political victory became the only motivation.

That’s why we had rhetoric about socialism and tyranny when the vast majority of people will retain the private insurance that they already have. And it’s why Democrats are hailing this as a victory on par with the passage of Social Security and Medicare, even though in substance the legislation takes an entirely different (and more conservative) approach.

If you’re interested in moderate politics, health care reform was anything but. It took partisanship and political extremism to entirely new levels. But if you’re interested in moderate policy—combining ideas of both parties to enact gradual but meaningful change—somehow that’s exactly what emerged.