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Posted by on Mar 22, 2010 in Health, Politics | 19 comments

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.

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  • Leonidas

    The partisan approach and resorting to reconciliation and bribery was no victory for moderates, nor is a tax on you for simply being alive.

    A policy victory for moderates would have involved taking those parts of the bill with wide bipartisan support, and voting them through without the excess baggage and pork. This didn’t happen as the far left wanted the Easter bunny in the bill and threw in the unpopular progressive agenda items as well.

    BTW citing a legislation proposed by a Chaffe from Road Island that didn’t make it out of Committee when Republicans controlled both Houses of Congress is hardly a credible measure of a Republican piece of legislation. This is like citing Zell Miller’s speach at the Republican National Convention as a model for the Democratic position. Its just plain silly.

    • Elyas

      Republicans controlled both houses of Congress in 1993? I must have missed that one.

  • DdW

    Agree with everything, except the title.

    It should be”Health Care Reform a Policy Victory for Americans”

    Thank you

  • Leonidas

    “Health Care Reform a Policy Victory for Nanny Staters who wouldn’t open their own insurance businesses with their own money”.

  • DLS

    This was only a “victory” for partisan Democrats and results-starved liberals, who enjoy the relief of their getting past the problems they had created for themselves earlier this year, and being able to pass legislation again. This legislation is shrunken greatly and progressively from what the Democrats originally sought. Liberals and Democrats didn’t like this legislation at all until yesterday, when it was determined that they might pass it, after all. All the hyperbole of the past two days is dishonest and ridiculous.

    That this legislation resembles, in the end (after progressive dimunition) what liberals or what Republicans might have sought is merely coincidental, not characteristic of the legislation and much less of the effort.

  • CStanley

    Sorry, but no. The hope of a moderate victory in the healthcare reform debate died with Wyden Bennett.

  • rudi

    Eisenhower and Nixon push for health care reform. In todays environment neither are moderates..,5051195
    LOL Even Eisenhower was a socialist in 1954…

    • BBQ

      Goldwater called Ike’s policies “dime-store New Deal”, so it’s not like he was liked by conservatives even in the 50s. Goldwater’s side won, Eisenhower’s has been dead or on life-support for twenty years.

  • DLS

    Go, states (Republican attorneys general), go. Let the fun begin.

  • Leonidas


    How We Can Achieve Bipartisan Health Reform

    As 12 U.S. senators from both sides of the aisle who have widely varying philosophies, we offer a concrete demonstration that it is possible to find common ground and pass real health reform this year. The process has been rocky, and slower than many had hoped. But the reports of the death of bipartisan health reform have been greatly exaggerated. Now is the time to resuscitate it, before the best opportunity in years is wasted.

    It got wasted. Hyperpartisanship won instead.

  • DLS

    “Hyperpartisanship won instead.”

    Obviously — the Dems are relieved that they’ve resumed passing legislation in the face of a (now almost non-existent) GOP opposition.

    I worry that hyperpartisanship (and hyper-ideology) will resume last year’s course this year, now.

  • casualobserver

    Yes, I think the title of the post is appropriate……..the price of the recent bribery needed to pass the bill is getting to be reasonably moderate…..

    U.S. Congressman Bart Stupak (D-Menominee) announced yesterday three airports in northern Michigan have received grants totaling $726,409 for airport maintenance and improvements. The funding was provided by the U.S. Department of Transportation Federal Aviation Administration.

    All that and a frameable autograph of Barack Obama to boot!

  • JSpencer

    The only truly “moderate” result in the eyes of GOP leaders would have involved the dems caving to all the negativity and misinformation that comprised most of it’s opposition.

    It’s painfully obvious that a great many so-called “conservatives” no longer have any grasp of what is and isn’t “moderate”. One need go no further than TMV to see evidence of this.

  • davidpsummers

    The reason the bill is moderate is almost entirely due to Democratic moderates in the senate. The leadership didn’t really want to compromise with them, and I think if they had been able to bypass them, the leadership would have pushed through a much more liberal bill.

    And, in the end, I think we would have had a much better bill if we had simply built around a consensus centrist bill, rather than the hodge-podge we got from taking a liberal bill and dropping/adding until the Democratic moderates could support it. However, the leadership of both parties made sure to force their moderates into line (after some near misses, like Bacus wining over Snowe).

    I’m a little disappointed that moderates in both parties didn’t go ahead draft an alternate bill. The would have faced opposition from the partisans, but the bipartisan nature would have made it hard to oppose.

  • superdestroyer

    HCR was no victory for moderates but a resounding victory for the left. Laying the ground work for total government control in the future while using tax dollars to pay off core liberal groups and sticking the middle class with the bill is genius. In a few years, the U.S. will have single payer and the only people who will be willing to work in health care will be fresh off the boat immigrants. Image the quality of health care when most of the workers are not literate in English.

  • TheIndependentCuss

    The vote was certainly a victory for Democrats, but I will stop short of agreeing that it is a victory for moderates.

    Two things bother me about this bill:

    1) It mandates the purchase of insurance by individual citizens with penalties for those who fail to comply. If we can force citizens to buy health insurance, what else can we force them to purchase? And will they then also be forced to observe specific health regimens “to help keep costs down”?

    2) When a government mandates the transfer of wealth from its citizens to the private sector, the practice is called “fascism” or “corporatism”. Fascism is bad news; just ask those seasoned citizens who recall the mid-twentieth century. Will there be a limit placed upon how much can be charged by these private entities? High cost (along with lack of availability) was a major motivator in this scheme; will it be controlled? Or will the sophist excuse of “We can’t tamper with the free market!” again be disingenuously employed — as they force us to buy what the “free market” is peddling?

    Don’t get me wrong — we desperately needed health care and health insurance reform. I’m just not certain that this was the sort that we needed. I would have preferred some sort of cost controls indexed to the inflation rate and an end to the practice of denying insurance to anyone. If it required a small subsidy to achieve these goals, then so be it. “Let the market decide!” just wasn’t working — unless one considers millions of consumers taking it in the shorts to be “working”.

    Someone recently argued with me that “Taking over forty percent (???) of the nation’s economy just isn’t right!” I argued back that, if the health care industry truly does represent a whopping forty percent of America’s economy, perhaps that is part of the problem.

    Incidentally, I am new to this blog — and relatively new to the recognition of myself as a political moderate.

    Jeff Dreibus

    • ProfElwood

      Welcome to TMV, Jeff.

      Maybe the “40%” person was just thinking ahead. Since there seems to be very few politicians trying to limit expenses on health care, it may get there sooner than you think!

      • Dr J

        it may get there sooner than you think

        Yes, it’s pretty clear how it plays out from here. Costs continue to rise, insurance companies continue to take the blame. Politicians shriek “the free market has betrayed us again!” and pass more waves of regulations making it illegal for costs to go up further. The completely unexpected result is that quality and availability deteriorate, and the public gradually learns to lower its expectations like we have for the DMV and our schools.

        Healthcare is too big to fix at a stroke, and we don’t know how. But we had a chance to start undoing the perverse incentives at the heart of our dysfunctional system. Instead we’ve doubled down on them.

        No, this was not a victory for moderates.

    • TheIndependentCuss

      Thanks, Prof. And you just may be right about the predictive nature of that “figger”.

      Jeff Dreibus

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