Sunday, July 26, 2009

Forget Bipartisanship
As we get toward nut-cutting time on health care reform, some analysts are concerned that any measure that seems likely to emerge from the protracted negotiations in Congress might not bear the imprimatur of support from both parties that was a hallmark of earlier landscape-changing legislation from Social Security in the '30s to Medicare in the '60s to tax reform in the '80s. Depending on the course of negotiations, any bill with a decent chance of passing will have the support of between maybe zero and a half-dozen Republicans; the Democrats, for better or worse, will "own" any new health care system. Traditionally, this has been a deterrent to any big change in policy: neither party wants to present such a clear target for any voters who are unhappy with transformative legislation. That Republicans wouldn't get on board for the Clintons' proposed health care overhaul 15 years ago, or Democrats with President Bush's effort to privatize Social Security in 2005, helps explain why neither package was passed, or even voted on.

I'm starting to think, though, that this is much more a problem for the likes of David Broder, who value bipartisanship for its own sake, than for anyone else--certainly the public. The reason why is because achieving bipartisanship today is demonstrably harder than was the case seventy, forty, or even twenty years ago. There's no "middle" to speak of anymore.

(At least, not in the corridors of power. Public opinion itself is pretty much unchanged--which is why it's not as much of a stretch as it might seem to an engaged voter that in just 25 years, it's a virtual certainty that hundreds of thousands, possibly millions of voters cast presidential ballots for Ronald Reagan, Bill Clinton, George W. Bush and Barack Obama.)

This graphic somewhat explains how things have changed over time (and it's mostly gotten worse since 2001, as remaining moderates like Senators Max Cleland and Lincoln Chafee and Representatives like Chris Shays and Sherry Boehlert have retired or lost):

By the '80s, when the Tax Reform Act was passed, the middle was beginning to clear--but there were still enough moderates on both sides of the aisle to strike a deal. Perhaps even more important, you had a motivated Republican president, Reagan, and an equally motivated Democratic Speaker of the House, Tip O'Neill. They both needed a win, and they both could exert considerable pressure on their underlings to get a deal done. That more than made the difference from the '30s and '60s, when Democrats enjoyed unified control of the federal government (as they do today, of course), and there remained enough moderate Republicans to address clear national needs for retirement security and health coverage for particularly vulnerable populations.

Today, the few remaining Republicans even marginally willing to deal--almost all in the Senate, and almost all toward the end of their careers--admit variously that they're under great pressure from their colleagues to do no such thing and that much of the opposition to proposals is entirely motivated by politics. This is the ultimate manifestation of the Rovian political style: solving the actual problems of the country is barely even a consideration when there's a political fight to be won. In fairness, it probably runs contrary to everything we know about human nature to expect anything different: just as kids who are raised without responsible parents in an atmosphere of antisocial lawlessness are more likely to engage in crime and fail in their human relationships, Republicans who build their careers entirely on demonizing opponents and appealing to the worst instincts in voters are more likely to persist in those approaches as they make their way up the political food chain.

But that's all there is anymore. Short of taking a Republican plan--assuming one could discover such a thing--word for word in legislation, it's all but impossible to imagine a health care reform proposal that would enjoy support from the minority. The overwhelming majority of the Republican caucus seems unserious about solving the problem, and until that changes, they don't deserve even a seat at the table. Let the Democrats pass the best plan on the merits--which, to be honest, might be a bigger problem still--and let them face the consequences. At some point, politics must take a back seat.


The Navigator said...

This is absolutely right, but there's the additional factor of the parties' ideological alignment. It's not merely that the moderates have all left - it's also that the parties are more closely sorted along ideological lines than any time in decades. Fiorello La Guardia and John Lindsay weren't merely somewhat-less-conservative Republicans; they were out-and-out liberals who were in the Republican party for reasons of inertia, tradition, family ties, etc. Similarly, James Eastland and John Stennis and Strom Thurmond weren't just less open to civil rights bills than the median Dem - they were out-and-out segregationists. In the 21st century, though, the conservatives are in the GOP, and the liberals are Democrats. I tend to prefer this because I like the ideological cohesion that you theoretically get when you vote for a party and you know what that party stands for. But there aren't really any Everett Dirksens to deal with anymore.

David said...

Yeah, this was my original point and it might have gotten lost somewhere in the wave of digressions... a winning majority on health care reform probably wouldn't be much different ideologically than the
bipartisan groupings that passed legislation in the days of FDR or LBJ, it's just that this time they'll all be Democrats.

Chris said...

Who need Republicans when you have these Democrats?

Anonymous said...

I recently had the opportunity to attend an international conference of the System Dynamics Society. It would be hard to describe in a sound bite what these people do, but in essence it's a group of people, mostly in academia but increasingly from industry as well, who build fascinatingly complex models of the behavior of large, interrelated systems. Many of them are passionately committed to making the world a better place and are tackling serious issues - national smoking behavior, climate control, health care, energy infrastructure, etc.

One of the striking things about many such systems is a worse-before-better dynamic that many metrics possess when you're investing in making improvements and waiting for those improvements to have an effect. There was a really interesting workshop on a Healthbound simulation of national healthcare that the authors have been working on for years - since well before the current administration.

The model suggests that meaningful improvements health care will require investments that will take 10+ years to pay off - considerably longer than most politicians' electoral cycle time horizon. Other interesting outcomes to the model suggest the following: the single biggest leverage point for increasing national health outcomes is creating more pathways to affluence; extending coverage to more people will only create additional disparities in outcome unless the supply of health care providers is seriously increased; reducing reimbursements to cut costs would dry up the supply of providers and lead to significantly worse outcomes.

The workshop's hosts made the point that individuals have small amounts of resources but large capacities for delaying self-gratification (ie saving for retirement or kids' education) and national governments and transnational entities are the opposite. They believe that communities (like neighborhoods, cities and metro regions)have a medium level of both and represent some of the greatest potential for concerted, effective action to address these kinds of issues.