Bruce Bartlett laments that in his pitch for comprehensive healthcare reform, President Obama didn’t go all out and call for a single-payer system — not because he would have gotten it, but because the eventual watered-down legislation would have still been more effective of the legislation currently on the table.
The real problem, in my view, is not that the Democrats’ ambitions were too large, but rather that they were too small. In particular, I think they erred by not making the case for a single-payer system in the first place. Had they done so, the plan they eventually developed would have appeared to have been a modest alternative.I say this not because I favor a single-payer health system—although I don’t fear such a system particularly, either. Rather, it’s because I understand political dynamics—you often have to ask for twice what you want in politics in order to end up with half of what you need at the end of the day. The great mistake that administrations of both parties often make is to put forward plans that have no bargaining chips or fallback positions built into them. The various trade-offs inherent in any major policy initiative were made within the administration rather than between Congress and the administration. This meant that the administration’s initial proposal was really its bottom line position; it had nothing to negotiate with and once the inevitable compromises started, the logic and integrity of the proposal quickly collapsed.
On the policy merits, Bartlett’s probably right: the world’s other wealthy nations all have healthcare systems with robust government involvement or regulation, and they get better results than the U.S. does while spending far less. But there’s no reason to think that starting point would have gone over well in the current political climate. The legislation on the table right now is pretty mild stuff — ending rescissions, “pre-exisiting conditions” and lifetime caps on treatment; mandating folks get covered and helping folks who can’t afford insurance pay for it with subsidies; ending fee-for-service and so on — and it’s been caricatured pretty effectively as “a government takeover of healthcare.” Even if you were just setting the bar high to put everything below that in bounds, how well would an actual proposal that the government take over the healthcare system go? And if Democrats are acting like a bunch of punks on this stuff, who would be out there stumping for something that was even more politically radioactive from the jump?
There’s also the issue of opening with a starting position so outside the realm of the plausible that the person you’re dealing with would even take you seriously afterward. (“You want $1200 for this apartment? How about $3.78 and a bag of Fun-Yuns?”) You might recover, but you’re just as likely to get laughed out of the room.