It’s a complex, nuanced piece, and well worth reading in its entirety, but a point Ackerman makes in his conclusion screams out for comment.
This is not an argument about whether Obama “pushed hard enough” on this or that, or whether Harry Reid sold out such-and-such. The obsession with this kind of short-term thinking is the whole reason why we’re in this mess. It’s quite possible Obama couldn’t have gotten elected if he’d proposed anything more ambitious than the “Demo-plan.” And once in office he may not have been able to get his Demo-plan passed without dropping the more liberal features.
But all of that is beside the point. Whether or not a better health reform plan could have passed at this precise moment is a secondary issue. The larger question is what this bill tells us about this precise moment. Obama came into office with every whim of history leaning in his direction: a discredited Republican predecessor, a crisis of deregulated finance that reached a crescendo literally weeks before the election (what luck!); the largest Democratic majorities in decades (in a sense, even larger than the 1965 majorities; not counting southerners, the Democrats had 47 Senate seats in 2009, versus 40 in 1965). Such a clear shot will not return for decades.
And the result: The Democrats shot their historical wad on health care by re-introducing Bob Dole’s bill from 1994 and justifying it as a free-market solution. How is that a “huge progressive victory”?
Wait? Uh, what? Bob Dole’s bill from 1994? Ackerman just sort of snuck that in there. But take a look at this “executive memorandum” from the Heritage Foundation, “Dole’s Health Care Compromise: A Prudent Foundation for Reform”:
[Dole’s] bill requires insurers to renew policies and prohibits pre-existing condition limitations in new policies, while protecting insurers by allowing reasonable waiting periods. It also limits premium variations to differences based on age, family size, geogra- phy, and other risk factors, but not health condition. Further, the bill blocks states from mandating insurers to include costly benefits that buyers do not want. It introduces malpractice reforms to reduce legal costs, and reforms the antitrust rules to make it easier for groups of physicians or other providers to do business.
The bill also encourages the creation of purchasing groups, including non-employer associations, to bargain for good insurance rates. But wisely, it does not mandate health alliances, or force- employers to pick plans for their employees. Thus, Americans could join health insurance purchasing associations based on, say, a church, a union or a farm bureau, not just an employer-sponsored pool.
Mmm. Yes. That does look vaguely familiar. Wow. Obama sweeps into power with “every whim of history leaning in his direction,” and an unprecedented opportunity to push for real reform, and we get… Bob Dole.
And if you, like me, are sick and tired of hearing “it’s a start” and “it’s better than doing nothing,” there’s this:
But it gets worse. The decentralized private payment system will inevitably start crowding out the public insurance we already have, especially Medicare. With continued double-digit medical inflation, the slow-motion dismantling of Medicare isn’t a possibility, it seems like an eventual certainty. (Just look at the current deficit hysteria, which is now being propitiated by the White House and its independent commission.) We are on a moving train going in the wrong direction; instead of turning the train around, this bill tries to solve the problem by having us all run towards the caboose.
Barring some sort of divine intervention, whatever version of health care reform that passes will be an unmitigated disaster for America. I didn’t vote for Obama (or, I should not have to add, McCain), and wasn’t expecting much, but this tops my most pessimistic imaginings.