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Health Reform And The Specter Of 1994

Ed Kilgore is managing editor of The Democratic Strategist, a senior fellow at the Progressive Policy Institute, and a frequent contributor to a variety of political journals. 

It's becoming increasingly obvious that not only wholesale Republican opposition, but Democratic divisions, are risking the enactment of health reform legislation this year. Some of those divisions are rooted in relatively narrow objections this or that bill--e.g., jurisdictional squabbles between committees or between House and Senate approaches--or this or that provision--e.g., union opposition to taxation of high-end employer-sponsored health benefits. But the bigger division which falls roughly along ideological lines involves "moderate" Democrats (sometimes, as in last week's Senate "gang of six," working with like-minded Republicans) who seem to prefer delaying action on health reform to enactment of anything that vastly increases federal budget deficits, fails to reduce health care inflation, or exposes Democrats to conservative attacks on "big government."

It's fair to say that the prevalent attitude among other Democrats towards these "moderates" is one of anger and betrayal, on the theory that only political cowardice or total submission to the health care industry could possibly explain their point of view. And one talking point heard often in denunciations of Democratic foot-draggers on health care is that as "everyone knows," the failure to enact health reform in Bill Clinton's first two years caused the Democratic midterm debacle of 1994. Steve Benen, for example, stipulates this assumption about 1994 and quickly goes on to suggest that maybe "centrist" Democrats don't really give a damn if their party loses seats or even control of Congress in 2010. This attribution of evil motives is also more-or-less incorporated by reference in an otherwise fine post today by TNR's Jon Cohn on the Democratic politics of health reform.

As someone with still-vivid memories of 1994 and of the raging and inconclusive debate that ensued about the origins of that electoral debacle, I have to say that no, it's not at all self-evident that the failure of a Democratic-controlled Congress to enact universal health coverage was the primary cause. For one thing, there was a lot going on in November of 1994--a vast number of Democratic retirements, the final stage of the ideological realignment of the South (exacerbated by racial gerrymandering in the House), and residual resentment of a Democratic majority in the House that had been in place since 1954. But even if you believe health care was the single largest factor in the 1994 results, it's not entirely clear that the failure to enact health reform, as opposed to the unpopularity of the reforms being proposed (not to mention the timing of the health care debate, which in 1994 was on the very brink of the midterm elections), was the predominant factor.

And even if health care was the predominent factor, it's not at all clear that the defeat of the Clinton health plan, as opposed to the composition and presentation (at least as perceived by the public) of the Clinton health plan, was the vote-killer. Yes, there has always been a point of view in the debate over 1994 that "disappointment" over the Clinton administration's strikeout on health care, compounded by other White House strategic decisions (most notably the promotion of NAFTA and GATT and the prioritization of deficit reduction at the expense of "investments" in the budget), "discouraged" the Democratic "base" and led to conservative-skewed turnout patterns in 1994, and depressed Democratic performance among those who did turn out. But it's just a point of view, not incontrovertible fact. A Kaiser Family Foundation election-night survey in 1994 that focused on health care reached a different conclusion:

The survey shows that the voters' vision of health care reform has shifted toward that held by many moderate Republicans and Democrats. Thirty-one percent of those surveyed said they were less supportive of major health reform than six months ago, with half of those citing as their reason that they did not think the government would do it right. More voters now want Congress to make modest changes in the health care system (41%), rather than enacting a major reform bill (25%). In addition, one in four voters favor leaving the system as it is. [Tables 4 and 5]

"These results say that voters want the new Congress to place health care high on their legislative agenda," said Dr. Robert Blendon, Professor and Chairman of the Department of Health Policy and Management at Harvard University. "But what the public means by health reform now comes closest to a more moderate vision: one which is more limited in scope, incremental, and that involves a much more limited role for government."

My point here is not to argue that this or that theory about 1994 is the gospel truth (though I personally think there are elements of truth in the "discouragement" and the "rejection of big government" theories, along with non-issue explanations). It's that I wouldn't buy the idea that go-slow Democrats today know their position on health care will produce an electoral disaster, and just don't care. For every good, loyal Democrat who has internalized the "discouragement" narrative about 1994, there's another good, loyal Democrat who "remembers" 1994 as a tale of an "over-reaching" White House and an arrogant congressional Democratic leadership who relied on a secretive process to produce a highly complex health plan that was then marketed as a giant new government entitlement, repelling swing voters.

In the end, motives for the current behavior of Democrats on health care only matter so far. As it happens, I favor the argument that Senate Democrats ought to be pushed (with real consequences) to support a cloture vote on health care--and on climate change--no matter how they feel about the underlying legislation, which would make it a lot easier to get something done.

But the intraparty debate will become an unfortunate dialogue-of-the-deaf if the contending factions base their political assumptions about the consequences of various courses of action on health reform are based on different interpretations of an election held fifteen years ago.

--Ed Kilgore

[Cross-posted from The Democratic Strategist]