You are using an outdated browser.
Please upgrade your browser
and improve your visit to our site.
Skip Navigation

Explaining My Health Care Polyannaism

For more than a month now, I've taken a stubbornly optimistic line on the fate of health care reform -- I've given it slightly better than even odds of passing all along. You've probably noticed that most political reporters have a very different take. They write about health care reform in the past tense, or at best as a very long shot. Perhaps you wonder why my take differs so strongly. I certainly do.

I don't think the answer is that they have access to better information. In most cases, they probably do. In this case, though, I'm fortunate to benefit from the reporting of Jonathan Cohn, who is extremely plugged-in. I'm not basing my views entirely on Jon's reporting, and he shouldn't be held responsible for my analysis. I've been basing my view all along on the fundamentals of the situation -- what incentive to the players have to act, and what structural barriers stand in the way of passage.

Part of my relative confidence stems from the fact that the media got the story wrong last fall. Starting in July and continuing through autumn, the health care narrative revolved around public anger and Democratic disarray. In reality, the important development was that all 60 Democratic Senators decided that Republicans were acting in bad faith and they had no choice but to pass a bill.

Much of the reporting we see now tends to cast the prospects for passing a bill in a negative light without doing much to substantiate that evaluation. Take the lead of this Associated Press article, entitled "Outlook no brighter for Obama's new health plan":

Starting over on health care, President Barack Obama knows his chances aren't looking much more promising. A year after he called for a far-reaching overhaul, Obama unveiled his most detailed plan yet on Monday. Realistically, he's just hoping to win a big enough slice to silence the talk of a failing presidency.

There are two statements here that claim to have access to Obama's thoughts: he knows it's not promising, and he's really just hoping for a compromise bill. This is necessarily a speculative claim -- nobody can know what Obama is actually thinking -- yet it's being presented as fact.

Or take this story in Politico:

And Obama’s plan did nothing to answer the central question facing Democrats: how to get a bill through the Senate — now one vote shy of a filibuster-proof majority — in one of the most toxic environments for incumbents in recent memory.

This is almost certainly not true. The central question is how to get the House to pass the Senate bill. Getting 50 of the 59 Democratic Senators to vote for relatively popular changes to a bill they already voted for is comparatively simple. The filibuster doesn't come into play at all. Other stories evincing a lack of understanding about key dynamics, like how the reconciliation process would work, further my suspicion that many reporters are falling for a lazy narrative based on momentum.

I continue to believe that the Democratic Party as powerful forces pushing it toward enacting a bill:

1. A failure to enact legislation would create an overwhelming narrative of failure for the Congress, making any attempt to sell positive achievements impossible.

2. Failure would make the already depressed Democratic base morbidly depressed. Can you imagine telling Democratic voters that the cause of a century failed because, even though it passed the Senate and House and had an eager president waiting to sign it, the two Houses couldn't iron out their relatively small disagreements?

3. A successful bill will spawn news coverage about the potential impact of the new bill, and as the latest Newsweek poll shows, increasing the public's information about the bill makes them more supportive. At the very least, a signing ceremony and a united Democratic Party offers a strong chance to turn the not-insignificant chunk of voters who oppose the bill for not going far enough into supporters. Conversely, a failure to pass a bill will spawn "anatomy of a disaster" coverage -- that's how the Clinton health care plan became "the failed Clinton health care plan" -- and further dampen support for a bill most Democrats are already stuck with having voted for.

4. The institutional dynamics continue to make passage attainable. Unlike the 1994 health care bill, and unlike Republicans seeking to privatize Social Security in 2005, the opposition party lacks the votes to obstruct a bill. Moreover, the key vote rests with the House, not the Senate. House members are less egotistical than Senators, and more prone to cooperate with the leadership and a same-party president on a bill deemed urgent.

5. Democrats understand that passing a bill would represent a monumental achievement. That fact is important to understand their behavior to date. Why did every Democratic Senator vote for a bill, while 40 House Democrats voted no last summer? Not because the Senate caucus is more liberal than its House counterpart. It's because every Democratic senator needed to vote yes in order for the bill to survive. Opposing the bill becomes very difficult when that vote can decisively block an historic reform.

To be sure, demoralization, panic, exhaustion and division are powerful forces, too. I think that as time goes by, clear thinking has a better chance to prevail, because professional politicians tend to be reasonably good at assessing their self-interest. Perhaps reporters covering the issue at ground level, witnessing the demoralization, panic, exhaustion and division, are placing too much weight on those dynamics they see firsthand and too little on the opposing incentives I described above.

Again, I'm not guaranteeing passage of a bill. I'm not even almost guaranteeing passage of a bill. I realize that there's a very strong chance of failure. The psychological threshold of 50% makes people tend to conflate any prediction over that level with a guarantee. (See Megan McArdle.) Clearly, no matter how many times I make it clear that "more likely than not" only means more likely than not, it's pretty clear that I'm in for a lot of taunting if the not comes to pass. But the question of whether health care passes is one of enormous historical import, comparable if not equal to the outcome of a presidential election. I think much of the prevailing analysis is poor, so I'll continue to give my take.