Way back on December 2, 1993, an ambitious right-wing think tank denizen and former aide to Dan Quayle by the name of William Kristol circulated a terse, four-page memo to Republican leaders warning of the political dangers of allowing a Democratic president to reform the U.S. health-care system. The memo’s language is almost comically deferential, reflecting what was then its author’s near-complete non-notoriety. “Nothing in these pages is intended to supplant the many thoughtful analyses of the Clinton health-care plan already produced by Republicans and others….” The thrust of the memo’s argument was clear and unapologetic: Republicans must resist health-care reform lest its success be allowed to “revive the reputation of the party that spends and regulates, the Democrats, as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining the growth of government.”
Democrats have redefined the playing field of American politics to ground that is inherently favorable to their team.
• Big Fat Story: Who's the Health-Care Bill Going to Help? • Lee Siegel: Pass the Christmas Pork, Please We will never know if Kristol was right about 1993: His role as a political swami rather famously leaves much to be desired, (as hundreds of thousands of Iraqis might attest, were they still alive). But we do know his memo succeeded in bludgeoning the mind of what was then, relatively speaking, the Republicans’ moderate leaders—turning them from Clinton conciliators into Republican road warriors. Of course the Clintonites screwed up considerably themselves, failing to embrace any number of perfectly palatable compromises the Republicans (and their own recalcitrant members) had on the table, demanding more than the system could deliver, and ending up, in the words of Elvis Costello, with “less than zero.”
Exactly why Barack Obama has been able to succeed where so many other presidents, going back to Harry Truman, have failed before him is not easy to pinpoint—at least not yet. The United States has long lagged behind other nations in the quality of the health care it delivered to the majority of its citizens.
• Dana Goldstein: The Left's Tea PartyTruman’s plan never really had a chance, particularly with the Korean War dominating his presidency. Lyndon Johnson focused his attention largely on the elderly and the indigent, and ended up creating Medicare and Medicaid; not bad at the time, one must admit, but they both left the vast majority of middle-class Americans at the mercy of a mercenary industry dedicated to denying coverage whenever it proved unprofitable. Ted Kennedy writes in his eloquent and moving memoir, True Compass, of his bafflement at Jimmy Carter, who, after running on a comprehensive reform plan almost identical to the one Kennedy spent his career fighting for, was almost immediately replaced “by the President Carter who wanted to approach health insurance in incremental steps, over time, if certain cost-containment benchmarks were met—and after the 1978 midterm elections (p.359).
Barack Obama, it must be added, not only passed comprehensive health-care reform, but he passed it in a Senate whose barriers against the filibuster of legislation have been considerably reduced to next to nothing. (Filibustering, rather than voting against legislation, is the ideal way for a politician to kill something without being forced to take responsibility for an actual vote. After all, who can mount a campaign against you on behalf of an issue called “cloture?”)
The obvious answer to the question of how Obama managed it is that he gave away the Democratic store. The bill he passed has no public option, no expansion of Medicare to those under 65, and additional restrictions of abortion funding. It is littered with provisions showering holiday goodies on the insurance industry, the pharmaceutical industry, the citizens of Nebraska.
To win, Obama and his advisers appeared to offer up one concession after another, coupled with gratuitous insults to the Democrats’ liberal base—as if they needed some outrage on the left to make the whole thing feel kosher. Over all, the 60 votes secured by Harry Reid demonstrated, as no political-science lesson can, that the passage of major legislation in this country makes sausage-making look awfully pretty.
The question, to return to Kristol’s terms of analysis, is what it will mean politically. Sen. John Barrasso (R-WY) told ABC News, "I think it's going to be a historic mistake for the country if this is what happens to health care," said Barrasso. "Now, as you know, the changes don't actually go into place until four years from now, so people aren't going to be able to see immediately what the problems are. But they are going to notice the cuts in Medicare and, specifically, the increased taxes which go into effect the day that this bill is signed into law."
He has a point. And the Democrats’ concession on this point is one, from the standpoint of a political observer, I find most puzzling. Why in the world would they agree to a bill that leaves them vulnerable to the whims of the insurance companies—and Republican rhetoric between now and 2014, when they have to win congressional and presidential elections in 2010 and 2012? How can you sell the benefits if all that people have experienced are the costs?
You can argue, as American Prospect editor Mark Schmitt does, that it comes down to good government, an aspiration even the most cynical Democrats on occasion find unavoidable. “[T]he bill as it has passed provides the basic components needed to construct a workable system of near-universal health coverage, and all that is outstanding—implementation and legislative improvement—can be accomplished without anyone needing to beg at the feet of a gleefully sneering Joe Lieberman or Ben Nelson.”
But why then, are (most) Democrats so happy and (all) Republicans so glum this Christmas? My guess is that Democrats are gambling on exactly the same ground that so worried William Kristol 16 years ago. They’ve redefined the playing field of American politics to ground that is inherently favorable to their team. When Americans complain about their health care in the future, are they going to look to the party that wants to do nothing to fix it? No, they’re going to go with the side of political activism and government involvement. The other side, after all, isn’t even in the game. Republicans had their chance and all they could say was “Bah Humbug.”
Eric Alterman is a professor of English and journalism at Brooklyn College and a professor of journalism at CUNY Graduate School of Journalism. He is the author, most recently, of Why We're Liberals: A Handbook for Restoring America's Important Ideals.