The Democrats best strategic decision on health care is to immediately pass a scaled-back package of health care reforms. If Democrats don’t move quickly, Republicans will. This will hand Republicans a big win, will result in policies that Democrats in the House like even less than the Senate bill and make the losses in November even greater.
Assuming no feedback, the Democrat’s options on health care reform are limited to ‘worse’, ‘worser’ and ‘worstest.’ The House could pass the Senate bill – unlikely and it would look like Democrats were cheating to get around the Brown victory (which accurate). They could cram as much as possible through reconciliation – extremely tricky, which is why it wasn’t done last fall and it would look like Democrats were cheating. Or Democrats could give up on reform which would fail to address a major economic and social problem, fail to deal with an issue important to voters, and prove that Democrats are incapable of governing.
But of course Democrats are not the only players in this game. If one takes into account possible Republican actions the best course of action becomes obvious.
If I were a Republican I would modify my advice from several weeks ago (here) and introduce a series of smaller health care reform bills that would be popular with the American people and that are already part of the Democratic package such as barring rescissions, lifting the anti-trust exemption for insurance companies, allowing people to buy health insurance across state lines, and so forth. I would do it a bill at a time which wouldn’t require full agreement on the massive package (different Republicans could defect on different bills as long as the overall vote on each were large) wouldn’t look like massive over reach, and would rack up a series of wins. It would also force Democrats to support reforms they have already voted for and that the American people like or vote against health care reform because they don’t want to be bi-partisan. The Republicans would go into November saying (correctly) they led the charge on health care reform, they forced bi-partisanship and changed the tone in Washington, and they are better equipped to run the country. As a policy matter the bills probably wouldn’t provide long-term solutions to health care and would almost certainly be worse (from the perspective of Democrats) than similar individual bills that Democrats would write
Given this obvious strategy, if I were a Democratic I would start introducing small packages of fixes immediately. These fixes would put Republicans in a tricky spot (supporting reform or being obstructionists), would demonstrate momentum and prove the Democrats can govern. Republicans, in response, would declare victory because it was only their hectoring and the Massachusetts Senate race that led to these changes – but they would be following Democrats, and Democrats would deliver reform. And, not insignificantly, the reforms would be better (from the perspective of Democrats) than the Republican versions. If Democrats do nothing they will likely lose to an obvious Republican strategy. If Democrats act immediately they can still claim victory and get the health care debate moving in a good direction for the first time in decades.
The choice is easy: play and win, don’t play and lose.
