MA's health politics: rethinking Tweedledee.
Jonathan Cohn writes about the upshot politics of the new individual-mandate based Massachusetts universal healthcare law:
[Progressives should be] thankful, because nationally the most important impact of this new law may be on politics, not policy. Once Romney starts boasting about how he achieved universal health coverage in Massachusetts, it will become that much harder for conservatives to demonize the very concept as "big government." Oh, they'll try--and they'll have at least some success. But now Democrats will have this retort: If a Republican governor and leading presidential contender with strong conservative credentials thinks universal health care is a good idea, how radical an idea can it be?
And Ezra, after giving a brief useful summary of the bill's provisions (a longer summary of the bill and its likely political fallout can be found here), points out the related major reason why the program just might work (emphasis mine):
What emerged, while not glorious, is a distinct improvement on the status quo. Single adults making less than $9,500 will receive free care with no deductible, those netting up to 300 percent of the poverty line ($48,000 for a family of three) will be subsidized on a sliding scale, and individuals with the resources but not the willingness to purchase health care will be fined about a $1,000 annually, presumably through taxes. The bill has no dedicated funding source, so there's a certain amount of apprehension over its implementation, but look for it to get the money it needs -- not only does the cash exist, but Romney desperately wants to tout this achievement in 2008.
Interesting too that Massachusetts' last attempt at a universal health care bill (based mainly on an employer mandate combined with pay-for-performance) faltered for years due to lack of funding... right after the 1988 election and during the embattled end of Dukakis' recession-plagued governorship, until Republican Weld took over in 1991 and killed the program off. Political incentives and the political strength of the parties involved almost certainly do make a big difference. And it does look like the stars are aligned for this bill.
So are we possibly entering a bizarro world where the 2008 Republican primary is fought over health care rather than the Confederate flag? Are we re-entering a golden age of moderate national Republicanism? (I mean actual, boring, public-minded moderate, not McCain media-friendly hard-right-"maverick"-style moderate). Probably not, but another interesting aspect of the Romney bill is how similar it looks to Michael Calabrese and Laurie Rubiner's proposed individual-mandate plan -- albeit with the caveat that the New America team proposes full federal implementation and talks a little tougher about directly imposing the mandate on states and citizens as well as regulating insurance companies. Rubiner is, of course, currently health guru to Hillary Clinton.
I cede that it's unlikely that Romney will win the 2008 GOP nomination (despite Katherine Jean Lopez' ongoing efforts) and that there are more important short-term things at stake... like a test-drive of universal health care. But, hypothetically, what would Clinton vs. Romney 2008 contest look like? My guess: Clinton-Rubiner proposing to expand the "Massachusetts miracle" to the whole country while the actual governor of the state that produced the "miracle" -- by working across the aisle with the Democratic Legislature (changing the tone etc. etc.) -- sagely warns that health care is best left to the states in grand anti-federalist Republican tradition. And standing himself as direct evidence of the assertion.
I'm not liking those political optics at all. If Romney is seriously going to change the debate for Republicans (and the change among rubber-band ideological conservatives could potentially be seismic; at The Corner, even Jonah Goldberg is suddenly sounding reasonable), shouldn't it be matched with a similar seismic shift on the Democratic side? Then 2008 could potentially actually be about a clear health care choice rather than a quibble between Massachusetts Republicanism and New America Democraticness (or, for that matter, McCainiac "maverick" Republicanism and New America Democraticness, which we also lose). Progressives are sounding almost giddy about the prospect of going down to the Romney vision rather than to something worse. So why not take the plunge and go down (or maybe even prevail) with guns blazing single payer? (caveat: Canadian vested interest etc., but still...)
[Progressives should be] thankful, because nationally the most important impact of this new law may be on politics, not policy. Once Romney starts boasting about how he achieved universal health coverage in Massachusetts, it will become that much harder for conservatives to demonize the very concept as "big government." Oh, they'll try--and they'll have at least some success. But now Democrats will have this retort: If a Republican governor and leading presidential contender with strong conservative credentials thinks universal health care is a good idea, how radical an idea can it be?
And Ezra, after giving a brief useful summary of the bill's provisions (a longer summary of the bill and its likely political fallout can be found here), points out the related major reason why the program just might work (emphasis mine):
What emerged, while not glorious, is a distinct improvement on the status quo. Single adults making less than $9,500 will receive free care with no deductible, those netting up to 300 percent of the poverty line ($48,000 for a family of three) will be subsidized on a sliding scale, and individuals with the resources but not the willingness to purchase health care will be fined about a $1,000 annually, presumably through taxes. The bill has no dedicated funding source, so there's a certain amount of apprehension over its implementation, but look for it to get the money it needs -- not only does the cash exist, but Romney desperately wants to tout this achievement in 2008.
Interesting too that Massachusetts' last attempt at a universal health care bill (based mainly on an employer mandate combined with pay-for-performance) faltered for years due to lack of funding... right after the 1988 election and during the embattled end of Dukakis' recession-plagued governorship, until Republican Weld took over in 1991 and killed the program off. Political incentives and the political strength of the parties involved almost certainly do make a big difference. And it does look like the stars are aligned for this bill.
So are we possibly entering a bizarro world where the 2008 Republican primary is fought over health care rather than the Confederate flag? Are we re-entering a golden age of moderate national Republicanism? (I mean actual, boring, public-minded moderate, not McCain media-friendly hard-right-"maverick"-style moderate). Probably not, but another interesting aspect of the Romney bill is how similar it looks to Michael Calabrese and Laurie Rubiner's proposed individual-mandate plan -- albeit with the caveat that the New America team proposes full federal implementation and talks a little tougher about directly imposing the mandate on states and citizens as well as regulating insurance companies. Rubiner is, of course, currently health guru to Hillary Clinton.
I cede that it's unlikely that Romney will win the 2008 GOP nomination (despite Katherine Jean Lopez' ongoing efforts) and that there are more important short-term things at stake... like a test-drive of universal health care. But, hypothetically, what would Clinton vs. Romney 2008 contest look like? My guess: Clinton-Rubiner proposing to expand the "Massachusetts miracle" to the whole country while the actual governor of the state that produced the "miracle" -- by working across the aisle with the Democratic Legislature (changing the tone etc. etc.) -- sagely warns that health care is best left to the states in grand anti-federalist Republican tradition. And standing himself as direct evidence of the assertion.
I'm not liking those political optics at all. If Romney is seriously going to change the debate for Republicans (and the change among rubber-band ideological conservatives could potentially be seismic; at The Corner, even Jonah Goldberg is suddenly sounding reasonable), shouldn't it be matched with a similar seismic shift on the Democratic side? Then 2008 could potentially actually be about a clear health care choice rather than a quibble between Massachusetts Republicanism and New America Democraticness (or, for that matter, McCainiac "maverick" Republicanism and New America Democraticness, which we also lose). Progressives are sounding almost giddy about the prospect of going down to the Romney vision rather than to something worse. So why not take the plunge and go down (or maybe even prevail) with guns blazing single payer? (caveat: Canadian vested interest etc., but still...)
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