The Politics of Healthcare

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Jonathan Cohn takes a look at the many compromises Barack Obama is making in order to get a healthcare reform bill passed:

Put aside, for a moment, the policy merits of these moves. The politics are lousy. Obama would be in danger of producing legislation that seems to offer little up-front benefit, particularly for the electorally vital middle class. And if some of these people end up paying even modestly higher taxes to help finance reform they’re not likely to be happy about it. It’s hard to imagine such legislation provoking a backlash that could produce total repeal. It’s not so hard to imagine such legislation creating bad political feelings, the kind that linger around until the next Election Day and pave the way for legislative retrenchment later on.

The key to healthcare reform is that it be popular with the public.  The Medicare prescription bill, for example, was generally popular because it provided a clear and concrete benefit.  Broader healthcare reform, however, is going to have a harder time.  If there’s no public option, for example, and most people simply keep the employer-based healthcare they already have, then what’s the selling point?  Most people will just see higher taxes funding better coverage for the poor, and you don’t have to be the world’s biggest cynic to understand that this isn’t going to be overwhelmingly popular.  Helping the poor is all well and good, but like it or not, most of us want to know what’s in it for ourselves if our taxes are going up.  That’s just life.

Right now, we’re running the risk that the answer is “not much.”  Healthcare reform needs a little more obvious sizzle if it’s going to survive the coming tsunami of conservative agitprop, and the bills wending their way through Congress don’t have much of that left.  Jon is right: it’s lousy politics.

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