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Reform or Revolution?

Ross Douthat makes the case that ObamaCare was doomed from the start:

You can make big changes to small programs, and small changes to big ones. But comprehensive solutions tend to produce comprehensive resistance. And the more sweeping the stakes, the greater the chance of political disaster — whether your name is Clinton or Gingrich, Bush or Obama — when your bill goes down to defeat.

Such a bill would have had many fewer beneficiaries — but far fewer enemies as well. It wouldn’t have transformed the system, controlled costs for the long term, or guaranteed universal care.

Douthat argues, as did many Republican lawmakers, that Democrats overshot the mark, attempting something too grand, too complex, and too scary. He contends: “The lesson for Democrats should be obvious. They wanted, admirably, to help the low-income uninsured, and Americans with pre-existing conditions. And that’s exactly what they should have done — with tax credits or vouchers or a Medicaid expansion for the poor, and better-funded risk pools for the sick.”

But is that what they really wanted to do? Or did they want to plant the sapling of a European-style welfare state that couldn’t be rooted out, setting up a new relationship between citizens and their government? At times, many liberals were candid that this is precisely what they had in mind. The public option, they confessed, was the proverbial camel’s nose under the tent, the entry to a single-payer universal-health-care system. It was not simply, one could argue, that in their zeal to tinker with the existing system Democrats went overboard. It often seemed (because they said so) that they intended a “new foundation” for the country. That would entail a whole new model of government dependency for each and every citizen.

In the wake of the Scott Brown epic upset, Democrats are reduced to seeking small, focused fixes to the existing health-care system to save political face. Liberal pundits are beside themselves that they’re likely to get “no more” than something to address pre-existing conditions, some equalization of tax treatment for individual-purchased insurance plans, tort reform, and a lifting of the ban on interstate insurance sales. Well that’s “all” that’s left, given that ObamaCare has crashed and burned. Greg Sargent notes with chagrin:

Is it really advisable, in political and policy terms, for Dems to agree to pass something approximating the GOP plan and no more? Because in the real world, that’s the only way Dems will win any bipartisan cooperation.

It’s quite a comedown to simply reform the existing system. With visions of a revolutionary transformation of American society dancing in their heads, the Left imagined they could get far more. The voters, however, didn’t want to throw out the entire health-care system. They simply wanted cheaper health care and some portability. But if it meant a scary new regime of government control and “comparative effectiveness research,” well then the Democrats could forget the whole thing as far as ordinary Americans were concerned.

So Douthat, I think, is partially correct. Mega-reform wasn’t going to happen. Mostly it wasn’t going to happen because the proponents of the ObamaCare weren’t candid with the public, which they rightly suspected all along wasn’t going to go for a reorientation of a sixth of the economy and their own personal health care. Reform is hard enough; it’s near impossible when it’s a camouflaged revolution.


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