Democrats on Health Care: Their Own Worst Enemy

My favorite moment in Barack Obama's recent health care summit came when Senate majority leader Harry Reid surgically exposed the emptiness of a key Republican debating point, using the classic political tactic of jujitsu: he allowed the force of the opposition's argument to carry it into the abyss. Senator Tom Coburn of Oklahoma, an obstetrician, had delivered a passionate — and seemingly well-informed — statement about the need for medical-malpractice reform. "O.K., Senator, you win," Reid responded. "Look, we Democrats don't see malpractice the same way you do. Our traditional supporters among the trial lawyers hate it, of course. And the Congressional Budget Office says it would save only about $5 billion per year. That's peanuts when you're talking about a $2 trillion health care system. But providing health security to all Americans — making sure they have coverage, making sure the insurance companies can't take it away — is just too important. So we'll include your malpractice provision in our bill. Can I assume you'll now vote for it?"

Oh, wait a minute. That didn't happen. Reid did make a statement; it was filled with platitudes, anchored by an emotional anecdote. It was the sort of statement that seemed old a year ago, when the health care reform death march began. It did nothing to advance the negotiations, or to discomfort the Republicans. It followed a very similar statement by House Speaker Nancy Pelosi. It was followed by a raft of near identical statements by the other Democrats — almost all of them sclerotic committee chairs with far more seniority than debating skill. They produced a Woodstock of heart-tugging anecdotes, but not much else ... except, perhaps, another demonstration of the smug Democratic incompetence that got us to this point. (See the top 10 players in health care reform.)

The contrast between the Republican and Democratic presentations at the health care summit is telling. The Republican leaders, Mitch McConnell and John Boehner, said very little; they let their members with health care expertise do the talking. The Republican delegation had an average age of 60; it included three medical doctors and young policy wonks like Representative Paul Ryan, 40, of Wisconsin. The Democratic delegation had an average age of 66; it included Charlie Rangel, fresh from his "admonishment" by the House Ethics Committee. In the absence of Ted Kennedy, it had no senior legislative health care expert from the Senate — unless you count Senate Finance Committee chair Max Baucus, of whom the less said, the better. (Senator Ron Wyden, who has done the most creative thinking about health care policy of any Senate Democrat, was added to his party's roster at the last moment and was allowed to speak only briefly, toward the end of the day. He used no anecdotes, but deftly subverted the Republicans' position with data from their favorite health care consulting firm.)

It should be noted that the Republican position on health care has been outrageous. The party's real goal has been to stop any and all legislation for political reasons — to deny Obama a major victory. To that end, Republicans have purposely mischaracterized the Democratic plan from the start — as socialism, a government "takeover" of health care. It isn't, of course. In fact, the bill's cataclysmic inelegance is caused in large part by the President's promise that the current, hopelessly complicated system would remain the same for the 80% of the public that's satisfied with the insurance it has. Furthermore, the late-blooming Republican alternatives, like the Medicare privatization plan offered by Ryan, are so brutal and extreme that the vast majority of Republicans would never vote for them, lest they be trampled by a frothing mob of senior citizens. Of course, no Democrat tried to cross-examine Ryan on his Medicare plan: "So, Congressman, you want to give the elderly vouchers to explore the health insurance market on their own — and the vouchers would decline in value over time? ... Really? Wow." (See the top 10 health care reform ads.)

The insidious cleverness of the Republican blocking strategy demanded a more precise Democratic response. It demanded more forceful leadership from the President, to be sure. It demanded a brisk, disciplined legislative process. But that seems well beyond the capacity of the current Democratic leaders. The most egregious example was Reid allowing Baucus to dawdle for three months, attempting to cut a deal with the Republicans on the Finance Committee, during which time support for the bill curdled as Tea Party Summer unfolded. The Democrats also allowed their own special interests — the lawyers, the labor unions — as well as individual members to barnacle the bill with codicils and special deals that worked against the greater good.

And yet, miracle of miracles, it may pass. And if it passes — contrary to the conventional wisdom — it will work to the Democrats' advantage. Next fall, their candidates will be able to say, "Because of us, no one can ever take away your health insurance. My Republican opponent voted against that." That is, if they have the brains to make the argument.

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