The Health Care Follies Continue

Nate Silver has an interesting take on the Democrats and the health care bills. He examines the polling numbers from PPP and finds that things are bad for the Dems either way...

I don't particularly expect a boost in the Democrats' numbers if they pass a health care bill: the plan, after all, has become somewhat unpopular. Their numbers might even get a little worse. But I'd expect a larger drop in their numbers if they fail to pass health care. Then, you're getting something close to the worst of both worlds: the people who don't like health care are still going to blame you for making the effort, but the people who do like the plan will become despondent and wonder what the whole point of electing Democrats to the Congress was in the first place.

Put differently, it seems that the unpopularity of health care has already been mostly "priced in" to the Democrats' numbers -- and indeed they've paid a price for it, although the economy may still be the more important factor. But failing to pass a health care bill would not undo the damage: it would only make things worse by depressing the base, making leadership look incompetent, and producing week after week of horrible news cycles.

Sure, the "status quo" in which health care neither passes or fails might be the best case scenario for the Democrats. Better still might have been the scenario in which they'd looked at horrible unemployment numbers that rolled in month after month during the spring, and decided to forgo healthcare in lieu of more populist economic policies (something which, rumor has it, some very senior White House staff was urging back in May and June). But the Democrats can't undo six months of debate on health care. Nor can the tenuous "status quo" hold. The health care bill, to state the obvious, is either going to pass or it's going to fail -- barring something completely out of left field like a major terrorist attack or another financial collapse, it will not just go away.

Both polling and common sense would seem to dictate that the best way for Democrats to cut their losses would be to pass a health care bill -- particularly one with a public option -- and then move on to debating financial regulation and a jobs program, where public sentiment should be more on their side. They should probably not expect to gain ground if they pass health care -- but they're likely to lose more if they don't.

Nate's a smart guy, and I don't know that he's wrong on this point -- the Dems might suffer more if their base fails to come out next fall. What's left unsaid, however, is that the Dems don't seem to have a way to convince the rest of the electorate that health care reform (as embodied by the bills in existence and by whatever might pass) is a good idea. That strikes me as a bigger problem. The polling numbers seem to be pushing health care reform down below 40% in terms of popularity -- if they go much further down, then the only people who will be supporting it will be the Democratic base.

Some percentage of this relates to the economy, as Nate notes. If the jobs picture were not grim and the public believed the recession was over, health care reform might have a few more points added to its popularity. But that's not the reality that Democrats face. Still and all, they may have a better argument to make, but they haven't made it. Cue Yuval Levin...

Remember back when OMB Director Peter Orszag was on television all the time talking about reducing costs? Have you seen him lately? Me neither. The case for Obamacare as cost reduction just won’t pass the laugh test anymore, and no one seems to make it. The case for covering everyone isn’t heard all that much either, since the Democrats’ plans won’t do that. The case for improved efficiency hasn’t really survived the machinations necessary to get a bill through the House and to get another to the Senate floor — as what remains after the wheeling and dealing is anything but efficient. It seems like the only case being made to (and by) wavering Democrats in Congress now is that the bill just has to pass. History is calling, we have never been closer to agreement, this is our chance, do it for the president, and on and on. The theory is that it’s this or nothing; some combination of the Reid and Pelosi bills has to pass or else we just leave our health-care system as it is.

Levin notes that others (like Tevi Troy and Senator Tom Coburn in Forbes) make the case for alternative reforms. But I'm focused on the first part of what he noted -- the Orszag cost-control component of health care reform is no longer being emphasized. I don't think this is just the laugh-test issue, although that's important, since it is exceptionally difficult to prove to the American electorate that government programs and oversight would make operations more efficiently and less costly.

The problem with the Orszag cost controls argument is that (a) people don't believe government will actually engage in cost-cutting, and (b) they're afraid the government will. Seniors have to be scared of what the proposals mean to Medicare, and the alleged idea that they would cut the deficit while extending coverage to millions of uninsured... well, Mickey Kaus has been railing against Orszagism for months, so here's a good summary...

The old argument--Classic Orszagism--claimed simply, if enigmatically, that the solution to the budget crisis was Obama's health care reform, because somehow only when the government insured coverage for all would it have the leverage necessary to "bend the cost curve" down. One problem with Classic Orszagism was that it scared the elderly, and near-elderly, who are hardly crazy to see the suggested restrictions on mammogram spending as the opening bid in an ongoing campaign to "scientifically" lower high-tech expenses (by playing up the "anxiety" caused by false positives, for example). Another problem is that if the government can bend the cost curve, the logical place to start is with Medicare--and, indeed, the powerful Fed-like "IMAB" board in Harry Reid's bill is mandated to cut only Medicare. But if we can cut Medicare, why not just cut Medicare--without also adding Obama's admittedly expensive subsidized coverage for the uninsured?

If all you cared about was the deficit, that would be your position: First see if we can cut Medicare, then talk about extending health care to everyone in a few years. The fierce reaction to the mammogram recommendations, though, reinforced an already amply justified skepticism of the governments ability to reduce treatments to constituents who see them as life-saving. Why do we have any expectation that the cost curve will be bent at all, ever?

Mickey actually does a decent job of explaining the better rationale Dams might have for health care reform -- in his view (and the view of those on the left) it's the good and right thing to do as a developed nation to make sure all of your citizens have access to basic health care, even if that means higher taxes or cuts to other entitlements like Social Security and Medicare. The Dems haven't spent a lot of time advancing Kaus' argument (for purposes of this discussion, let's leave aside the argument as to whether all of our citizens already have access to basic health care). I suspect the Dems haven't pressed this argument is because they don't think it would work, particularly in times of economic crisis. But it would be a better argument than the one they have made, some of which Megan McArdle noted. She pointed out that the GOP arguments against the bill are inconsistent, and she's right. But the criticisms may be both inconsistent and valid.

The Dems seem to have a bigger problem -- they can't come up with a good argument in favor of the bill. Maybe that's been their problem all along.