Sunday, December 6, 2009

Understanding "Broad Partisan Support" for Health-care Reform

By most accounts, President Barack Obama's proposed surge in Afghanistan has won broad bipartisan support from both parties. It might be worth examining this elusive idea to determine the conditions for it, and why it is, as a goal for health-care reform, an unachievable contradiction in terms.

Let’s start with “partisanship.” It is clear that the purists on either side of the political aisle are not pleased with Obama's decision to send 30,000 more troops to Afghanistan for 18 months. The anti-war wing in the Democratic Party does not approve of an escalation in Afghanistan, while the neo-conservative hawks in the Republican Party do not like the fact that the president set a timeline for troop withdrawal. What is important to note here is that Obama has achieved bipartisanship by making some friends angry, and making some foes happy. Both ends of the ideological extreme had to be spurned in order that “broad bipartisan support” be found. Bipartisanship, traditionally understood, captures our intuition about fairness that no side should ever asymmetrically receive the short end of the stick.

If the president managed to find broad bipartisan support for his Afghanistan strategy, it is nearly impossible that he will achieve the same in health-care reform, because he and Senator Harry Reid seem quite determined not to have to resort to the Reconciliation tactic (which requires only 51 Democratic votes in the Senate) to pass health-care reform. So they must contend with a potential Senate filibuster. A switch from majority to supermajority decision-making changes everything, even the meaning of "bipartisanship."

Unlike the decision to send in more troops in Afghanistan where the political center is the median voter or the 50th Senator (assuming the Vice-president casts the tie-breaking vote), the center of the political spectrum for health-care reform is the 60th Senator who could potentially break a Republican filibuster. In other words, unless the Democrats use Reconciliation, which will restore the applicability of the normal spatial metaphor governed by the median voter / politician, bipartisanship as traditionally understood will not deliver health-care reform. It’ll only get Democrats 5/6th of the way there.

In part because majorities have become an elusive thing in Washington, we have tended to conflate “broad support” with “bipartisan support,” as exemplified in the well-worn phrase, “broad bipartisan support.” But the two can be very distinct in certain circumstances. The rules of the Senate, and by extension of the Constitution, dictate that a preference for supermajority decision-making is necessarily a bias against bipartisanship. In practice, if a supermajority is ever to be found in the Senate, at least one end of the ideological extreme must always be on board. That means that our traditional understanding of bipartisanship that no one side should be forced to receive the short end of the stick becomes a road-block to finding a supermajority. (Notice that this is not the case for the “broad bipartisan support” for Obama’s surge in Afghanistan, where extremists on both sides were symmetrically spurned and so the President could find a way to walk a tight-rope.)

There’s no way to walk a tight-rope toward the public option, so either Obama must give it up or he must forget about or redefine “bipartisanship” as traditionally understood as symmetrically exacting on both Democratic or Republican partisans. If he wants a pure public option, the President must get off the tight-rope and walk on the left side of the rope to reach his destination, with the help of a few moderates like Olympia Snowe and Mary Landrieu. In doing so he would be taking sides, as indeed he already has, and the opposition, who will have to be asymmetrically spurned for the mathematics to work out, will cry foul. And that is why we no longer hear much aspirational talk about “broad partisan support” for health-care reform. All this might seem obvious, but amazingly, it has taken the President a long time - including an agenda-distracting summer of health-care town halls - to realize this basic insuperable decision-making fact of the august body from which he only recently departed.

1 comment:

Anonymous said...

I would like to pose this question to any Senator worth their salt (assuming the senator is not a attorney). Why is TORT REFORM not a major component of this bill? Studies performed by and that liability insurance costs are approaching nearly one third of the operating expenses for specialty care physicians, units and facilities. Aside from medical provider costs, insurance carriers such as Humana Health Plans state that their costs of medical liability and defensive medicine accounts for nearly 10 cents out of every premium dollar collected (verified). Compare that to Humana’s reported pharmaceutical claims of 15 cents out of every premium dollar collected. Or better yet, 21 cents out of every premium dollar collected is paid back to physicians for physician treatments. Without TORT REFORM, medical provider costs will never drop.