Health care and the mid-terms

Miracle or monstrosity?

Democrats and Republicans alike are taking a gamble on health reform

Time to calm down?

IF MOMENTUM is what counts in politics, this has been a wonderful week for Barack Obama. A party that was expecting a battering in November’s mid-term elections can now campaign on a promise redeemed. But the knife-edge 219-212 vote in the House of Representatives on March 21st, which could easily have gone wrong for the Democrats, was only the first half of a double gamble, and the outcome of the second will not be known till November. Will voters reward them in the mid-terms for getting their signature legislation through at last? Or, as the Republicans are hoping, will voters punish the Democrats for using underhand tactics to ram through a government takeover that the country cannot afford?

Bill Galston, a former Democratic strategist who is now a senior fellow at the Brookings Institution in Washington, dc, says that having invested so much in health reform, it is better for the Democrats to have passed the legislation than to have laboured mightily and still failed. But he does not think the victory will necessarily save the Democrats from a drubbing in November or even be a net positive. Polls suggest that both the measure itself and the manner of its passing—without a single Republican vote in favour—are broadly unpopular. A Pew survey conducted before the climactic vote in the House on March 21st showed 38% in favour and 48% opposed. A CNN poll published the next day showed 39% in favour and 59% opposed. Our own YouGov poll, however, shows opinion more evenly divided, even though people are nervous about the cost implications (see chart).

Nor can this week’s victory be relied on to re-energise the new voters who supported Mr Obama in 2008 but stayed at home in last year’s governors’ races in Virginia and New Jersey and January’s Senate election in Massachusetts. The turnout for the mid-terms is likely to be smaller, older and whiter than it was for the general election of 2008, and Republican voters seem angrier and so more likely to vote. It may prove hard to transfer this week’s excitement in the White House to Democratic activists in the field, many of whom hoped for more audacious change, such as a government-run insurance option open to everyone, and are disappointed by a measure that hands millions more customers to the insurance companies and closely resembles the approach the Republicans themselves offered up as an alternative to Hillarycare in 1993.

Republican rage

Despite the resemblance, the Republicans have been swift to denounce the legislation as an abomination and its centrepiece—an obligation on all citizens to buy health insurance on pain of a fine—as a violation of the constitution. Republican attorneys-general (and one Democratic one) are mounting legal challenges and the party leadership promises to “repeal and replace” the law when back in power.

Apart from injuring America, the Republicans say, the Democrats have scored the mother of own goals. “This is the people’s House,” declaimed John Boehner, the chamber’s Republican leader, at the end of Sunday’s debate, “and the moment a majority forgets this, it starts writing itself a ticket to minority status.” The Republicans claim that using reconciliation to pass amendments in the Senate with a bare majority offends against a tradition of bipartisan lawmaking in far-reaching social legislation. John McCain, 2008’s Republican presidential nominee, said the Democrats had “poisoned the well”, and that his party would therefore withhold co-operation on legislation from the president for the rest of this year.

By framing the debate in such stark terms, however, the Republicans are taking a gamble of their own. One danger for them is that familiarity will soon start to make the new law look less scary, and the direness of Republican prognostications correspondingly overheated.

In a pep talk before the critical vote Mr Obama told Democrats on the Hill that it would be harder when the bill was law for critics to “mischaracterise” its implications. Voters would notice that “nobody is pulling the plug on granny”, that people who liked their insurance policies would be able to keep them, and that there was no “government takeover”. Although the reform is to be phased in over several years, the White House is already highlighting potentially popular changes that will kick in this year in good time to influence the mid-terms, such as letting young people remain on parents’ policies up to the age of 26 and stopping insurance companies from denying insurance to children on grounds of a pre-existing condition.

On March 23rd a USA Today/Gallup poll provided some evidence of attitudes shifting in the president’s direction. This found 49% of respondents saying it was a good thing that Congress had passed the bill, against 40% taking the opposite view. About half said they were positive (“enthusiastic” or “pleased”) about the reform whereas about four in ten were negative (“disappointed” or “angry”). The largest single group, 48%, described the bill as a good first step that should be followed by further action. So the Republicans’ promise to campaign for a wholesale repeal of the bill may well backfire.

It is, after all, a fairly hollow threat. Without a veto-busting two-thirds majority on the Hill, the Republicans cannot hope to repeal the bill until Mr Obama leaves the White House, in 2013 at the earliest. By then, repeal may strike voters as scarier than the new law itself. Departing from the party line, David Frum, a former speechwriter for George Bush junior and now a fellow at the American Enterprise Institute, questioned whether Republicans could really repeal the law once its new protections and entitlements became popular. “Even if Republicans score a 1994-style landslide in November, how many votes could we muster to reopen the ‘doughnut hole’ and charge seniors more for prescription drugs? How many votes to re-allow insurers to rescind policies when they discover a pre-existing condition? How many votes to banish 25-year-olds from their parents’ insurance coverage?”

Indeed, Mr Frum concludes that it is in fact his fellow Republicans rather than the Democrats who have scored the own goal. He argues that, for all their talk of bipartisanship, the Republicans decided early on that instead of co-operating with Mr Obama they would turn health reform into his Waterloo, inflicting a crushing defeat like the one they imposed on Mr Clinton in 1994. This time they bet wrong on the outcome. Instead of seizing what might have been a chance to improve Mr Obama’s ideas, says Mr Frum, “we followed the most radical voices in the party and the movement, and they led us to abject and irreversible defeat.”

Buttressing Mr Frum’s argument, there are signs of a backlash against the hateful extremes adopted by some opponents of Mr Obama’s bill. The spectacle of Republican congressmen egging on the protesters who shouted vile abuse at black and gay Democrats has done the party no good. A spate of violent attacks on Democratic representatives’ offices is not pretty either.

Messrs Galston and Frum are cerebral types working at some remove from the passions feeding the grassroots of their parties. But Mr Galston’s warning that health reform may not avert a setback in November, and Mr Frum’s that a call for repeal could backfire, are likelier to find their mark as the mid-terms draw nearer and the economy becomes the overwhelming issue again. After their big gains of 2008, and if unemployment is still at a miserable 9% or so, it would be a miracle if the Democrats did not suffer hefty losses, even if this week has put a spring in their step. Yet it could also be riskier by November for Republicans to portray health reform as a monstrous offence against the American way. A lot of Americans may by then have come to like it.