The Spectacle Blog

David Frum’s Alternate Health Care Reality

By on 6.29.12 | 2:23PM

David Frum is once again arguing the Obamacare repeal is a "fantasy," an unattainable policy goal even if a Republican president and Congress we elected and seriously wanted to achieve it. He is relying on some rather questionable political analysis to get to this conclusion.

Frum asserts, "2012 is now also a referendum on Mitt Romney's healthcare plans." But why isn't it also a referendum on the sitting president's own enduringly unpopular health care plan, which has now been outed as a middle-class tax increase by its very protectors on the Supreme Court? Yes, President Obama will lean hard on the more popular elements of the bill and say Romney wants to repeal them. But that's precisely what he has done since the law passed and its support in the polls has barely budged.

He also remains wedded to his view that Republicans could have gained meaningful concessions from the Democrats on the health care bill if only they had been willing to compromise. Frum never mentions who he spoke to on Capitol Hill or in the White House who told him how fruitful such negotiations could have been, or what votes would have actually been moved. But he is asking us to believe Republicans could have accomplished more under Democratic supermajorities in both houses of Congress after Barack Obama had just been elected with 53 percent of the vote than they could potentially accomplish with a Republican House, Senate, and president.

If that sounds implausible, so is the alternate universe in which a handful of Republicans could have produced a health care bill worthy of conservative support. The Democrats controlled three-fifths of both houses of Congress. At one point, they had a filibuster-proof Senate majority. They didn't need any Republican votes. Yes, the president would have liked some Republican votes if they could be had. But he was content to have just eight Republicans vote for cap and trade while only three voted for the stimulus. Obama called the health care bill bipartisan back when it had one Republican supporter. That should tell us something about how much Obama would have been willing to sacrifice for bipartisan cover.

With such large Democratic majorities, the fate of health care reform hinged -- much like it did during the Hillarycare debate in the 1990s -- on whether they could get a bill that went far enough for the liberals without losing too many votes from Democrats representing more conservative districts. Far from pushing the bill wildly to the left, unanimous Republican opposition greatly strengthened the hand of moderate Democrats. If you don't believe me, ask yourself how the public option was defeated in the Senate without appealing for any Republican votes or why Nancy Pelosi's House passed the pro-life Stupak amendment. Without any Republican support, the Democrats needed the ideological outliers in their caucus on board.

Start bargaining with Republicans and the Democrats then have to worry about keeping House liberals in the fold. The Progressive Caucus had to be dragged into making concessions to Joe Lieberman and Bart Stupak. How much would they have given up for Charles Grassley or even Olympia Snowe before some of them started voting against the bill? The idea that they would have gone along with a health care bill that contained neither the public option nor Medicaid expansion -- remember that a lot of liberals, including Obama himself, weren't crazy about the individual mandate initially -- doesn't pass the laugh test. And the universe of gettable Republicans was always much smaller than the number of liberals in the House.

Remember that Romneycare relies heavily on Medicaid too. Tinkering with the exchanges or debating whether the bill should be more tax-financed or more deficit-financed rightly wasn't a hill many conservatives wanted to die on in 2009 or 2010. Some of the Republicans in the early bipartisan negotiations supported things like a trigger for the public option, which was to the left of the bill that eventually passed.

Some version of Romneycare with tighter restrictions on abortion funding was probably the most conservative health care legislation that could have passed Congress and gotten Obama's signature. Some version of Romneycare is what we got without any Republicans votes, with the abortion funding restrictions a casualty of pro-life liberals in the House deciding to drop their insistence on them.

Now back to 2013, when a potential Republican majority will supposedly be so much weaker than the small Republicna minority of 2010. I don't have much confidence that Romney or the Republicans will try very hard to repeal Obamacare. But I have no doubt it is possible if they seriously try.

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