If Dems were as willing to stand up to Republicans on foreign policy as they are on domestic policy, we’d all be a lot better off.
It’s a common refrain in Democratic circles: in the major political disputes in DC, Dems will say the right things, and endorse the right policies, but when push comes to shove, they’re going to cave. It doesn’t matter if Bush is ridiculously unpopular, and it doesn’t matter if Dems are in the right, because they just don’t have the stomach for a prolonged political fight.
But the criticism is only half right. On matters of foreign policy and national security, Democrats do, regrettably, back down far too often, in large part because they fear the perception of weakness (which, ironically, they perpetuate by yielding to GOP demands). But on matters of domestic policy, Dems fight from a position of strength and confidence. They don’t fear a public backlash, because they know their position is going to be more popular with voters anyway.
This week’s fight over Medicare is a terrific example of what Dems can do when they play the game properly. Paul Krugman explains in a spot-on column today just how significant the Dems’ win really is: “It was the first major health care victory that Democrats have won in a long time. And it was enormously encouraging for advocates of universal health care.”
In previous years, payments to doctors were maintained through bipartisan fudging: politicians from both parties got together to waive the rules. In effect, Congress kept Medicare functioning by expanding the federal budget deficit.
This year, the Democratic leadership decided, instead, to link the “doctor fix” to the fight against privatization and offered a bill that maintains doctors’ payments while reining in those expensive private fee-for-service plans. Last month, the Senate took up this bill — but Democrats failed by one vote to override a Republican filibuster. And that seemed to be that: soon after that vote, Senators Max Baucus and Charles Grassley had another bipartisan fudge all ready to go.
But then Democratic leaders decided to play brinkmanship. They let the doctors’ cuts stand for the Fourth of July holiday, daring Republicans to threaten the basic medical care of millions of Americans rather than give up subsidies to insurance companies. Over the recess period, there was an intense lobbying war between insurance companies and doctors.
And when the Senate came back in session, it turned out that the doctors — and the Democrats — had won: Senator Kennedy was there to cast the extra vote needed to break the filibuster, a number of Republicans switched sides and the bill passed with a veto-proof majority.
But this is about more than just one victory on one bill. The Dems’ efforts this week portend what will hopefully be an even more significant victory in the near future.
Because, as Krugman noted, if Dems can play for keeps on healthcare the way they did this week, they’ll know what to do once Bush leaves office (if Obama can beat McCain):
Here’s how it will play out, if all goes well: early next year, President Obama will send his health care plan to Congress. The plan will face vociferous opposition from the insurance industry — but the Medicare vote suggests that this time, unlike in 1993, Democrats will hold together.
Unless Democrats win even bigger than expected, however, they won’t have the 60 Senate votes needed to override a filibuster. What the Medicare fight shows is that the Democrats could nonetheless prevail by taking their case to the public, daring their opponents to stand in the way of health care security — so that in the end they get some Republicans to switch sides, and get the legislation through.
A lot can still go wrong with this vision. But the odds of achieving universal health care, soon, look a lot higher than they did just a couple of weeks ago.
What’s more, TNR’s Jonathan Cohn took this one step further, arguing that this week also showed that physicians, unlike in previous years, are poised to be a Democratic ally, not an opponent.
From the late Progressive Era, when medical societies in California and New York squelched drives for “compulsory sickness insurance” in those states, physicians have been a powerful — and at times pivotal — opponent of universal coverage. The American Medical Association famously attacked Harry Truman’s proposal for national health insurance in the late 1940s, turning “socialized medicine” into a permanent part of the political lexicon. And it fought bitterly, if unsuccessfully, to block the creation of Medicare in the 1960s.
But physician opinion about universal health care seems to be shifting, as noted previously in this space. And one reason, it’s widely assumed, is their exasperation with the health insurance industry. Historically, it was doctors’ intense desire to remain autonomous — clinically and financially — that drove their opposition to universal coverage. But in the 1990s, as insurers turned to the techniques of managed care, doctors learned that insurance company overseers could be just as onerous — and, seemingly, even more arbitrary — than government.
The fact that Kennedy, of all people, should emerge as the physicians’ savior says it all. For most of his career, many doctors saw him as public enemy #1, since he was the lawmaker most closely identified with universal coverage.
To be sure, the medical community opinions are far from unanimous. Plenty of physicians still hate universal health care — and Kennedy!
But if a large segment of physicians see their interests diverging from the insurance industry’s, that changes the political calculus about universal coverage. Doctors are a powerful lobbying force, as much for their symbolic power as their leverage in Washington. A coalition of reformers that counted physicians among its strong supporters would be difficult to defeat. In fact, I’ve always thought the winning strategy for universal coverage was one that pit both doctors and employers (who would benefit from more consistent and controlled benefit costs) against insurers and drugmakers.
As if we needed another reason to vote Democratic this year. On healthcare, McCain is a disaster. But imagine what a Democratic president and a Democratic Congress — neither of which are willing to back down on the issue of healthcare — can do for a healthcare system in desperate need of massive reform.