This week will be one of the most consequential weeks ever for the American health-care system. At stake are two conflicting visions for a system that touches every single American, and without doubt needs to be improved in order to dispense care properly and appropriately. Yet recognition of the need for improvement by no means accepts Democratic arguments that their proposal is the only possible path, and that opposing their proposal is tantamount to accepting the status quo. We have learned far too much in the last 15 months to fall into this false dichotomy.
For Democrats, this week will be the culmination of two decades of work on the health-care issue. They have seen it as one of their top political issues, and it is essential to their strategic and policy vision. In the future, policy strategists may see this effort as a model for how to force an issue onto the national agenda, if not necessarily for a way to increase political popularity.
For the Republicans, they came late to the party. For too many years, while Democrats built a policy and political apparatus around the health-care issue, Republicans ducked Democratic attacks on the issue and were for too quiet in pushing their own proposals. As a result, much of this year has been an uphill struggle for them. Yet they have gained ground admirably, and have begun the hard work of developing health-care messages and policies that they can take to the American people.
At the Blair House health-care summit a few weeks ago, they stood their ground against Professor Obama — and by most accounts trounced the Congressional Democrats there — by focusing on substance and specific objections, rather than the generalities and anecdotes put forward by the Democrats.
This week’s outcome will tell us who won this battle, but it seems that the Democrats have a losing political hand either way, at least in the short term. If the Democrats pass the bill, they will further harm their chances in November’s mid-term elections. If they lose the vote, they leave President Obama weakened and subject to the charge that they could not accomplish much of anything, even with control of the White House and large majorities in both chambers of Congress.
Yet for the Republicans, there are challenges in both scenarios as well. Should the bill pass, the Republicans will do better this November, but will have to face the prospect of even more Americans becoming increasingly dependent on the government for health care. This will make Republicans more vulnerable to Democratic demagoguery on adjustments to health-care spending levels in the future. Furthermore, it will make Republican-favored market-based health reforms harder to achieve, as Congress will likely have little appetite to re-open the health-care issue again in the near future.
On the other hand, if the bill fails, we will still have a bloated and inefficient health-care system, and voters will start looking to Republicans and asking the question, “What’s next?” This past year has shown that Republicans are finally coming up with some answers. Let us hope that they get the chance to apply their proposed solutions before the Democrats send us irretrievably in the opposite direction.