Jon Cohn of The New Republic and I disagree pretty strongly about the right way to reform heathcare, but he’s written an excellent analysis of the central political and policy difficulty at the heart of Obamacare: the president’s pledge that “if you like your health care plan, you will be able to keep your health care plan, period.” After explaining why this pledge is basically untenable, Cohn proposes a different strategy for the Democrats:
In an ideal world, the best approach would to be to admit that promising everybody the opportunity to keep their coverage, as Obama has done, is just not that advisable. A better promise would be that government won’t force anybody to drop good coverage–that the relatively modest number of people switching insurance will be making a change for the better. There are signs that the House legislation is at least moving in that direction, since it seems to have a more porous firewall–and an apparent commitment to high subsidies.
After acknowledging the downsides of this approach, including its paternalism, Cohn explains its political logic:
Embracing this argument would also mean telling some people with insurance that their world is going to change. But Obama–or any of his allies–can say honestly to those people that change is coming anyway. As proof, they can point to the aftermath of Clintoncare, when all those people who turned against the plan ended up enduring radical changes in insurance anyway. It happened because employers, buckling under the burden of employee-benefit costs, decided to make changes on their own. They moved everybody into managed-care plans–which, as it happens, is precisely the prospect that scared so many people about the Clinton reforms.
The same trade-offs apply to those of us who want to create a more consumer-driven healthcare marketplace. And my gut instinct is that it is better to be honest and upfront about the trade-offs than to pretend that the healthcare status quo is acceptable or even salvageable. At the heart of the president’s recent political difficulties is, I think, the sense that he isn’t leveling with the public.