If you haven’t read Ramesh Ponnuru’s Time column on the president’s political miscalculations on health reform, you really should.

Stanley Greenberg, who was polling for Clinton back then, recently reminded Democrats that the insured public in the early ’90s just could not be persuaded that the President was going to cut its costs by expanding coverage for others. No amount of clever strategizing is going to make the sales job easier this time. Instead, the President is in a series of double binds. The more he emphasizes how much has to change, for example, the more people are going to doubt his pledge that they can keep their doctor.

I wonder, however, what happens if the Obama administration fails to cajole Congress into passing a comprehensive bill, despite massive Democratic majorities in both houses of Congress. David Frum has raised this question and he’s come up with a troubling answer.

If we win, we’ll trumpet the success as a great triumph for liberty and individualism. Really though it will be a triumph for inertia. To the extent that anybody in the conservative world still aspires to any kind of future reform and improvement of America’s ossified government, that should be a very ashy victory indeed.

I’d go further. Healthcare has been a serious Republican liability for over a decade. Without the healthcare issue, recent political history would have been fought on national security, economic growth, taxes, and education, terrain far more favorable to the center-right. If we accept that reforming healthcare is an iterative process — not something that will happen in one fell swoop — it might make sense to push for a compromise measure like Wyden-Bennett coupled with Medicare reforms like those proposed by James Capretta. No, it’s not ideal. Reform will have to be reformed, which is where conservative policymakers will be able to play a central role, e.g., by encouraging a shift away from fee-for-service.

Last month, Arnold Kling, a libertarian economist who wrote The Crisis of Abundance, a brilliant analysis of the American healthcare system, wrote the following:

The basic problem that the Democrats have with health care reform is that when it comes to taking our system away from free markets, there is just not that much farther we can go. We already regulate the practice of medicine and allied health services with licensing cartels. We already regulate individual health insurance practically out of existence, particularly in states that require “community rating” and “must-carry,” which force insurance companies to charge the same price to all comers, which means that the only price they can safely charge is the price that assumes you are only asking for insurance because you just came down with a really expensive illness. We already have government insuring the poor and the elderly.
In contrast, there is a lot of room to move health care in the other direction–toward free markets. The only real health care reformers are those of us on the libertarian fringe. The two major parties are just posturing. That’s why I haven’t written much about the day-to-day debate on “reform.” It is not clear to me that defeating the Democrats’ legislation is something I should root for. We’re still nowhere near considering real reform.

This is a fairly pessimistic view, but one wonders if coverage expansion might actually provide the impetus for a more sweeping set of reforms. The alternative is defending the fast-unraveling status quo.