Today’s Forbes.com column — not shockingly — is about Scott Brown. The main point I try to get across is that Specter’s switch from Republican to Democrat changed the dynamics surrounding health reform legislation dramatically. Specter was less a liberal Republican than an idiosyncratic mix of liberal and conservative instincts, depending on the issue and depending on Pennsylvania politics. So while he was identified as pro-labor, he opposed card-check, in part due to the threat, one has to assume, of a primary challenger from the right like Pat Toomey. And on health reform, he stood in the vital center with Snowe, Collins, and possibly Graham: amenable to a deal, but opposed to a public insurance option, wary of spending too much, and friendly-ish to a mandate but skeptical and unfriendly to a mandate that would actually work.

Then Specter suddenly became one of the more liberals members of the Democratic caucus, and he changed the incentives facing Senate Democrats. If Massachusetts voters elect Scott Brown, they will essentially undo the Specter flip.

Granted, you can’t just pull an “undo” switch in politics. This is an iterative process. Deals that were imaginable at the start of 2009 are not imaginable at the start of 2010.

The Democratic narrative, as I understand it, is that the political incentives for a bipartisan deal with the Republicans was never there, so entreaties to Olympia Snowe, etc., were ultimately a waste of time.

My response is — what were the real redlines? Had the White House been interested primarily in expanding coverage to the poor and near-poor and improving affordability for the small-group and individual insurance markets, there was a straightforward route to doing so:

(1) federalize Medicaid and streamline eligibility requirements, a step that would have a wide variety of benefits in terms of improving the long-term fiscal outlook for the federal government and state governments;
(2) some form of Medicare buy-in for people aged 50 and up or 55 and up;
and, more complicatedly, (3) either extending the generous tax treatment of employer-provided coverage to non-employer-provided coverage or drawing on the Katherine Swartz model for a public reinsurance program.

What is this structure missing? Well, it’s missing a mandate, which the private insurers wanted, but the reinsurance program would address some of their concerns. Moreover, there was no political will to establish an effective mandate, and so we’re left with an entirely notional mandate that will do very little in practice — “young invincibles” will have a powerful incentive to go without coverage, not least because they can take advantage of guaranteed issue and community rating regulations when they choose.

The deal I’ve described isn’t a terribly attractive one for conservatives. In my view, (1) is a step conservatives should embrace and (3) is a maybe, depending on how the program is structured.

But note the main line of Republican attack on the Democratic proposal — that it would undermine Medicare. Had the Democrats gone for (2) from the start, they’d be very hard to attack. The incentives for moderate Senate Republicans to get on board would have been, I suspect, very strong. This would have been a replay of the S-CHIP debate, with conservatives painted in a negative light.

So why didn’t the White House go this route? My impression is that a universal structure was a very high priority — that is, a structure that could become the basis for a broader transformation of the health sector.

All this is to say that Republicans in the House and Senate have had good reason to be skeptical. The notion that opposition to the Democratic health reform model represents a kind of unreasoning intransigence is more than a little self-serving.

The irony is that, as Mickey Kaus has persuasively argued, Medicare expansion was the much smarter move politically.

**–There is the pattern: Once Democrats have established key, long-demanded institutions–Social Security, Unemployment Compensation, Medicare–voters are then quite happy to elect Republicans–Eisenhower, Nixon, Reagan–to run the resulting, larger government. They’re especially happy to do it once it’s clear the Republicans won’t tamper with the basic structure. (A semi-exception is AFDC-welfare, where voters never demanded, and in fact hated, the basic structure–giving no-strings cash to single parents who could work.)
***–If they’d gone the Medicare buy-in route, by way of contrast, the Dems could have lowered the entry age by two years or so every session–all the while pledging to lower it another two years or ten years if they were returned to power. Cover and cover, expand and expand, elect and elect. …

The architects of the reform model placed a great deal of faith in a very opaque, hard-to-explain model that was from the start extremely vulnerable to attack from the right and to a lesser extent from the left.

So shouldn’t we be thrilled that the Obama White House fumbled this effort so badly? Not really. Scott Brown said something very astute on Hannity.

HANNITY: If you win this race it will be a political earthquake. Last question. If you were to grade Barack Obama up to this point, one year into his presidency, what grade would you give him? BROWN: He needs some work to do. He was too slow in reacting in the recent terrorist bombing. But I’m glad he’s finally talking about it. But we need to solve that problem right away for the safety of our kids and all of our families. HANNITY: A, B, C, D? BROWN: I’m not going to give him a grade. I just want to make sure he solves the problems and keep us safe because we’re in some serious trouble. Al Qaeda is trying to hurt us and also our kids. And I’m ready to go down and work to help. If the White House fumbled their central domestic initiative so badly, how well does that bode for the equally thorny problems they have to confront on financial sector reform and foreign policy challenges ranging from Afghanistan to Iraq to Iran? President Obama is the only president we have, and I think Scott Brown has the right attitude here: yes, some Democrats think that a Republican victory in Massachusetts represents everything ranging from a blow against civil rights to a startling indifference to the preventable deaths of tens of thousands. My own interpretation is that most conservatives running for office, like most progressives, want to do the hard work of getting the country out of “some serious trouble.”