As you probably know if you’ve been following the presidential campaign news, Barack Obama released his long-awaited health care reform proposal earlier this week, and it’s getting decidedly mixed reviews from the chattering classes. Two progressive blogger/journalists with pretty good street cred on health care issues, Ezra Klein and Jon Cohn, have published quite similar takes, praising many of the details of the plan but decrying its timidity in challenging the health care status quo–most particularly its failure to provide universal coverage (other than for children). On the positive side, it does indeed seem that Obama’s plan represents sort of a greatest hits collection of incremental health care reform ideas. It picks up John Kerry’s underappreciated 2004 proposal for federal reinsurance of catastrophic health costs, which could have a big impact on rising insurance premiums. It adopts the federal employee health plan model for a national insurance purchasing pool, which makes abundant good sense substantively and politically. It calls for a federally-driven shift towards prevention and chronic disease management, along with IT investments to help control costs and improve quality, which ought to be a point of agreement among those who may disagree on financing mechanisms and/or the role of public and private sectors. It includes a direct assault on health care industry abuses through federal regulation, instead of treating such abuses as an unavoidable byproduct of for-profit involvement in health care. It does cover all kids, which makes sense if you aren’t going to cover everybody. And it provides very robust subsidies to make voluntary health insurance affordable to as broad a segment of the uninsured as possible, along with an employer mandate to avoid erosion of existing coverage. Those are a heap o’ positives, but the negatives, most especially the plan’s failure to include a universal individual mandate for health insurance, and its complexity, are likely to get more attention, on both substantive and political grounds. Substantively, the plan obviously fails to fundamentally overhaul the current system, with its patchwork of public and private programs, its heavy reliance on economically damaging and arguably regressive employer-based coverage, and its failure to cover everyone. And politically, the plan will reinforce claims that Obama isn’t quite the transformative, great-leap-forward progressive so many have seen in him. One particular problem for Obama is that his plan superficially resembles the Massachusetts initiative signed by Republican presidential candidate Mitt Romney, with the crucial exception that Massachusetts did include a universal individual mandate for coverage (underfunded, to be sure, but still in place). Another is that Obama’s plan achieves less than universal coverage at a pretty steep price tag, given its lavish subsidies to tempt rather than force individuals into obtaining insurance. Beyond the initial reactions, perceptions of Obama’s plan will be crucially influenced by his rivals for the Democratic presidential nomination. John Edwards is already in a position to exploit Obama’s incrementalism on health care, given his own comprehensive universal plan, which not only embraces an individual mandate for coverage but also provides a stronger Medicare-style public option attractive to Democrats who favor a single-payer system. Given Edwards’ competition with Obama for the support of left-leaning Democrats, this could become an important point of distinction between the two candidates, at least among activists. But the other shoe that will soon drop is Hillary Clinton’s; she’s slowly rolling out a very thorough and comprehensive health care reform proposal, building on her unquestioned expertise in this field. Still under wraps is what she would do to achieve expanded coverage. If she goes for a universal plan (which is quite likely), then Obama will begin to look like an incrementalist outlier among those who care about policy details.
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By Ed Kilgore
After absorbing a lot of Democratic gloom-and-doom about the midterms, I offered some silver lining at New York:
The 2022 midterms don’t look great for Democrats, who will try to buck history by hanging on to super-slim congressional majorities. Thanks to the particular lay of the land, Democrats have a decent chance of maintaining control of the Senate. But the House? Not so much: The two times since the New Deal when the president’s party won net House seats in a midterm (1998 and 2002), the president in question had sky-high job-approval ratings. Even if you believe Joe Biden’s plunge in popularity has been stemmed or even turned around a bit, he’s not going to have 60 percent-plus approval in November 2022 unless really crazy things happen. There’s just too much partisan polarization for that these days.
Thankfully for Democrats, even if they lose their congressional majorities next year, Biden himself won’t be an underdog for reelection in 2024. After all, the last two Democratic presidents were reelected after historically terrible midterms. Democrats lost 54 U.S. House seats in 1994 and 63 in 2010. Yes, they had bigger majorities going into those elections than Democrats have now. But they lost the national House popular vote by an identical 6.8 percent in both midterms, which is pretty bad, particularly since Democrats suffer from a voter-inefficiency problem in House elections (too many voters concentrated in too few districts).
It’s possible for a president’s party to lose a midterm so badly that bouncing back in the next cycle is all but impossible. Consider the man whose unique comeback accomplishment Donald Trump will be emulating if he runs in 2024, Grover Cleveland. The president Cleveland defeated in an 1892 rematch, Benjamin Harrison, was a Republican whose party lost an incredible 93 House seats in the 1890 midterms. This, mind you, was at a time when the House had only 332 members, which means the GOP lost over half their caucus in one cycle (an even worse percentage than in 1894, when Democrats lost a record 125 House seats during the midterm after Cleveland’s comeback triumph). In this era of polarization, nothing like that is going to happen to Democrats in 2022.
Looking more broadly at the power of incumbency, there have been 13 sitting presidents since World War II who were on the general election ballot. Nine of them won. The four losers all faced special circumstances. Gerald Ford had not previously been elected to anything more than the U.S. House; he ascended to the vice-presidency and then the presidency when disgraced predecessors resigned, and he pardoned the president who appointed him, the especially disgraced Richard Nixon. Jimmy Carter was caught up in a historical realignment that he had held off four years earlier by carrying his native South, which then resumed a massive Republican trend. George H.W. Bush suffered from a terrible economy but then also a party split (third-party candidate Ross Perot won a lot of previously Republican voters). And we all know about Donald J. Trump, who was impeached twice and seemed determined to offend swing voters.
In retrospect, what’s most remarkable is that Ford and Trump very nearly got reelected despite their handicaps, exhibiting not the weakness but the strength of incumbency. And it’s with that perspective that any early handicapping of a potential 2024 rematch should be considered. Trump benefited from incumbency in 2020, as will Biden in 2024. So the idea that the 45th president has some built-in advantage over the 46th — absent the renewed election coup so many of us fear — doesn’t make a lot of sense.