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The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

The System and Health Reform

One of this week’s “must-reads” is an eloquent, angry piece by Hendrik Hertzberg for The New Yorker that explains and laments America’s “health care exceptionalism,” and attributes it largely to our constitutional system. An extended quote is in order:

In other free countries, legislation, social and otherwise, gets made in a fairly straightforward manner. There is an election, in which the voters, having paid attention to the issues for six weeks or so, choose a government. The governing party or coalition then enacts its program, and the voters get a chance to render a verdict on it the next time they go to the polls. Through one or another variation of this process, the people of every other wealthy democracy on earth have obtained for themselves some form of guaranteed health insurance or universal health care.
The way we do it is, shall we say, more exciting. For us, an election is only the opening broadside in a series of protracted political battles of heavy artillery and hand-to-hand fighting. A President may fancy that he has a mandate (and, morally, he may well have one), but the two separately elected, differently constituted, independent legislatures whose acquiescence he needs are under no compulsion to agree. Within those legislatures, a system of overlapping committees dominated by powerful chairmen creates a plethora of veto points where well-organized special interests can smother or distort a bill meant to benefit a large but amorphous public. In the smaller of the two legislatures—which is even more heavily weighted toward conservative rural interests than is the larger one, and where one member may represent as little as one-seventieth as many people as the member in the next seat—an arcane and patently unconstitutional rule, the filibuster, allows a minority of members to block almost any action. The process that results is less like the Roman Senate than like the Roman Games: a sanguinary legislative Colosseum where at any moment some two-bit emperor is apt to signal the thumbs-down.

He’s right, of course; America does differ fundamentally from countries with parliamentary systems where parties run on manifestos that are almost immediately implemented; intraparty dissent may well exist, but not on such basic issues as health care. Hertzberg could have gone further in his analysis of American exceptionalism: here party identity among candidates for Congress is largely self-selected, with primary voters offering the only (and rarely exercised) curb. Currently, 49 Democratic House members represent districts won by John McCain in 2008; ten Democratic senators represent states carried by McCain. There’s a strong presumption that the switch from total control of the federal government by Republicans prior to 2006 to total Democratic control today will create a natural backlash against Democrats in 2010 and perhaps beyond, especially given the dire economic situation. This is one of many factors in our system and our traditions that militate against big legislative reform efforts, particularly when, as is the case today, the “out” party decides to operate as an obstructionist force.
Add in the chronic mistrust of the federal government and particularly Congress among Americans from both parties and no party, and the power and money deployed by a threatened private-sector health care industry, and the extraordinary difficulty facing the Obama administration and its congressional allies in enacting meaningful health care reform is no big surprise.
So let’s continue to cut Barack Obama some slack in how he’s handled health care reform. He could have postponed action for a year, pleading the economic emergency; had he done so, he would have earned standing ovations from many pundits of the center and center-right. He could have “gone incremental” right away, and lowered expectations to a manageable level. Instead, for all the tactical manuevering going on right now, he’s still pushing pretty much the same ideas for reform that he campaigned on. But make no mistake: reforms of similar magnitude in the past required either gigantic majorities beyond anything Democratic currently hold (the New Deal, Medicare and Medicaid), or significant support from Republicans (the Civil Rights and Voting Rights Acts). Hertzberg is right in finding many aspects of our system frustratingly reactionary. But if we wait for, say, a parliamentary system to save us, we’ll be like premillienialist Christians waiting for the Rapture: standing in place, looking beyond the skies for redemption.

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