President Obama and Democrats in both houses of Congress are hurtling toward a health care precipice, and if they go over, it will be in no small part because of a dubious calculation that they are making about the last time they lost Congress.
First, the precipice. In policy terms, Democratic leaders in Congress are clearly preparing to “jam down” a policy, whether in its Waxman form or its Baucus form, that is, not to put too fine a point on it, recklessly irresponsible. Virtually every assumption on which the policy train left the station has been exploded long before it reached its destination. The overall cost, deficit neutrality, health care cost savings through preventative medicine and other meansall have fallen, one by one, to independent analyses. Promises that no one would lose coverage they like, or that Medicare benefits would not be cut, or that taxes would not rise on anyone with an income below $250,000 have likewise been buried by reality. Facing a projected $9 trillion deficit over the next decade, and facing the imminent bankruptcy of Medicare, Congress is preparing to add another open-ended medical entitlement to the federal budget, one that will almost certainly grow quickly beyond its projected cost.
In political terms, Democrats are working up the nerve to roll these dice, already weighted toward snake eyes, after having completely failed to win the public debate. That is to say, they are about to reconfigure one-sixth of the American economy in the midst of the most severe recession in 30 years with no public agreement, let alone a consensus, backing their approach. Most polls show opponents at least evenly matched with supporters of the plan, and supporters below 50 percent in any event. And this picture fails to account for the intensity gap, with opponents clearly more strongly committed than supporters.
Yet Obama, Pelosi, and Reid are ready to plunge ahead. If they fail, it will only be due to a sudden bout of prudence by vulnerable Democratic back-benchers. What explains this behavior?
Ideology is one explanation. Clearly, universal health care has become an article of faith among modern liberals, who consider it not just a policy preference but a moral imperative, failure to achieve which exposes America as inferior to its social democratic European allies (and perhaps even to Cuba).
While left ideology is a powerful driving force, there is something else at work. The Democratic leadership, and many ordinary Democrats in and out of Congress, have convinced themselves that passage of a billany bill, no matter how costly, unworkable, or unpopularis better than coming away from the health care debate empty-handed. This analysis is based on a questionableindeed, almost certainly wrongaccount of the last major push for health care reform, which ended when the legislative effort fizzled out in the fall of 1994 and Republicans gained control of Congress in the dramatic midterm elections a couple of months later.
That account, advanced by prominent political scientists within two years of the failure of ClintonCare and embraced by Obamas strategists and Bill Clinton himself, holds that Democrats were punished in November 1994 by voters who were angered by the failure of Congress to act on a matter of crucial national concern. Liberal voters were dispirited and moderates soured on Clintons promise of “change.” If todays Democrats want to avoid Speaker Tom Foleys 1994 fate, they need to pass a health care bill. Their base will be mollified, and independents will see an administration and a Congress that can deliver on the big issues. Clinton has predicted that passage would see Obamas approval rating skyrocket (as his own would have done if only Congress hadnt lost its nerve).
It is an interesting account, and serves well the short-term interest of Obamas vote-counters. However, there is little reason to believe it is true.
The 1994 electoral earthquake was the result of several factors. One was the Clinton tax increase of 1993, passed by one vote in each house. It was a gigantic legislative accomplishment, but passage did nothing for Clintons approval rating. Another, according to Republican pollster Frank Luntz, was the crime bill of summer 1994, a bill that included gun control measures and a healthy dose of pork-barrel spending on things such as midnight basketball leagues. It also passed with some difficulty, and did nothing to help Clinton. Apparently, achieving passage of unpopular legislation does not actually help a president that much. (This failure actually led to a moaning by the administration that voters had not understood what it had accomplished.)
Then there was health care. Immediately after Clintons health care speech to a joint session of Congress in September 1993, his plan was supported by approximately two-thirds of voters. One year later, that figure had fallen to as little as one-third. When Senate Majority Leader George Mitchell announced the Senate would not act on the measure, it was because he and Senate Democrats had concluded that this turn in public opinion had rendered the measure too risky to tackle. The idea that Democrats would have improved their electoral position by passing a measure supported by one-third of the voting public is belied both by common sense and by the failure of the passage of the similarly unpopular budget and crime bills to do so.
Indeed, Republicans campaigned hard not against the failure of the bill but against the big-government content of the bill, and Democrats in swing districts, ever sensitive to public sentiment, backpedaled from ClintonCare as quickly as their feet would carry them. Republican campaign ads morphed the local congressman or senator into Bill Clinton to good effect not because the congressional majority had separated itself from Clinton too much but because it had still not done so sufficiently. When voters finally gave the GOP its congressional majority, they did so largely because the critical bloc of 1992 Ross Perot supporters swung in behind the Republicans. These independent voters were deficit hawks whose concerns would surely have been heightened, not lessened, had Congress jammed down a health care bill estimated by the Congressional Budget Office to add hundreds of billions of dollars to the deficit over the following decade.
In short, there is every reason to believe that the account driving Democrats to pass a flawed health care bill is not a reliable guide for action today. The 1994 Clinton health care bill died because it was a bad bill, the public knew it, and Congress knew the public knew it. The same conditions apply today, except that Democrats have a year to come back and try again if they choose to take advantage of the opportunity. For that to happen, though, a non-trivial bloc of Democrats will have to break out of the entrancing but fantastical tale told by their leaders that seeks to convince them that the route to political salvation lies in passing a highly problematic bill over massive public objections.
Andrew E. Busch is an Adjunct Fellow of the Ashbrook Center, Professor of Government at Claremont McKenna College, and Ann and Herbert W. Vaughan Visiting Fellow at the James Madison Program in American Ideals and Institutions at Princeton University.