Yuval Levin points out that the way the health care legislative process has played out makes it easy to miss the forest for the trees. The trees were the public option, Medicare expansion, and abortion language; the forest is the legislation that exists now that nearly all of the bargains have been struck.
What should we make of that forest? Levin finds that it is “really quite appalling, and should be so not only to conservatives.” He argues that “in essence, what’s left of the bill compels universal participation in a system that everyone agrees is a failure without reforming that system, and even exacerbates its foremost problem — the problem of exploding costs.” Levin explains:
[The] bill requires all Americans to pay large and growing premiums to our existing private insurance companies. It then prohibits those companies from charging people differently based on their health, age, and the like, which means they will just charge everyone more. The bill has some subsidies to help people who can’t pay their premiums, but that just means that most Americans will be paying the insurance companies more and more for premiums both as individual health insurance customers and as taxpayers. The bill is basically a massive subsidy to the insurers — it is not a reform of the system.
It is obvious that conservatives should oppose such legislation, and they will do so. But Levin argues that liberals should oppose it too:
For liberals, [the legislation] is not as good as the bill the Democrats originally proposed, and it is also worse than the status quo — because it funnels huge amounts of money to the insurance companies they hate so much and doesn’t really change the system. Democratic members of congress should look past the narrower debates about the public option, abortion funding, and the like, and ask themselves just what exactly is the case for voting for this bill now? What are its merits? What ends does it serve? They won’t come up with much.
Levin may be correct when it comes to liberals in general, but not when it comes to liberal politicians. I doubt that any liberal Senators really hate insurance companies much. To be sure, they find it useful to demonize them, but that’s something else. And even for politicians who genuinely dislike insurance companies, the opportunity to regulate (and arguably more or less run) them is irresistible.
In any event, this is the best opportunity liberals are likely to have for many years to expand the number of Americans who have health insurance and to expand the government’s power over this enormous chunk of the economy. Given the primacy of these two goals, It seems quite unlikely that liberals will derail this legislation.
The best hope for derailing it now lies with center-left Senators from Red States because these members (a) may face electoral constraints and (b) may not be preoccupied with expanding government power. Blanche Lincoln certainly meets the first criterion, but probably not the second; nor is it clear that she has the force of personality to stand in the way of this train. Ben Nelson probably meets the second criterion and seems to have enough force of personality. However, Nelson also seems like a natural dealmaker, and if he can get the kind of abortion language he’s been seeking, he may not feel highly constrained by his electorate.
In the end, Jim Webb may be the Senator to watch. Last month’s landslide Republican win in Virginia’s gubernatorial race must have made an impression on Webb. Moreover, while Webb is no conservative, neither does he appear to be an out-and-out statist. Finally, force of personality has never been a problem for Webb. In fact, he seems like a natural maverick. After three years of going along with the crowd, this is his chance to play a role for which he is well-suited, a role that could make him a hero in Virginia.
Between Nelson and Webb, there is at least some small hope of stopping this train.