After Massachusetts, why the Democrats should still pass health-care reform

By Jacob S. Hacker and Daniel Hopkins
Tuesday, January 19, 2010; 2:40 PM

Forget the question of whether a Republican Senate victory in Massachusetts spells the end of health reform. It doesn't -- unless Democrats let it. The Senate has already passed a bill that is far from perfect but far better than nothing. If Democrats lose a Senate seat, the House should simply enact it in return for strong commitments from President Obama and Democratic leaders that they will fight to improve the bill in the future, including through the filibuster-proof budget process.

The real question is what message politicians and pundits will take out of the Massachusetts surprise. (As of this writing, we do not know whether that surprise will be a near-loss for Democrats or a GOP triumph.) Many argue it means Democrats should run from reform. But that would not just be disastrous for American health care. It would misread the results and ignore the lessons of history. Not passing health reform would guarantee that dire predictions about the Democrats' fate will come true.

The bills in Congress hardly enjoy runaway popularity. But the problem isn't that health-care reform itself is unpopular. It is that people are turned off by the current debate about it. And those repelled by what is happening in Washington include a lot of liberals as well as conservatives. In a recent nationwide CNN poll, for example, 10 percent of respondents opposed reform from the left because they felt it was not liberal enough. Another 40 percent supported reform outright, bringing the total supporting the current bills or something more liberal to 50 percent -- compared with 45 percent who oppose the bills because they think they are too liberal.

Those disenchanted liberals are not going to vote for Republicans. They might stay home if Democrats do not remind them that they want to do more on health care down the road. But they are much more likely to stay home if a bill doesn't pass. And by 2010, most of them will probably come around to support the legislation -- as will, we expect, a sizable chunk of those who are now opposed.

Most campaigns, after all, attract attention for more than a long weekend and provide more of an opportunity for voters to learn. And when the public is polled about the specifics of the health-care bills, its key elements are consistently popular. These include a requirement on employers to provide coverage, progressive taxes to fund reform and tough regulations on health insurers. Perhaps the most popular element -- the public option -- is in the House bill but not the Senate bill, and, therefore, it's off the table. But it is precisely the kind of long-term goal that Democrats could use to rally their troops in 2010 and beyond.

But doesn't the Massachusetts election tell us that reform is a political loser? Well, no. Republican candidate Scott Brown made no secret of his opposition to federal health reform. But his most prominent advertising in the run-up to the election focused on taxes, the local Democratic "machine" and his pickup truck. Until the final days, Democratic candidate Martha Coakley complacently failed to ask voters for their support. Pundits are all too eager to read elections as mandates -- and politicians all too eager to claim them. As voters, however, we are limited to the choice before us: We can't choose the pickup truck of one candidate and the policies of another.

What's more, Brown is no radical Republican. He supported a health-care bill in Massachusetts that looks an awful lot like the current Senate bill. Revealingly, he now says he wants that law to stay in place. Once a bill passes, Brown's stay-the-course approach is likely to be the position on national reform of a good number of wavering Democrats, as well as enough Republicans to make backtracking difficult. As a clear concession to that reality, House Minority Whip Eric Cantor said last week that Republicans would pursue only a "partial" repeal of health-care reform in their 2010 campaign.

Even today, the Democrats are more trusted on health care than are Republicans. Yes, President Obama's approval on health care has steadily declined from mid-October. But Obama's position has remained constant since his September speech. What has changed is what has not changed: Four months later, there are seemingly endless negotiations and concessions, and yet no new law. Passing health-care reform will end this attrition.

In any event, congressional Democrats have already voted on health-care bills -- they cannot escape that. Instead, they should ask themselves: Would they rather defend a successful law or an unsuccessful year-long legislative imbroglio? As was true after the Clinton health plan went down in flames in 1994, failing to pass health-care reform would cripple public perceptions of the Democrats' ability to govern. And as was true in 1994, the Democrats most endangered would be moderates, not liberals. The Blue Dogs may be hearing the loudest calls to turn tail. But they stand to lose the most if the governing reputation of their party goes down with reform.

If there is a lesson in the Massachusetts vote, it is this: pass a bill. The nation needs reform. Democrats need an accomplishment. And Democratic activists and voters need a new cause: fixing reform, not abandoning it.

Jacob S. Hacker and Daniel Hopkins are professors of political science at Yale and Georgetown universities, respectively.

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