Reform doesn’t work piecemeal

REFORM DOESN’T WORK PIECEMEAL…. One of the less reasonable health care options raised yesterday by panicky Democratic lawmakers was the notion of breaking the package into pieces. The “incremental” strategy would make it easier to approve some of the more popular elements of the larger legislation.

This is a very bad idea.

For one thing, it would drag out the reform debate for several more months, which isn’t exactly what the public is clamoring for. The goal should be to wrap up the process, not make it longer. For another, Republicans won’t be any more cooperative when rejecting reform’s component parts than they were when rejecting the sum total.

But most importantly, health care reform doesn’t actually work that way. The parts are interdependent. Usually, it’s conservatives confused about this; House Dems should know better. If, for example, you force insurers to cover those with pre-existing conditions, but you do so with no mandate, insurance companies would pay more without the benefit of a wider risk pool, including healthy people who pay in premiums but do not need treatment. One without the other would make care more expensive for everyone.

President Obama explained this fairly well yesterday to George Stephanopoulos.

“I don’t know how we avoid taking on these big problems. Let me just give you a very simple example, just so you get a sense of why these things are so important.

“If you ask the American people about health care, one of the things that drives them crazy is insurance companies denying people coverage because of preexisting conditions. Well, it turns out that if you don’t … make sure that everybody has health insurance, then you … can’t stop insurance companies from discriminating against people because of preexisting conditions. Well, if you’re going to give everybody health insurance, you’ve got to make sure it’s affordable. So it turns out that a lot of these things are interconnected.

“Now, I could have said, ‘Well, we’ll just do what’s safe. We’ll just take on those things that are completely noncontroversial.’ The problem is the things that are noncontroversial end up being the things that don’t solve the problem.”

Exactly. As Jon Chait explained, “Cantor does say he wants to ban discrimination against people with preexisting conditions, but for reasons I’ve explained over and over again, you can’t do that without an individual mandate, and you can’t do that without subsidies for those who can’t afford the mandate. So the preexisting condition stuff is just a way of posturing for a popular goal without admitting you oppose the necessary steps to accomplish it.”

This can’t be done piecemeal — taking out one major provision causes the other provisions to fail.

Chait also noted that House Dems are tired and frustrated, but added, “If they fail to pull themselves together, future generations will look back at them, note that Congress had passed comprehensive reform in both chambers, had the backing of an eager Democratic president, and could finish the deal by getting 218 of their 256 Democratic members to sign on, and somehow refused. I still find the idea that they’ll allow this to happen unfathomable. If they do succumb, it will be because some deep and recurrent character flaw rose to the surface at the worst time, once again.”

Kevin Drum added, “It’s beyond belief that we could get this close to a century-old goal of liberalism — we are, literally, just a hair’s breadth from the finish line — and then allow the most significant social legislation of the past 40 years to slip from our grasp just because we’re tired and pissed. All we need is one roll call vote in the House. That’s how close we are to passing this genuinely historic bill. One vote. Then the next day we can start in on the next 20 years work of improving and finishing what we’ve begun. We can’t allow this to fail now. We can’t let the Fox/Drudge/Rush axis win. So call your congressman. Go organize a rally. Write a letter to the editor. Lobby your union president. Do something. Do it now.”

Pass the damn bill.