We already tried incrementalism

WE ALREADY TRIED INCREMENTALISM…. Sen. Lamar Alexander (R-Tenn.) was rewarded for his dishonesty during the White House health care summit with an invitation to appear on ABC’s “This Week.” He reiterated a point he raised during the bipartisan discussion, and said Congress, as an institution, is simply incapable of passing major legislation on any issue.

“I’ve watched the comprehensive immigration bill, I’ve watched the comprehensive economy-wide cap and trade, I’ve watched the comprehensive health care bill, they fall of their own weight, because we’re biting off more than we can chew in a country this big and complex and complicated,” Alexander argued. “I think we do better as a country when we go step by step toward a goal.”

We talked the other day about one of the reasons this is so unpersuasive. Whether Alexander understands the policy details or not, there are plenty of parts to health care reform, but they’re inter-locking. It’s easy to say we’ll take some steps now, and leave others for later, but to make it so that those with pre-existing conditions aren’t discriminated against, for example, we’ll need mandates and subsidies. It’s like an engine — the parts don’t work unless they’re part of a larger whole.

But there’s another truth that often goes overlooked. We’ve been trying to address the problem through Alexander’s preferred approach — incremental, piecemeal reform — and the system keeps getting worse anyway.

After President Bill Clinton failed to get Congress to pass his health care bill in 1994, Republicans, who then had substantial victories in the House and Senate, worked with him to pass legislation like the health care privacy bill, a children’s health insurance program and the Balanced Budget Act, which contained significant changes to the Medicare program. Under President George W. Bush, the Republicans went on to pass a drug benefit under Medicare. “In the space of less than 10 years, you have several major bills,” Mr. Butler said. […]

But President Obama clearly prefers passage of a broader bill. In wrapping up Thursday’s session with lawmakers, he and other Democrats warned that an incremental approach was likely to provide too little relief to the people already feeling the effects of a broken system. “It turns out that baby steps don’t get you to the place that people need to go,” he said.

Alexander keeps saying we should try to do a little bit at a time, overlooking the fact that we’ve been doing a little bit at a time. He wants to get “step by step”? As Frank McArdle, a consultant with Hewitt Associates explained, “We’ve had a lot of incremental reforms already.”

S-CHIP expansion here, Medicare expansion there. Some insurance reforms here, some expanded access there. This has been the model for 15 years — since right-wing opposition led to the death of the last attempt at comprehensive reform. Is the system any better as a result of incrementalism? No, it’s considerably worse, and deteriorating further with each passing year.

We tried it Alexander’s way. Why stick with failure?

In the larger context, I honestly don’t know if Alexander is right about what America’s institutions are capable of accomplishing. Congress was once able to pass landmark legislation like Social Security and Medicare, but perhaps, in light of Republican obstructionism, Democratic sheepishness, and an effective far-right noise machine, hopes that lawmakers can respond to big problems with equally big solutions are a thing of the past. It’s possible we’ve entered a period in which our challenges are too great, and once-strong American institutions are simply no longer up to the task. We’ll have to collectively settle for small ideas from small politicians with small ambitions.

But I nevertheless hold out hope that President Obama and congressional Democrats will prove Alexander and his meek allies wrong. The governing majority can still pass the health care reform package we’ve been waiting generations for, and prove that the United States can still confront a huge crisis and respond in kind.