I've suggested how difficult I think it will be for UHC for the US to get enacted in this universe.
But - no time like the present to make a start, on the planning, at least.
Let's consider the 08 Dem prez candidates.
Clearly, UHC is not going to get enacted without a Dem trifecta, and decent majorities in both houses - let's say they manage 265-170 and 60-40. (This is Christmastime, after all!)
But a Dem prez so committed to the cause as to make it his overriding domestic priority is essential if UHC is to have any chance.
Right now, so far as I'm aware, no plausible candidate has proposed the enactment of an immediate (as opposed to incremental or pie-in-the-sky) scheme of UHC, let alone single payer.
(I'm inclined to think that only single payer is capable of dealing with the problems of breadth, depth and cost of coverage that the current system is afflicted with. For now, I'll assume all UHC schemes are alike.)
Suppose, then, a field of candidates later this year (Stage 1): they will all have received a massive amount of lobbying from lefty groups, the lefty sphere and Uncle Tom Cobbley to persuade them to propose immediate UHC; and they would have been noncommittal.
Suppose Candidate X made that proposal: surely the reaction of his fellow Dem candidates would be to paint him as a bomb-thrower, looney druther merchant or, at the very least, in need of a good lie down?
This would be a Dean Scream in Surroundsound!
And the media (loving horse-race and hating issues, as they do) will just love flooding the zone - with kerosene.
Just what would the reward be for a candidate to make such a proposal? No doubt, a good many uncommitted lefty activists may be won over; but won't those committed to other candidates be equally keen to mock at X for being a day-dreamer or snake oil salesman?
(Thinking back to Deaniacs v Kerryites 03/04 - one can't expect much comradely spirit to be flowing at that point!)
Fast forward to Stage 2: the interminable period running through to election day. Let's say Candidate Y wins the nom after a few primaries (in spite (or, perhaps, because) of failing to get specific on health care), and soon afterwards the GOP decides on its candidate (let's call him Z).
There is no way that health care is not going to be a major issue - it could well be the top domestic issue.
Y may be opposed to immediate UHC; in favor; or undecided. He may change his mind on the issue during the course of the campaign, perhaps more than once. (He may, of course, change his preference among different brands of UHC - but I said I was leaving that question alone...)
Let's suppose that he strongly supports immediate UHC: does he announce it? If so, when? And in what words?
The longer he leaves it, the more open he is to charges of empty showmanship - of offering a pre-election gimmick.
And the more answers he will have given on health care on talk shows and the like before the big annoucement that might form the basis of some gotcha or other.
There's also the anti-UHC lobby to consider: no doubt, they're mostly contributing to GOP candidates, including Z. But a promise from Y of immediate UHC will no doubt open billfolds like nothing else for all kinds of hi jinks, with a view to killing any such scheme in the egg.
Consider the polls: if Y is miles ahead, why should he take the risk of announcing on UHC. If he's neck and neck, or even behind, won't such an announcement lose, as well as win, him votes?
End of August, we have the convention. We'll need a platform and some speeches, including one from Y. Will there be a UHC plank? Will it be 1948 all over again? Who will be our Hubert Humphrey?
Parallel with the presidential process on UHC, a similar, and even more complex, lobbying process will have been going on with Dem MCs and candidates. Many of them will support immediate UHC, (though not all of those will want to make a public commitment), and a good few will not; still more will so resent being put on the spot about it as to be seriously prejudiced against any move in the 111th.
Not that a Congressional (or any other) candidate is bound by the platform; but needing to put something in black and white may be a catalyst for conflict.
No doubt Y would like to give the networks some reason to cover the convention; but a floor fight over platform wording wouldn't be on his list of possibilities.
In fact, getting past the convention without committing himself on UHC is likely to be part of Y's gameplan.
Moreover, the closer to the final stages, the more risk averse Y is going to be - except if he's already blown it, and can afford to go out in a blaze of glory. (Not much use to anyone else, that.)
Finally, we come to Stage 3: Y is victorious (yay us!), but only by dint of having shuffled and shimmied on UHC. When he's recovered from the victory parties ('Pearl Mesta' Pelosi eat your heart out!), and comes to considering his SOTU, that's his big chance to make his pitch.
Let's say he does so: the complaint is bound to be that he has no mandate for so fundamental a change. And that he won the election on false pretences by deliberately keeping the voters in ignorance of his plans.
When, under this scenario, does he tell his boys in Congress? The leadership is likely to be miffed, to put it mildly, at having such a plan sprung on them; some may oppose the plan on its merits; others may fear that their own priorities will be sacrificed.
Y risks that the very goodwill essential to the passage of UHC has been soured by the secrecy on the subject without which he might well not have been elected in the first place!
Go back to Stage 2: if UHC is to stand any chance of passing, public opinion will have to be rallied behind it; there's no way it can be finessed through the Congress by LBJ-like sleight of hand.
Isn't the real reason why Y would fear nailing his colors to the UHC mast that UHC is not popular?
He may say, The context of an election campaign is too partisan and confrontational an arena for the complexities of a UHC plan to be explained.
But - clearly, there will be confrontation whenever and however the plan is put forward. Confrontation with (almost?) all GOP MCs, with the insurance industry and their friends, etc, etc.
That's a one-shot model: it assumes that the only chance of enacting UHC is in the 111th. Clearly, that's not so.
(The bankruptcy bill - what was finally enacted as S 256 in the 109th - is an example of a complex bill that passed only after several attempts.)
But healthcare is different: the sort of battering ram pattern of the bankruptcy bill is rarely seen.
(Wagner-Murray-Dingell was the epitome of a battering-ram bill - and went precisely nowhere over several sessions. In the late 60s and early 70s, dozens of bills vied with each other, with little result. On the other hand, King-Anderson was the basis of the act (Social Security Amendments Act of 1965, HR 6675) which set up Medicare. But that's about it, so far as I know.)
So, let's summarize on the pure politics of the thing (leaving the merits out of it for the moment) from the viewpoint of the Dem prez candidate at each stage:
- healthcare reform has generally proved to be a loser;
- public opinion on UHC is largely unformed (except by unfavorable memories of Hillarycare);
- there is no good time during the campaign to announce a UHC proposal;
- many other domestic priorities (the deficit, for instance) would likely have to be sacrificed or downplayed to leave space for UHC;
- the management of the legislative process would be immensely complicated, and risks taking presidential attention away even from important foreign policy issues - eg war in Iraq, Afghanistan, God knows where else.
(I suspect the consultants to our Candidates X and Y would have a few hundred more queries along similar lines!)
This is a (very) rough version of a tiny part of the sort of analysis that those of us in the lefty sphere who support UHC need to be doing now.
(Confucius say: without questions, there can be no answers...)