Recently, Howard Dean wrote a recommended diary with the following observation:
The realities are Congress rarely passes reform that is not incremental and it is important that the increments they pass are headed in a direction we ultimately want to go. Expanding Medicare would do that.
Sounds reasonable, right? Incremental progress as a path to eventual reform. But before you buy this line of argument, ask yourself the following: how many times in the next century will the Democratic party get the legislative opportunity to pass each of these incremental improvements leading to a public option?
I probably won't live to see the answer, but if there was a betting pool I'd think a fair guess would be six or seven. Six or seven chances at an incremental improvement by 2110, when children born today will already be dead and their children mostly over 65.
Why six? Because on average we seem to get a shot at this about every 15 years.
Whether you're talking about a full-blown public option or just a step towards one, this sort of reform seems to require a major legislative advantage, at least in today's climate. The last major attempt at reform was in 1993-4, when Hillary Rodham Clinton chaired the Task Force on National Health Care Reform.
That was the previous time that we had democratic control in the house, senate and White House, and it lasted two years. 15ish years back. The time before that was 1977-1980. Four years, about 30ish years back.
Here's a handy chart of the last century of total Democratic majorities:
|2009-present||At least two years|
Of course, the fourteen year stretch was in response to the Great Depression, and it was possible in part because we had no presidential term limits. Looking at more recent history, we see roughly a 15-year span between periods of governmental dominance, and 2-4 years seems like a good bet for the span of these periods in the near future.
The basic message here is that "incrementalism" is a sham. Incrementalism only makes sense if you have many opportunities to make small steps. When it comes to health care in particular, the opportunities are few and far between. If the bus comes by once a day, you don't take it one stop at a time.
So yes, Dr. Dean is right when he says that "Congress rarely passes reform that is not incremental." Of course it is rare: most of the time you can't do it. But right now, they can. Surely this is an argument for acting when the opportunity arises, not a justification for wasting our first shot of the 21st century.