Republicans, it seems, are going to run on repealing health care reform. Bad call. They are, I believe, misreading the polling.
It’s true that the health care bill is unpopular. But as many people have pointed out, a significant fraction of those who say they disapprove of the bill disapprove from the left. And more generally, answers to the question "Do you approve of the Senate bill?" are not the same as answers to the question, "Do you want to roll back what’s in the bill?"
Consider Massachusetts. As I’ve pointed out in the past, the MA health reform has low approval ratings — yet 79 percent of the state’s voters want the reform to continue.
Indeed, just 11% of voters there want to repeal MA's health reform law. And as Krugman points out, even though voters have been decidedly negative on the bills before Congress, voters have consistently said the nation would be better off with health care reform than without it.
If Republicans -- as seems overwhelmingly likely -- do end up running on a "repeal" pledge, they may be making a mistake, but it's important to remember that Democrats could make a similar mistake, for they too must decide how to position themselves relative to health care reform.
Broadly speaking, once it passes, there are three different positions one can take on health care reform:
- Say that health care reform once and for all solves the national health care crisis ("Mission Accomplished")
- Say that while health care reform is a major step on the path towards solving the national health care crisis, it doesn't finish the job and more must be done, particularly on cost containment/affordability ("Mend it")
- Say that repealing health care reform is essential to addressing the national health care crisis ("End it")
For Republicans, the choice is between options #2 and #3 -- "Mend it" vs. "End it."
For most Democrats, the choice is between options #1 and #2 -- "Mission Accomplished" vs. "Mend it."
Just as Republicans are erring by opting for the absolutist "End it" positioning, Democrats would err by opting for the absolutist "Mission Accomplished" positioning. Instead, they should claim credit for the good things in the health care reform bill -- insurance reforms, expansion of coverage, closing the Medicare Part D "doughnut hole," starting cost containment inside Medicare -- but own up to the fact that this bill doesn't finish the job. Health care spending is still out of control, and we aren't getting enough for it. Health care costs must come down, and they must come down significantly.
Conceding that this bill doesn't fix every problem under the sun doesn't condemn the bill, it's a simple recognition that the problems with our health care system are massive and can't be fixed in one step.
It is also important to point out that if it were not for corporate special interests and a dysfunctional Senate, this bill could have done even more. The fact that those obstacles exist does not mean the bill doesn't do good things, but it does mean that there is still work left to be done.
With the finish line in sight, declaring "Mission Accomplished" must be an awfully sweet temptation. But doing so would be an blunder of Rovian proportions. It might feel like good politics, but it wouldn't be good politics.
If Americans must choose between "Mission Accomplished" and "End it" when it comes to health care reform, the political system will have failed them once again. There's no telling which side will prevail. But if the choice is between "Mend it" and "End it," mend it will win every single time.