By Ezra Klein
Since the election, there's been a lot of talk about what President Obama and the Democratic leadership could've done differently. I offered six ideas here. But there's been rather less discussion of what individual legislators could've done differently. Consider, for example, Joe Lieberman.
The health-care law doesn't really kick into effect until 2014. There are a couple of reasons for that. The most legitimate is that it takes some time to properly set up exchanges and subsidies, to dialogue with the industry and advocacy groups so the regulations work for both consumers and providers, and to give the various stakeholders time to adjust to the new rules and transition smoothly.
The less legitimate -- but perhaps more important -- reason was that self-described moderates in Congress (and eventually the President of the United States) arbitrarily decided that the bill shouldn't spend more than $900 billion over its first 10 years, no matter whether the bill cut and taxed its way to deficit neutrality. But for the system to work, it would have to spend more than that implied on a per-year basis. So the legislation's architects simply delayed its start. That way, the 10-year price tag was only capturing six years of spending. That got them to a per-year number that could actually work.
The problem, of course, is that this meant the bill didn't begin delivering benefits until 2014. But it was always possible to add provisions that would begin earlier, and thus would give the legislation supporters more quickly. A few of these -- for instance, allowing parents to keep children on their insurance until age 26 -- made it into the final law. But the most promising idea didn't. And it was Joe Lieberman's fault.
Late in the negotiations over the public option, a group of five conservative Democrats and five more-liberal Democrats seemed near to an unexpectedly smart compromise: Allow adults over 55 to buy into Medicare. This idea had a couple of different virtues: For one, it opened an effective and cheap program up to a group of Americans who often have the most trouble finding affordable insurance. For another, the Congressional Budget Office has said this policy would improve Medicare's finances by bringing healthier, younger applicants into the risk pool. Oh, and it's wildly popular with liberals, who want to see Medicare offered as an option to more people, and since Medicare is already up and running, it could've been implemented rapidly.
But Lieberman killed it. It was never really clear why. He'd been invited to the meetings where the compromise was developed, but he'd skipped them. He'd supported the idea when he ran for president with Al Gore, and he'd reaffirmed that support three months prior to its emergence in the health-care debate during an interview with the editorial board of the Connecticut Post. But now that it was on the table, he seemed to be groping for reasons to oppose it. About the best he managed was that it was "duplicative," which was about as nonsensical a position as could be imagined. Nevertheless, he swore to filibuster the bill if the buy-in option was added. The proposal was duly removed.
It's easy to say that this made for worse policy. Medicare buy-in was a smart, helpful idea that should've been included in the legislation. It's harder to say whether it had a defined political cost in the election: Liberals would've been a lot happier if they'd managed to add this to the law, and maybe more of them would've turned out to vote. Seniors might've been pleased to see Medicare's finances improved, and many of the people who would've been helped by the new rule would've been, well, their children. The law could've begun delivering benefits earlier, and maybe that would've helped its popularity. Polls of doctors and the public have repeatedly shown broad support for making Medicare available to more Americans.
Put all this together and it might've saved a few seats, or perhaps it wouldn't have saved any seats at all. Or maybe it would've changed everything. At any rate, it's the sort of thing that might've made a difference, and its absence was the result of one senator's incoherent intransigence. We're pretty used to looking for what the White House did wrong, and what the congressional leadership did wrong, but in a Senate where there were 60 Democrats for a time, there are a lot of cases where the decisions of one or two individual senators made a big difference to legislative outcomes. They deserve scrutiny, too.
The health-care law doesn't really kick into effect until 2014. There are a couple of reasons for that. The most legitimate is that it takes some time to properly set up exchanges and subsidies, to dialogue with the industry and advocacy groups so the regulations work for both consumers and providers, and to give the various stakeholders time to adjust to the new rules and transition smoothly.
The less legitimate -- but perhaps more important -- reason was that self-described moderates in Congress (and eventually the President of the United States) arbitrarily decided that the bill shouldn't spend more than $900 billion over its first 10 years, no matter whether the bill cut and taxed its way to deficit neutrality. But for the system to work, it would have to spend more than that implied on a per-year basis. So the legislation's architects simply delayed its start. That way, the 10-year price tag was only capturing six years of spending. That got them to a per-year number that could actually work.
The problem, of course, is that this meant the bill didn't begin delivering benefits until 2014. But it was always possible to add provisions that would begin earlier, and thus would give the legislation supporters more quickly. A few of these -- for instance, allowing parents to keep children on their insurance until age 26 -- made it into the final law. But the most promising idea didn't. And it was Joe Lieberman's fault.
Late in the negotiations over the public option, a group of five conservative Democrats and five more-liberal Democrats seemed near to an unexpectedly smart compromise: Allow adults over 55 to buy into Medicare. This idea had a couple of different virtues: For one, it opened an effective and cheap program up to a group of Americans who often have the most trouble finding affordable insurance. For another, the Congressional Budget Office has said this policy would improve Medicare's finances by bringing healthier, younger applicants into the risk pool. Oh, and it's wildly popular with liberals, who want to see Medicare offered as an option to more people, and since Medicare is already up and running, it could've been implemented rapidly.
But Lieberman killed it. It was never really clear why. He'd been invited to the meetings where the compromise was developed, but he'd skipped them. He'd supported the idea when he ran for president with Al Gore, and he'd reaffirmed that support three months prior to its emergence in the health-care debate during an interview with the editorial board of the Connecticut Post. But now that it was on the table, he seemed to be groping for reasons to oppose it. About the best he managed was that it was "duplicative," which was about as nonsensical a position as could be imagined. Nevertheless, he swore to filibuster the bill if the buy-in option was added. The proposal was duly removed.
It's easy to say that this made for worse policy. Medicare buy-in was a smart, helpful idea that should've been included in the legislation. It's harder to say whether it had a defined political cost in the election: Liberals would've been a lot happier if they'd managed to add this to the law, and maybe more of them would've turned out to vote. Seniors might've been pleased to see Medicare's finances improved, and many of the people who would've been helped by the new rule would've been, well, their children. The law could've begun delivering benefits earlier, and maybe that would've helped its popularity. Polls of doctors and the public have repeatedly shown broad support for making Medicare available to more Americans.
Put all this together and it might've saved a few seats, or perhaps it wouldn't have saved any seats at all. Or maybe it would've changed everything. At any rate, it's the sort of thing that might've made a difference, and its absence was the result of one senator's incoherent intransigence. We're pretty used to looking for what the White House did wrong, and what the congressional leadership did wrong, but in a Senate where there were 60 Democrats for a time, there are a lot of cases where the decisions of one or two individual senators made a big difference to legislative outcomes. They deserve scrutiny, too.
By Ezra Klein | November 11, 2010; 1:30 PM ET
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