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Health Care: The Political Implications

- March 22, 2010

By now, anyone who follows politics closely knows that yesterday the House finally “passed health care reform”:http://www.nytimes.com/2010/03/22/health/policy/22health.html. I’ll leave it to health care professionals and economists to explain the economic implications of the bill, but I want to take a stab here at the political implications of the bill. As readers of this blog know, I have been skeptical that passing health care reform would be any worse for the political fortunes of the Democratic Party in 2010 than not passing health care reform at this point (see “here”:https://themonkeycage.org/2010/03/whats_worse_politically_passin.html and “here”:https://themonkeycage.org/2010/03/what_is_motivating_the_republi.html). Thus the following two pieces in the blogosphere caught my attention yesterday. The first was arguably the “oddest headline I came across”:http://www.politico.com/news/stories/0310/34746.html, which I found on “Politico”:http://www.politico.com:

bq. “House Republicans Begin Victory Lap”:http://www.politico.com/news/stories/0310/34746.html

Odd because this was not exactly what one expects to see after a party suffers a major defeat on a landmark piece of legislation. But of course the piece was about the “now familiar story”:http://www.washingtonpost.com/wp-dyn/content/article/2010/02/28/AR2010022803243.html that health care reform would lead to huge Republican victories in the fall. Thus it was with great interest that I read the following piece from “conservative blogger David Frum”:http://www.frumforum.com entitled “Waterloo”:http://www.frumforum.com/waterloo:

bq. Conservatives and Republicans today suffered their most crushing legislative defeat since the 1960s. It’s hard to exaggerate the magnitude of the disaster. Conservatives may cheer themselves that they’ll compensate for today’s expected vote with a big win in the November 2010 elections. But:

bq. (1) It’s a good bet that conservatives are over-optimistic about November – by then the economy will have improved and the immediate goodies in the healthcare bill will be reaching key voting blocs.

bq. (2) So what? Legislative majorities come and go. This healthcare bill is forever. A win in November is very poor compensation for this debacle now.

Interestingly, Frum seemed to be picking up on exactly what we at the Monkey Cage have been arguing (see “here”:https://themonkeycage.org/2010/02/the_economy_structures_everyth.html, “here”:https://themonkeycage.org/2010/03/whats_worse_politically_passin.html and “here”:http://www.politico.com/arena/perm/Joshua_A__Tucker_F9F8A355-F4F5-4B9B-A7C6-361DE7559D2C.html): the midterm elections in 2010 are likely above all else to be a function of the state of the economy, which, as Frum notes, may actually be looking better by November.

They will also, as “John has noted”:https://themonkeycage.org/2010/02/does_it_matter_if_everyone_hat.html, be a function of _President Obama’s_ approval ratings, which have “held relatively steady”:http://www.gallup.com/poll/113980/Gallup-Daily-Obama-Job-Approval.aspx at around 50% for months, despite all the supposed angst in the country since then over health care reform. And, if “President Clinton is correct”:http://politicalwire.com/archives/2009/09/22/clintons_advice_on_health_care.html, they may be going up now that health care reform has passed.

Meanwhile, let me take one last crack at interpreting the latest polls on support for health care reform. According to the “most recent Gallup poll”:http://www.gallup.com/poll/126521/Favor-Oppose-Obama-Healthcare-Plan.aspx, as of early March, 48% of Americans wanted their representative in Congress to oppose the health care reform plan, 45% wanted their representative to support it, and 7% didn’t know their opinion. (That’s worth noting again: as of early March, opposition to health care reform was running at 3% higher than support, or within the margin of error of the poll. So this was hardly a case where one party spoke for the people and another did not.) Let me posit one assumption: some fraction of that 48% that opposed the plan did so because they favored including either a public option or a single-payer system: in other words, they wanted reform to move health care policy _further to the left_ than it actually did. I don’t know (does anyone?) what proportion of that 48% this is, but it surely is not 0%. Let’s call this faction the “dissatisfied left”. So with that in mind, let’s forget the economy, incumbency effects, etc. and pretend for a moment that the 2010 elections will be contested purely as a retrospective vote on health care reform:

– Best case scenario for Republicans in 2010 : the dissatisfied left stays home (they are obviously not going to vote for Republicans), the remaining opponents of health care line up solidly behind Republicans, and a non-trivial proportion of these health care opponents turn out to be people who previously voted Democrat (or stayed home) and are disproportionately concentrated in swing districts in House races.

– Worst case scenario for the Republicans in 2010: the dissatisfied left is energized by fact that Obama actually managed to pass a major piece of social legislation and/or the Republican response to the health care debate, turns out to be a non-trivial proportion of the 48% the oppose health care, and the remaining opponents of health care are simply Republicans who never voted for a Democrat in the past or never would have under any scenario in the future, and tend to be over-represented in heavily Republican districts.

Again, personally I think most of what we know about midterm elections in the US suggests that the elections will not purely be a retrospective vote on a policy issue and instead will be a function of economic conditions and presidential approval, but even so, it is interesting to consider which of these scenarios is more likely to unfold.

Let the political implications of health care reform debate begin!

[Hat tip to “Ben Smith at Politico”:http://www.politico.com/blogs/bensmith/0310/Back_up_in_Gallup.html?showall for the Clinton reference.]

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Update: “Professor Stanley Feldman”:http://ms.cc.sunysb.edu/~stfeldma/ writes in with the following:

bq. If you look at the Ipsos/McClatchy survey from Feb 26-28 posted “here”:http://www.pollingreport.com/health2.htm, you can see that 37% of the respondents who said they opposed the Democrats’ health care reform proposal said they did so because it did not go far enough. 54% said they were opposed because it goes too far. In other words, 25% of the sample supported the Republican position while 17% wanted even greater reform (in addition to the 41% who supported the plan).

I must admit, the proportion of those opposing healthcare that are members of the “dissatisfied left” is even higher than I expected. So if we go back to the original game and pretend that the 2010 elections will be decided wholely by the health care vote, the Republicans can count on the support of the solid 25% of the population that opposed health care reform because it went too far (ie., the Republican position). Anyone want to venture a guess at for whom that 25% of the population voted in the previous election???