On the Republican Health Care Strategy

Jonathan Chait's argument a few days ago (and see also Ezra Klein a while ago on a similar theme) that Republicans blundered by not working with the Dems on health care, and thereby winding up with a worse bill from their point of view than they could have had, is worth exploring a little more. 

Ross Douthat responds that, essentially, moderate Democrats already were going to get the things that were available in a compromise, while a bill that any Republican Senators beyond the Mainers would be able to support was never really available.

Let's see...the first thing I'd say is that the basic math was, more than anything else, the driving force here -- the basic math, and the political context.  The most important thing about the political context is that the parties are perfectly sorted ideologically, and that the biggest discontinuity falls pretty much between the parties.  See here.  While there's little difference between Ben Nelson and Olympia Snowe, there is quite a large difference between the 58th most liberal Senator (McCaskill in the chart, but statistically it could be any one of a number of moderate Dems) and the, say, 63rd most liberal Senator (Voinovich).  To get to the bulk of the Republicans, it takes going far from center.  It was always going to be easier for Democrats to fund something that united the most liberal Senators with some group of Lieberman/Nelson/Snowe/Collins than it would be to find a group of sixty (or even seventy-five) in the middle. 

That analysis works if we think about Senators in terms of ideology.  But there's another way to think about Senators (and parties), which is as advocates for the interests of associated groups.  And, here, I think the key thing is the extent to which Barack Obama preempted the Republicans' natural role.  By making his own deals with the doctors, hospitals, and the drug companies, all early in the process, Obama essentially stripped the Republicans of relevance right from the start.  While they did to some extent wind up playing the role of advocates for the insurance companies, mostly what was left to them was ideology. 

The remaining question is whether this strategy will have consequences beyond the fight over the bill.  It'll be very interesting to see how the preempted, normally Republican-oriented, groups act during the 2010 election cycle.  Once the bill is signed, will they go back to their normal contribution and endorsement habits?  Or will they shift partially or strongly in a pro-Democrats direction?  For what it's worth, according to Open Secrets, the percentage of contributions to Democrats from "Health Professionals" and "Pharmaceuticals/Health Products" is the highest on record, going back to 1990.  Generally, for both of these Open Secrets categories, contributions are split evenly during cycles with a Democratic Congress, but this time so far the split favors Democrats.  It's a stat worth keeping an eye on as the 2010 cycle heats up and after the bill is signed.