I like, but am a little confused by, Ezra Klein's post today about interest groups, Republicans, and the health care bill. His main point is a great one, and absolutely correct -- the big difference this time around compared to 1993-1994 is that this time, the interest groups are on board.
I've been using Clinton's health care reform defeat as an example while teaching the presidency for years, and what I've always told students was that one of the lessons was that in order to pass something Clinton needed to buy off at least two of the major interest groups involved, whether it was large employers, insurers, hospitals, doctors, or Pharma. Obama went one better than my suggestion; he got almost everyone on board, and made the bill tolerable for everyone else. So my first confusion is why Klein titled his post "Twilight of the interest groups." His point, and it's an important and I think correct one, is that Republicans didn't seem to care at all about the interest groups that one would expect to be important to their coalition. But the interest groups didn't suffer from that. Some won, some lost, as will all happen, but it's pretty clear that everyone, eventually even the pro-lifers, had a seat at the table. Of course, what threw everyone is that it was a purely Democratic table, and again Klein is correct that it didn't have to be. Still, the interest groups (collectively) did about as well as could be expected.
It seems to me that the real question here is whether the Republican Party will take a major hit. On the one hand, I don't think it's at all certain. Those who have said that if health care reform passes and is popular that the Democrats will benefit over the long term are, in my opinion, probably wrong. Medicare is wildly popular, and the truth is that the Civil Rights and Voting Rights bills from 1964 and 1965 are wildly popular today. Yet the Democrats didn't benefit from these things electorally, not just because of race in the South, and not just because of Vietnam, but because they rapidly became just part of the normal things that government does. What passing health care reform will do, if the plan works, is to reduce the importance of an issue that's worked well for Democrats for decades.
However, on the interest group side, I think the risks for the Republicans are pretty large. There are a lot of interest groups that have always been part of the GOP coalition that may just walk after this. I don't think it will happen overnight -- among other things, groups might hesitate to leave a party that might take over the House in November -- but if the Democrats keep the House, and start looking like a party that might hold majorities for an extended period, they're going to be in a pretty good position to attract some groups that have always fallen on the other side of the aisle.
To put it another way: Republicans may be forced to choose between being the party of the tea parties, Rush, and Beck, or a party that can compete on even terms with the Democrats. The danger here is that they could easily choose the former. It seems like a pretty viable business plan -- take extreme positions, inflame your audience, and use the anger to squeeze every possible cent out of them. But I don't see why groups like Pharma or the doctors (or other groups that will matter on climate/energy and other issues) would bother to stick around for that.
Hey, I'm not predicting anything. But I do think that Republicans may have to make some choices. The need to do that will be reduced if they take control of the House this November (which might happen, regardless of health care or any of this stuff, if the economy is lousy enough), but especially if that doesn't happen, 2011 is going to be a very interesting year for the Republican Party.
This is probably a very petty quibble, and one that's not even particularly germane to the post as a whole, but I'd just like to politely point out that the AMA is really not particularly representative of doctors as a profession. Its membership comprises mainly surgical specialists, which is why our compensation schedule in this country is so procedure-based. Many physicians find the AMA largely unpalatable for a variety of reasons. We just haven't found a credible alternative yet.ReplyDelete
"Those who have said that if health care reform passes and is popular that the Democrats will benefit over the long term are, in my opinion, probably wrong. Medicare is wildly popular, and the truth is that the Civil Rights and Voting Rights bills from 1964 and 1965 are wildly popular today. Yet the Democrats didn't benefit from these things electorally, not just because of race in the South, and not just because of Vietnam, but because they rapidly became just part of the normal things that government does. What passing health care reform will do, if the plan works, is to reduce the importance of an issue that's worked well for Democrats for decades."ReplyDelete
Hmm...Yes and no, in my view. I agree that voters don't provide dependable long-term rewards to parties for their legislative achievements per se. On the other hand, these measures help to shape the public perceptions of what the parties are and what they stand for, which do have electoral consequences. The modern Democratic Party's current reputation as the guarantor of government entitlements and racial liberalism is based to no small degree on its role 40+ years ago in enacting that legislation, and, as time goes on, its decision to trade the support of white southern racists for dependable, overwhelming margins among minority voters looks more to me like a good deal in the long term, despite the undeniable costs it entailed.
As for the proposition that the issue of health care will fade away in importance once reform is enacted, I think that's really up to the Republican Party...as you say, it has some choices to make. Does the party ultimately make its peace with reform as it did, more or less, with other entitlement programs? Or does it continue to have a perennial partisan fight over it? Sure, Social Security and Medicare are "just another thing government does"...until the GOP makes noises about spending cuts or privatization, upon which they return to the political arena, usually to the electoral benefit of the Democrats. But the staggered implementation of reform over the next 5-to-10 years, in combination with a Republican base that will demand continued opposition to reform from many of its leaders on the grounds of fighting tyrannical Marxism, makes me think the fight's far from over.
Brad Plumer was wondering why special interests were sounding favorable toward the Kerry-Graham energy proposal, considering that it is not all that much different from the House bill, especially in terms of overall carbon reduction. Their proposal is structured so that special interests can be pitted against one another, creating a pretty good bargaining situation for the legislators--but that strategy works only if the special interests are not teaming up with the Republican caucus and standing unified against any legislation. So maybe we already have a case of the effects of a fall-out between special interests and Republican obstructionism. The special interests are taking the threat of EPA regs seriously, and are looking to benefit themselves individually, contrary to Republican strategy.ReplyDelete