Stanford Progressive

The Democratic Left Vs. Center: Posturing for Less Coverage

By Kai Stinchcombe, published January, 2010


The media has an easier time covering complex issues when opposing sides fall neatly along the standard left-right dimen sion: liberals want to cover more people, the right wants to spend less money, and the centrists want some of both sides. Not only are these dimensions muddied in the current healthcare debate, but much of the resistance coming from the centrist and conservative Democrats is political theater.

In this healthcare debate, the left and right dimensions are atypical. Those on the left prefer a larger government role and those on the right prefer a smaller government role, but because adding the public option helps keep prices down, more liberal democrats want a plan that covers more people and is cheaper for consumers. Moving towards the center increases the costs for consumers without increasing coverage.

According to almost every analysis of reform, including the Congressional Bud get Office’s study of the proposed public option and the Lewin Group’s oft-cited study of an exaggerated form of the public option, the stronger the public option, the more money you save. The main GOP argu ment, usually citing the exaggerated public option described in the Lewin report, is that the public option’s prices will be so good that millions of consumers will opt out of private insurance in favor of the public op tion (this assumes private insurers will take no steps to become competitive with the public option). The so-called centrist Dem ocrats in the Senate are fighting for a plan which leads to higher costs for consumers and employers seeking health insurance.

Neither the right nor the left is arguing for the government to take on a role health care provider (as in the UK); the debate is about who is best at defining the benefits and reimbursing providers. The nice thing about government as a definer and reim burser is that there are inherent efficiencies in a government role. The costs of health insurance over the provider costs — i.e. the costs of the actual care received — are in marketing the plan, figuring out which cus tomers are most likely to need healthcare and trying not to cover those patients, fight ing over who has to pay the bills, and set ting aside company profits.

Much of this furor caused by moderate and conservative democrats is political posturing meant to increase their impor tance in legislative process. Congressmen who want a lot of influence over the direc tion of the bill will get the most leverage if they say — publicly and privately — “There are bills I could vote for, but I’m not sure I like the details of the bill on the table.” This on-the-fence stance is exactly the position the moderate and conservative Democrats are taking in the current negotiations — the same position they would take if they were genuinely not sure if they were going to vote for it.

So which is it? Are they playing bad cop or are they genuinely thinking of walking away from the table?

These moderate Democrats are typically in districts where Republicans outnumber or are close to outnumbering Democrats. These members of Congress are faced with a tough election in 2010, to be sure, but they have two choices: either they are run ning on the ticket of a Democratic president who tried to overhaul healthcare and failed or a president who tried to overhaul health care and succeeded. Approval ratings of the president and the Democratic party will be critical to their success in the upcoming election. Just look at how swing-district Democrats fared after the 1994 elections after the Clinton healthcare plan failed in 1993 — it was the Republicans’ best year in half a century.

On the other hand, moderate Demo crats have a lot to gain in negotiations. In particular, concessions on Medicare reim bursements — especially rural Medicare re imbursement rates — are a critical issue for their donors and constituents. On this issue, they will likely get whatever they want in return for their vote for an overall package.

The critical legislators everyone is wor ried about, in other words, have everything to gain from seeming ready to torpedo a bill; but have everything to lose from actu ally torpedoing a bill. A bill will be passed, the question is how much of a faux battle will satisfy centrist and conservative Dem ocrats concerned about angry constituents. This will also determine how much higher healthcare premiums will be for all Ameri cans.


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