Saturday, March 23, 2013

What ever happened to the public option ?

Ezra Klein asks why almost no Democrats are advocating a public health insurance option as a way to cut the deficit and please the majority who supported such an option every time the question was polled.  Oh and make an efficient health care system. I think that's a very good question.  It would be silly for me to try to answer it sitting here in Rome when Klein regularly talks to top Democrats.  I am that silly blogger.


Remember the public option? It was, for many Democrats, their absolute top priority during the health-care reform debate. But they didn’t get it. 
among the Democratic base, the public option was extraordinarily popular. Many liberals turned on the entire bill when that element was cast aside. And it wasn’t just liberals. The option commanded substantial public support. Poll after poll showed it to be one of the more popular elements of health-care reform.
Given the intensity of Democratic support for the public option in 2009 and 2010, it’s something of a mystery why there’s barely any discussion of it in Democratic politics today. Although it’s still true that a public option can’t get the votes, nor can Medicare vouchers, a repeal of the health care [law] or making Medicaid a block grant program. But Republicans spend enormous amounts of time and political capital pushing all those ideas. Their theory is that if any of them have the potential to win approval in the future, they need to start pushing them now.

His question is why do Republicans keep pushing for extremely unpopular policies which won't be enacted any time soon while Democrats don't push for popular policies which won't be enacted any time soon.

My first thought is my Ezra is sooo young.  Democrats older than he is are still traumatized by 1972.   I think leading politicians, both Republicans and Democrats, are deeply convinced that the Republicans are America's party -- that the American people are basically conservative.  I think Democrats feel that we must hide our true beliefs to win elections.   Mere polls absolutely do not convince people who are well over 30 and remember "don't trust anyone over 30".   Google Kevin Drum "poll literalism" and note that, in 2010 Drum was convinced that Americans generally oppose higher taxes on high incomes.  OK most Democrats don't live in Orange county, but Drum is usually well informed.  It is a fact that state legislators think that their constituents are more conservative than those constituents are. This is more true of conservative legislators but also true of liberals.

Thes means that Democrats are likely to perceive 2010 as a once in a lifetime opportunity to pass progressive health care legislating, likely to believe that bills which can't be passed now can not have the "potential to win approval in the"  foresable future.  I think that when considering a legislative initiative Democrats consider possible victory the benefit and the political effects of the effort always a cost.

It is easy to understand how politicians might systematically misperceive politics.  First it is also known that senators  voting records are strongly correlated with the views of their richer constituents, somewhat correlated with the views of middle class constituents and not correlated at all with the views of poor constituents (Larry Bartles et al via the usually well informed Kevin Drum).  Also politicians are more likely to be my age or Drum's (about the same)  than Klein's.  Their guess about what the public thinks tends to correspond to the older public and there are now huge differences by age.  Finally predicting bad political consequences is a self fulfilling prophesy.  Timid shifty advocacy is costly.  A politician who thinks he must hide what he really thinks transmits insincerity.  People who don't have firm views on policy have firm views on double talk question dodging and generally acting as if one has something to hide.

A little more thought leads to two other explanations of the asymmetry.

Money.  Of course,  Health insurance companies hate the public option.  They will not make campaign donations to supporters of the public option and may donate to oponents of prominent supporters of the public option.  Congress people spend most of their working time asking for campaign donations.   It is costly to advocate policy shifts which would be costly to entrenched concentrated interests.   I'm not as young as Klein but I can be sooo naive.

Finally, it is fairly clear that Democrats like to solve problems. They are not as interested in symbolic votes as Republicans.  They are the grown up party.  They are the ones who feel they have to find compromises so the government doesn't default.

But I'm sure it's mostly about the money.

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