How Much Does Health Care Matter in the Midterms?

Megan McArdle Nov 2 2010, 1:15 PM ET

A topic of much debate in the news and the blogosphere over the past few days, and the breakdown is about what you'd expect: Democrats and progressives who supported health care reform arguing that pish-tosh, it's all about the economy, while Republicans, conservatives and libertarians who opposed it argue that of course it's practically the top thing on voters' minds.

I don't think there's any very precise way to know, but here are a few thoughts as to whether and how much it might have made a difference in today's results:

The Democrats basically spent a year focusing on health care reform instead of the current problem. I think that Obama does have a perception problem--one he is making worse by going around saying things like this. The perception is that he considers himself above the voters--that Obama, and Democrats, have focused on their priorities, not the priorities of the people who elected them. Voters didn't send Obama into office to have a historic moment in progressive politics, but Democrats plowed forward as if they had, despite some pretty fierce resistance from their constituents. Is this enough to turn the election all by itself? I don't know, because a lot of those voters are also pissed about a bunch of other things, like the terrible economy.
Doing health care actually meant not doing a bunch of other things that might have produced some tangible improvements. The president doesn't have that much control over the economy, but on the margin, things like temporary works programs and better unemployment benefits would have eased the economic insecurity of many voters who have lost jobs. Doing health care meant not even trying to do those other things.
Doing health care took the focus off of the financial industry. That has contributed to the perception that Obama sided with banks against ordinary people. What could have been a powerful tool to beat the Republicans faded away in the post-health care exhaustion; most people have no idea what's in the financial reform bill, and correctly perceive that this was nowhere near the top legislative priority of the administration.
Doing health care remains really unpopular. I cannot think of another piece of non-emergency legislation which passed on such a party line vote with a majority of the population against it. The much-predicted post-passage bounce in popularity has failed to materialize; the apparent change in the chart seems to come from a change in the mix of pollsters and the frequency of the polls. (Kaiser/FF, for example, one of the most HCR positive polls, had it at 42-41 on the eve of passage, and most lately at 42-44 (favorable/unfavorable). ABC/Post is similarly consistent. Can a party pass a massive piece of unpopular legislation, and not have that show up in election returns at all? I'd be shocked if so. And I'd argue the same for the stimulus and TARP, which so many Democrats voted for, and which will probably cost them.
Democrats who opposed the bill seem to be doing better than expected. Or so says the National Journal's Josh Kraushaar. Meanwhile, he says, "House Democrats who gave the decisive margin at the end - the so-called Stupak bloc, who held out their support until anti-abortion language was inserted and those who flipped their votes to support the bill -- read like a who's who of the most at-risk Democrats."

So it probably made some difference, but how much did it matter? If Republicans get fewer than 45 seats, I think we can say that health care didn't matter much at all. But as they start pressing towards 50, I think we can blame a lot of that advance on health care. Not all of it--Obama has made stupid messaging choices like the one I linked above, and TARP and the stimulus--which many at-risk Democrats supported--are undoubtedly taking their toll. But health care ate up virtually an entire year of a two-year administration, and it's their signature achievement; I don't know anyone who would point to a greater legislative victory, or a bigger advance on the progressive agenda. Given its unpopularity, I think it has to take at least half the blame for any "excess" losses. If Democrats lose the senate--or even get pushed to a tie where suddenly Joe Lieberman becomes a very, very powerful man--I'll be inclined to say that health care reform was an electoral disaster.