Time for a Health Care Post


So . . . John Edwards has a health care plan. You can find some serious analysis from Jonathan Cohn and Ezra Klein. Mark Schmitt's reaction, however, was just to say that candidates shouldn't release detailed plans at all:

[T]here will be particular problems with any health care proposal. They all have vulnerabilities, they all create situations in which people might have to accept change or might get less than they currently have. And the people who are most likely to vote based on health care are also people likely to be fearful of losing what they have. It will always be for political opponents to push that fear button.

I've argued in the past that it's good to campaign on a specific plan because if you do lay one out and do leave yourself exposed to the vulnerabilities Mark highlights and win anyway, then you're in a strong position as president to get your plan passed. Conversely, if you stand for election on vague promises and then try to get something passed, you'll have a big problem. As Kevin Drum says, "you'll get the feel-good vote during the election but then lose later on when you try to fulfill your campaign promise and run smack into....the fear button." The more I think about it, though, the more I think both perspectives on this are correct.

Which is part of why I came to the conclusion I reach in this column. I don't think it's smart for candidates to either run on specific universal healht care plans or to run on a promise to devise a specific universal health care plan once in office. Rather, what I'd like to see is a candidate who says that Medicare For All is the right idea, who concedes that Medicare For All probably won't be passing congress in 2009, and therefore promises to bring Medicare for As Many As Possible:

First, change the 2003 Medicare reform bill to give the government meaningful price leverage over the pharmaceutical companies and eliminate the role for private insurance companies. Beyond that, see what you can get -- Robert Kuttner laid out a few options yesterday. Propose that Medicaid cover everyone under 25. If you can't get that, take everyone under 21. If you can't get that, take everyone under 18. If you can get that, propose adding full-time students under 25. Then all full-time students. Then everyone under 25. Lower the threshold for Medicare to 50. Or to 55. Or to 60. Lower it to 64 if that's all you can get. Then come back next year and propose lowering it to 50. Or to 55. Or to 63. Keep coming back. Let people under the threshold "buy in" to Medicare on some terms.

To my way of thinking, this kind of approach (call it "flexible intransigence") is the best way of getting things done in the context of an American political system that makes large-scale change intrinsically difficult. And I think that when you look at successful partisan positioning on domestic policy, this is the sort of thing you see. When Democrats run and win on minimum wage hikes, they don't run and win on minimum wage plans they're running and winning on the general idea that the Democratic Party is committed to making the minimum wage higher. Similarly, the GOP will make taxes lower. Democrats, similarly, should be committed to "Medicare for more!" People like Medicare.

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Matthew Yglesias is a former writer and editor at The Atlantic.

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