Will Health Care Crash?

There's been tons written about why this time is different than last time. The conventional wisdom has it that last time health care crashed because of the arrogance of the Clintons. A plan devised in secret, crazy in its scope, was presented to Congress with a take-it-or-leave-it disdain and the thing naturally failed leaving tens of millions of uninsured and incremental steps until now, when the Obama administration is supposedly doing the right things.

I never bought the Clinton critique. Sure, the First Couple made mistakes. Would they have been wiser to let Congress come up with a plan? Probably. But the idea that that the Clintons were unwilling to take half-a-loaf back then is total revisionism. And the idea that their plan was some crazy piece of crap because it topped a thousand pages--Matt Bai was still pushing this in the New York Times magazine a couple of weeks ago--is one of the tropes of the health care debate. The sainted NAFTA was more than a thousand pages, as Jim Fallows noted in these pages some years ago. The Clintons made plenty of mistakes along the way but they didn't kill health care. The opponents of universal care killed it and, if I had to guess, I think they will again even on this skillful president's watch.

Yes, circumstances are better for passage this time, as every analyst notes. People are more sick of the current system than ever. There's a big Democratic majority in both houses. Some of the canards of last time--you'll lose your doctor-- have less impact now that HMOs are no longer a novelty but the norm. Who actually really gets to choose their own doctor anymore without paying some kind of price for it? And it helps that after $10 trillion of anti-Depression spending a hundred billion a year for universal coverage doesn't seems so bad. But the bottom line is that a lot of people have to give something up to make this work and that is what's likely to kill the bill. And now that the outlines of a real plan are on the table we see the wolves gathering, first in opposition to the very seensible idea of a public plan--because Karl Rove and Newt Gingrich HATED their health insurance when they were in government--and then surely later to the whole cost of the package.

I hope I'm wrong. I hope some kind of unviersal plan passes this year, but I'm not optimistic. I think too many of the players are too set against it. If you think we haven't had health care just because of the mistakes of the Clintons, then I think you're being naive about how Washington really works.