Disconnection and Reconnection
Ceasefire is Another "Once in a Lifetime" Chance for Reform

The most honest analysis of last night's shocker in Massachusetts is "Wow, I didn't see that one coming (until everyone else did just a few days ago)." But there will be no shortage of profoundly updated analyses (and excuses) by the many pundits who got most of this past year's health policy debate and its larger political context wrong. On the other side, one can find exaggerated claims of a mandate to move in an opposite direction, rather than simply calling a timeout and reflecting before reloading.

Hence, before the next round of clichés and conventional wisdom, a much humbler reflection would start with recognizing the profound disconnection between, on the one hand, the relentless push of the White House and the current congressional majority's leadership for a sweeping and contorted mix of health care overhaul provisions by any means necessary, and, on the other hand, the growing majority of overburdened Americans hoping for something better someday but willing to accept a political ceasefire. We do not have sustainable political majorities for any destabilizing policy changes. Trying to do less in Washington would accomplish more everywhere else.

We will know more over the next week about the calculated response of the president and Democratic leaders to seeing their defeat on this front snatched from the jaws of imminent victory. The temptation to double down, Vegas-style, on an unwise bet to make health policy history through more procedural shortcuts and backroom deals remains great (at least inside the central command bunker), but pursuing this course would not only be self-defeating, it would stress the larger political culture in which all parties must live and succeed. The alternative of cobbling together a scaled-down, less partisan compromise amid the overcharged atmosphere of 2010 remains equally unlikely.

For the moment, we are stuck in another stage of political stalemate despite a serious need for limited, but essential, health policy reforms. However, there remain several past historical examples of health policy changes that followed initially disastrous overreaches by majorities that misread their mandates. In 1996, a more limited set of reforms under the Health Insurance Portability and Accountability Act was passed on a bipartisan basis--just two years after the collapse of ClintonCare. In 1997, the Balanced Budget Act incorporated many of the Medicare policy changes so vigorously resisted when proposed by a new Republican-controlled Congress in 1995. (To be sure, these were much more political process accomplishments, because the actual policy provisions were of neither great value nor catastrophic harm . . . which often is close enough for government work.)

If and when the adults re-enter the health policy discussion, I hope they will encourage an end to the artificial urgency and apocalyptic desperation of the current debate. We need to restart with neither a blank page nor an overcrowded pile of 2,500 pages. After we listen more carefully to the often-contradictory messages coming from anxious voters and count more of their ballots this November, a healthier restart and reconnection with them is both possible and necessary--next year. That will be the next annual "once in a lifetime" opportunity.

Last night, Scott Brown reminded us that "we can do better." This past year, we've already nearly done much worse.

Thomas P. Miller is a resident fellow at AEI.

Photo credit: iStockphoto/Luca di Filippo

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About the Author


Thomas P.
  • Thomas Miller is a former senior health economist for the Joint Economic Committee (JEC). He studies health care policy and regulation. A former trial attorney, journalist, and sports broadcaster, Mr. Miller is the co-author of Why ObamaCare Is Wrong For America (HarperCollins 2011) and heads AEI's "Beyond Repeal & Replace" health reform project. He has testified before Congress on issues including the uninsured, health care costs, Medicare prescription drug benefits, health insurance tax credits, genetic information, Social Security, and federal reinsurance of catastrophic events. While at the JEC, he organized a number of hearings that focused on reforms in private health care markets, such as information transparency and consumer-driven health care.
  • Phone: 202-862-5886
    Email: tmiller@aei.org
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    Phone: 202-862-5826
    Email: Neil.McCray@aei.org

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