On the top secret “Journolist” yesterday we were
plotting world domination debating the fine points of political procedure, and some folks were making the case that progressive filibuster critics like me were being shortsighted. After all, the very same factors that make it hard to create a universal health care system would also make it difficult to disband one once it’s created. Maybe without the filibuster George W. Bush would have privatized Social Security? On the Social Security point, I think the claim is just empirically wrong. I saw no evidence that there were 50 Senate votes for Bush’s plan. It’s worth remembering that the GOP didn’t so much as get a privatization bill to clear a single committee in either chamber. The whole thing was a congressional non-starter.
And in general, I think the politics of the welfare state are asymmetrical. There are a lot of different sets of political institutions out there, some with more veto points and some with fewer. But you don’t see any instances, not even in the UK where there are very few checks on government authority, of a country dismantling a national health care scheme and deciding that sick people should be left to the tender mercies of the free market. What you do see is a ton of diversity in terms of when national health care is adopted and what it looks like, with both of those factors plausibly being shaped by political institutions.*
But the other thing is that my belief is that if the United States were the kind of country in which presidents who win elections are generally able to implement their campaign promises that Bush simply never would have promised Social Security privatization in the first place. Margaret Thatcher, after all, didn’t try and fail to dismantle the National Health Service; she simply never espoused it as a goal. Presumably not because she was unfamiliar with free market critiques of the NHS, but out of political caution.
One thing to ask about American politics is why it is that, say, Barack Obama and John McCain offered such dramatically different health care proposals during the campaign? Totally contrary to predictions based in things like the median voter theorem, both candidates proposed radical changes in the American health care system and both were proposing quite different radical changes. Even stranger, they both did that even though the overwhelming majority of voters tell pollsters that they’re perfectly happy with the health care they already have. I think that at least part of the answer is that the American political system is habituated to the idea that policy proposals aren’t actually going to be implemented. In a world of fewer veto points and stronger party discipline, you’d have to take campaign promises more seriously, and thus candidates would need to promise proposals more in line with public sentiment. Something like Social Security privatization was never a popular idea, and you just wouldn’t campaign on it.
Factors besides veto points play a role here. The nature of Canadian federalism is an important force in determining the structure of Canada’s Medicare system.