David Frum has an excellent post about how not only does the Obama health plan look a lot like what Mitt Romney signed in Massachusetts, it looks a lot like what Romney proposes in his book, only Romney can’t bring himself to admit it:
Romney sharply distinguishes his healthcare preferences from Barack Obama’s. For him, the red line is the public option. He adamantly opposes it. Yet in many other respects, there is common ground. Like Obama, Romney worries about the malign incentives of fee-for-service medicine. Like Obama, Romney regards the status quo as unsustainable. Like Obama, Romney is a big fan of the healthcare journalism of Atul Gawande.
And of course, the public option has now vanished from the Obama plan. Which means that the federal plan bears a closer family resemblance than ever to Romney’s idea: regulated health insurance exchanges, mandates to buy insurance for those who can afford it, subsidies for those who cannot. Romney’s preference would be to omit the mandate for those who “can demonstrate their ability to pay their own health-care bills.” (176) That would be precious few of us. And he wants to allow states ample leeway to innovate without hindrance by the federal government.
Responsible critics of Obama’s bill from the right have raised what I think are a few valid points along with a few points that I don’t agree with but don’t strike me as insane. But these critics have generally missed the boat in terms of what’s actually gone wrong by giving Republican politicians a total free pass on these kind of stunts. It’s been clear for months that a huge bloc of Democrats is desperate to get Republican votes for the plan and would be very happy to make any number of tweaks to the plan in ordert to get them if those tweaks actually come with a firm commitment to vote for the bill.
Something that people often aren’t as clear about as they should be is that electoral politics is a totally zero-sum game whereas public policy is not at all a zero-sum game. Consequently, as a legislative minority party has to choose whether it wants to play a positive-sum game of “let’s try to tweak your policy priorities to make them more to our liking” or a zero-sum electoral politics game. On health care, the Republicans decided to play zero-sum politics. For some GOP members, guys like Paul Ryan and Mike Pence, the substantive void between Obama’s vision and their own brand of cruel, sociopathic Randism is far too deep a void to bridge. But for plenty of others, Obama’s vision is plenty close enough to their own that good-faith compromise should have been possible.