Wednesday, October 7, 2009

Are we almost there to health care reform? What history tells us.

In his excellent book, Politics and Policy: The Eisenhower, Kennedy and Johnson Years, James Sundquest examines significant legislation passed between 1953 and 1966, including the passage of Medicare. He defines steps or stages that the policymaking process had to pass through for laws to be passed addressing major social problems. I think it is instructive to examine where the current debate over health care reform stands in regard to Sundquest’s stages.

First, says Sundquest activists seeking change must establish that a problem exists and that it can not be solved without national action, that the states and local governments can not or are not adequately addressing the issue. I think it is clear that the health care debate has passed through this stage. Most Americans, Democrat, Republican and Independent have come to the conclusion that we have a health care or at least health insurance problem and that some national action probably is necessary although there is no consensus on the nature of that action.

Second, says Sundquest, the positions of proponents and opponents must crystalize, arguments and even facts must become frozen, and the debate must become repetitive. We’ve reached that stage also. The arguments pro and con about health care reform have become fairly clearly defined with Democrats holding one view and Republicans another. You don’t see many proponents or opponents of health care switching sides anymore.

Third, says Sundquest, national interest groups must be formed to organize local support, condut research, feed information to political sponsors, create publicity, lobby key congressmen and senators, and so on. Again, this has happened with regard to the health care debate with some of it orchestrated by the White House.

Fourth, says Sundquest, the opposition becomes divided. A significant element of conservative opinion yields to the facts that point to national action as essential to the solution of the problem. Again, that seems to have happened or is beginning to happen. We’re seeing prominent conservatives coming out in favor of some kind of health care reform. Few Republicans, even as they oppose Democratic solutions, argue any longer that health care isn’t a national issue.

Fifth, says Sundquest, opponents discover that they can not succeed just by opposing. Indeed their efforts to oppose backfire in the sense that they create awareness of the problem. Additionally, their warnings of the danger of side effects that might follow national action to remedy the problem come to be seen as speculative whereas the problem activist are seeking to remedy becomes increasingly seen as real. At that point, opponents come to the realization that they may have made a tactical error and should have joined in recognizing the problem and working out a solution early on. At a late date, opponents scrabble to offer an alternative solution only to find that proponents who once might have been open to compromise no longer are interested or see the necessity to compromise. I think we are just entering this stage. After making some headway in turning Americans against health care reform during July and August, conservatives have seen some of their gains disappear recently. Supporters of health care legislation haven’t recouped their loses but they may have turned a corner particularly with key groups such as those over 65.

So where are we? By my count we are four fifths of the way there. As they say, four out of five ain’t bad.

Are we going to see health care reform. If we consider, Sundquest’s stages, it appears that we are well on the way to the passage of major legislation. However, proponents of reform still must navigate the final process of bringing a bill to the floor of the House and Senate, securing a presidential signature, and surviving the inevitable court challenges. As political scientist V.O. Key said for things to get done in Washington, “the obstructions of the Constitutional mechanism must be overcome.” See one of my other posts about that issue.

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