Tuesday, May 06, 2003

Dean, health care and incrementalism

I know some people are confused by Dean's health care plan. Both Max Sawicky and Mathew Yglesias are characterizing it as a non-plan apparently because it doesn't provide a comprehensive proposal for solving the health care problems in America. I think that this a deliberate decision on the part of the Dean campaign. Dean is trying to separate the question of coverage from reform. He admits that the health care system as a whole in this country is screwed up. But reforming it is a major battle that should be separate from the question of who gets coverage (this is why he no longer supports what Clinton tried to do in 1993). It is just embarrassing that one of the richest nations in the world leaves so many millions of its citizens completely exposed to medical disaster. The essence of Dean's plan is to first get everyone on some kind of plan and then try to make those plans better. I like this approach. It gets to the biggest problem in health care today (the fact that so many people have no coverage), forces the opposition to discuss the issue on the matter of coverage alone instead of getting bogged down in the details of any particular reform proposal, and lays the groundwork for more comprehensive reform in the future. After all, once everyone has a stake in the health care system, everyone will have an interest in making it better. I think this demonstrates that Dean is has inherited the incrementalist approach of Bill Clinton. I happen to agree with this approach, but I know many on the left who hate it. They think it provides to many opportunities to compromise important principles for illusory results. They are not entirely wrong. It takes courage to carry through on incrementalism and few politicians have the courage to do it. But if it is the only approach that actually gets us on the road to where we really want to be then I am all for it. It is also a steal from the Dubya/Rove playbook. Remember how Bush dealt with the abortion question during the 2000 campaign? He essentially said that while he personally supported banning abortion he didn't feel the political climate was such that the proposal could ever get passed (I agree with that). It was an acknowledgement that it is more important to devote your energies for what could be done rather than waste time on leaps towards the ultimate goal right away that were pretty much guaranteed to fail. Of course he said this in different ways depending on the audience he was talking to. If he was talking to mainstream audiences then he would emphasis the "I'm not going to push for a ban on abortion" message while, if he was talking to the red meat crowd, he would emphasize the "we must not forget the ultimate goal of banning abortion" part of the message. I think Dean could take the same approach to discussing health care. When talking with more left-wing audiences, emphasis the fact that he does support a more simplified universal health care system. But when talking to more mainstream audiences talk about how he supports covering those who are currently uninsured. It is possible to sell yourself to both constituencies without pissing either off (just so long as the the left version of the red meat crowd understands that they won't always hear what they want to hear in the more public dialog on the issues).

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6:33 PM  

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