Conor makes a bunch of worthwhile points in his case for incrementalism in health care reform, but while he may be right on the merits I suspect that the strategy he suggests is unlikely to be a political winner. As I’ve suggested before, if conservatives want to take the health care issue away from the Left they’re going to need to find a way to frame and argue in favor of their positions using morally weighty language: taking “smaller, discrete steps” may be all fine and good, but those steps have simply got to be bound up in a narrative according to which conservatives are genuinely in favor of reform, so that voters who are justifiably unhappy with the status quo don’t feel that voting Democrat is their only real alternative.
Proponents of school choice provide a helpful example of how such strategies can be implemented effectively. There is a strong empirical case to be made that school choice improves educational outcomes across the board, but its advocates tend to be most persuasive when they frame the issue as a straightforward matter of social justice, forcing politicians to confront voters over the question of why they’d rather bow to the demands of teachers’ unions than help poorer families to afford the same sorts of schools that their own children attend. It may be that school choice is also a less dangerously ambitious step toward reform than, say, a wholesale overhaul of educational standards, but the latter is the sort of rationale that only a wonk could be moved by – and by a similar token, few people outside the Republican base are likely to be all that alarmed when opponents of the public option in health care reform start raving about competitiveness and the role of the market in encouraging medical innovation.
The Republicans are not beating up on Obama for reinforcing the status quo. On the contrary, their tactic is to portray the Obama plan as something that is radical and threatening. Maybe that message helps them politically. But it undermines any possibility of a real debate about which direction to take in health care policy.
I would like to see a debate between reforms that free up health care market and policies that entrench the status quo. The fact that the Republicans are not engaging in that debate is just one more reason for believers in markets to view Republicans as unreliable allies.
If Conor is right, it could be that going all-out with pledges to abolish the status quo would not be a politically effective approach, either; but I think the more important point is that simply appealing to the virtues of “free markets” isn’t going to do enough to frame conservative reform proposals as intrinsically desirable. The message ought to be: Here’s what health care reform of our sort can do for you; what the other side is offering is just a costly giveaway to special interests that will do little more than tinker around the edges. Mere demagoguery may be sufficient to win the policy battles here and there, but conservatives need to do more than that if they ever want this issue to play in their favor in the long run. The pessimist in me is pretty confident about which sort of strategy the GOP will adopt.