Getting Around the GOP

Getting Around the GOP

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Capital Exchange is a new blog featuring debate among some of Washington’s smartest budget and policy experts. –Eric Pianin, Washington Editor and Moderator

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We're asked for three pieces of advice for President Obama about "engaging the Republicans" on health care, jobs, and other issues.  The obvious question is what "engagement" would mean  -- a search for agreement (if not quite a marriage), a pitched battle (the "engagement" between U.S. and Japanese forces at Midway), or a show ("appearing for a three week engagement").

The only major issue on which the Republicans have any incentive to come to some agreement is the expiration of the Bush tax cuts, because simply doing nothing would not fit their policy preferences.  Even there, they might prefer a game of chicken and blame. 

Otherwise, it looks simple.  Republicans have better prospects in November if the incumbents are not seen as successful.  The vast majority of congressional Republicans also will not agree with the majority of congressional Democrats on virtually any policy.  The most incremental health care reform would still make the Democrats look good.  All the incentives for Republicans are to say "No" and, as part of the show, misrepresent Obama's proposals by making charges about death panels, "government takeovers" of health care and so on. 

Under these circumstances, I actually have four suggestions for the President:

1) Any public engagement should be used to explain what he stands for, to the public.  Don't obscure differences; instead, present them in a way that  makes clear why voters might prefer the Democrats' approach.

2) Press the Republicans on cost control.  Ask them for their ideas.  The basic GOP idea, as President Bush put it in one of the 2004 presidential debates, is that health care costs too much because of third-party payment.  So there should be less third-party payment, which means less insurance.  If the Democrats are to make the case for their position,  they have to explain that the Republican version of  "cost control" is "make health care cost more for you."

3) But if the Democrats are to draw the line on cost control, they have to figure out what side of the line they're on.  Obama and Senate leaders have been listening to economists who think "health care costs" means "the share of GDP taken up by health care."  From this perspective, making it harder for people to get health care is a way to reduce costs --  if people can buy less, there will be less care, and the total will be lower.  That's why so many economists liked the falsely named "Cadillac tax" which would have forced more risky groups of workers to have less coverage.  But making care less affordable for many workers is not what the average voter would call "cost control."  Voters think "cost control" means "my costs are controlled."  Obama and his allies are not going to win over a skeptical public by pushing plans that promise no cost relief any time soon, save by making care less affordable for some workers.

4) Last, if Obama wants to negotiate with anyone it should not be Republican politicians but the business community.  The business community has always been the big prize in any struggle for support on health care reform, because of the conflict between its common ideological instinct, distrust of government, and the practical fact that government has more power to control costs than employers do.  This is the only country where employers are left on their own to deal with the medical complex and insurers, without significant government help.  That is the key reason why costs are so high for employers and for workers.  So, if there is to be any serious discussion, it should be between the administration and representatives of business.  The question should be, "What can we do that would control costs and you would accept?"  If the administration can cut some deal with parts of the business community, both a few Republican legislators and some more conservative Democrats will be more likely to vote for reform.  Business has some incentive to deal, Republican politicians do not.

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Joseph White is Director of the Center for Policy Studies at Case Western Reserve University.