The U.S. House of Representatives has passed the Senate health-care bill, which means (because both houses have passed identical bills) that President Obama can sign it into law.
One thing many people have pointed out is that this is the first time in U.S. history that such a huge piece of legislation has passed with votes from only one party. All the big initiatives of Lyndon Johnson’s Presidency, like civil rights and Medicare, passed with votes from both parties. This bill, on the other hand, received not a single Republican vote in either house.
This has been, and will be, cited as evidence that the bill is a bad one. But I don’t think it says much about it one way or the other, because — and this is also frequently pointed out — the two parties in the U.S. are very different from the way they were. Back when Medicare passed, both parties had their liberal and conservative wings. Similarly, the Civil Rights Act was opposed both by segregationist Democrats from the South and conservative Republicans like Barry Goldwater who felt it violated states’ rights. Today, the parties basically don’t have liberal and conservative wings. The Democrats still have something resembling a conservative wing (as witness the fact that a bunch of their members didn’t vote for this bill), and if the Republicans regain the majority, they’ll elect a few members who are to the left of the party on some issues. But it’s clear that one party is the conservative party and the other is a liberal party, and they are expected to vote more or less on party lines. When a member seems like he or she is going to break with the party, he or she usually falls back into line if the leadership requires it, as Bart Stupak did and as moderate Republicans usually do.
What creates a lot of the weirdness in the U.S. system is that it’s one that evolved in an era of lax party discipline, and the rules have never really adjusted to the current quasi-Parliamentary arrangement. The best-known example is the filibuster. It’s something that grew out of the old system where the “nays” and “ayes” didn’t split evenly along party lines, and Senators of both parties might team up to filibuster. Now, with the more ideologically divided parties, it’s as if there’s a Parliamentary system where the majority has no power to pass anything without the minority party’s consent. This may or may not be desirable, but it certainly creates some weird incentives.
The Republicans have done a very good job of adjusting to the new reality. And not only by using the filibuster (which, until Scott Brown was elected, they couldn’t even use without Democratic defections), but by understanding the effect that party discipline has. As Senate Republican leader Mitch McConnell explained recently, he and his House counterpart John Boehner realized they could reduce the popularity of the Democrats’ initiatives by denying them any Republican support: “Republican unity in the House and Senate,” he said, “has been the major contributing factor to shifting American public opinion.” Though it may operate differently in the U.S., it’s still a dynamic that is familiar in Parliamentary systems. The majority wants to pass something. They have the votes. The minority’s job is to unite in opposition, sour the public on the majority’s ideas and convince the public to put them in charge.
On the other side, one reason Nancy Pelosi has emerged as the star of the Democrats is that she understands this new dynamic. She is famously partisan and disdainful of deals with the opposing party, which means that she has the same attitude as her Republican opposite numbers, and is able to get things done in the new system. So after Scott Brown, some of the more “bipartisan” types wanted the Democrats to go for a scaled-down health care bill that might attract Republican support. As this long article explains, Pelosi said no: she would take nothing less than rounding up the votes for a comprehensive bill, and she convinced President Obama to do it her way.
The reason she was right is that there’s very little likelihood that they could ever have passed the smaller bills. The Republicans and Democrats agree on nothing: they have fundamentally different ideas about the role of government, health care, the environment and almost everything else. Both the Republican leadership and base dislike the idea of giving the Democrats bipartisan cover. Anything important that the Democrats want to do this year (in what might be their last year in the majority) they’ll have to do on party lines, and the same may well apply if the Republicans take back the majority. For better or worse, the U.S. is now becoming more of a Parliamentary government like ours. Well, if they’re going to have Canadian-style Socialized Medicine ™ they might as well have Canadian-style government.
Update: Here’s a link to David Frum’s already much-discussed post, where he argues that the Republicans could have avoided a large-scale, difficult-to-repeal bill if they’d been willing to make a deal. On policy substance, he’s probably right; if the Republicans had expressed a willingness to do those small-scale bills, the Democrats would have jumped at it. But I think that, politically, the Republicans would be in worse shape if they’d been willing to do that. They would have given the Democrats cover and elided the distinctions between the parties.
And more importantly, there’s really no common ground the two parties have. One of the preferred health-care solutions of the Republicans and their base is to allow health insurance to be sold across state lines — which in effect would wipe out individual state regulations on health care. Republicans/conservatives believe that health care suffers from too much regulation, while Democrats/liberals believe there’s not enough regulation. As Frum points out, the plan that just passed has its roots in what used to be considered moderate Republican health care ideas, but Republicans have mostly repudiated these ideas (except Mitt Romney, who keeps trying to oppose an Obama plan that is almost identical to his Massachusetts health-care plan) because they involve using the government to regulate health care. It’s hard to find a middle ground there. We’re just talking about two different ways of doing things and of looking at the world.
Finally, here’s what I assume is a preview of the new U.S. hospital system.