Editore"s Note
Tilting at Windmills

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February 25, 2010

INCREMENTALISM VS. COMPREHENSIVE CHANGE.... On health care, a key GOP talking point, outside concerns over process, is more of a meta observation: "comprehensive" approaches to public policy are fundamentally misguided.

Lamar Alexander has been a leading voice on the Republican side for incrementalism. His argument is that the White House erred by trying to pass such a big, sweeping reform bill, and so Democrats and Republicans should instead get together and pass popular parts of reform, one piece at a time. Analysts have pointed out that many reform ideas don't really work on their own; they have to be passed altogether in order to make the system work.

Right. There are plenty of parts to reform, but they're inter-locking. It's easy to say we'll take some steps now, and leave others for later, but to make it so that those with pre-existing conditions aren't discriminated against, for example, we'll need mandates and subsidies. It's like an engine -- the parts don't work unless they're part of a larger whole.

What's interesting, though, is that Republicans used to understand this -- not in some previous generation, but very recently. Senate Minority Leader Mitch McConnell (R-Ky.) said over the summer that "comprehensive" reform is "long overdue."

Around the same time, Republican Sens. Grassley, Kyl, and Enzi agreed that they support moving on a "comprehensive, inclusive" package.

Republicans have discovered that "comprehensive" is suddenly something to avoid, but they only came to that conclusion after the House and Senate already passed reform.

Steve Benen 11:20 AM Permalink | Trackbacks | Comments (10)

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Comments

Was that Sen. Coburn admitting that he orders unnecessary procedures strictly because of malpractice concerns? Why isn't this illegal? Malpractice concerns are part of his business and should be dealt with through liability insurance (at his expense) and doing a better job of being a doctor and communicating better with his patients. He shouldn't be spending taxpayer money to set up defenses in the event he is sued. Ironically, he then went on to complain about fraud. Isn't ordering unnecessary tests for your own benefit fraud? (And this isn't even considering the fact that he and his cohorts in the medical profession profit from these unnecessary tests).

Posted by: Jose Padilla on February 25, 2010 at 11:30 AM | PERMALINK

Yuh think the Repugnants no longer understand the inefficient Fail of dismembered health-care reform body part legislative acts?

Yuh think Lamar really wants the health-care reform deliberations to re-start, were the Dims stoopid enough -- and i dont put it past them -- to scrap the current bills?

Yuh think this whole dog&pony is anything more than kabuki?

Take a nap. Wait until 4:05 PM EST, hear what the Dims say they're gonna do (which has already been decided, but won't be announced until this circus is over) and you'll find out how bad what's left of health care reform is gonna be...

Yuh think someone is gonna jump up into the middle of the room and demand national health care right god damn NOW? Yuh think we can get McConnell and McCain to strip naked and dance the macarana together on the tabletop?

Posted by: neill on February 25, 2010 at 11:47 AM | PERMALINK

Does anyone really believe at this point that gop opposition to HCR is anything more than a desperate measure to ensure Obama cannot claim it as a major policy victory going into November?

Posted by: delcapslock on February 25, 2010 at 11:51 AM | PERMALINK

If the RepoTaliban really did believe in incrementalism then why have they not done it?
They could have been tacking bits of HCR legislation onto bills that they would vote for so that they would pass.

Never mind they are voting No on everything.

Posted by: Marnie on February 25, 2010 at 11:56 AM | PERMALINK

and the AP's headline: GOP to Obama at summit: 'We have a better idea' (AP)

Posted by: SaintZak on February 25, 2010 at 11:57 AM | PERMALINK

Moderates always say that progressives must be patient. This bill is part of a process of evolution. Fair enough. Given the path we are starting down, going in the opposite direction of where we want to end, what might be the next step?

Probably even before the mandates kick in, the insurance companies will be pleading for relief. Very many of the people forced to buy insurance, because of copays and deductibles, will not participate in preventative testing and wellness programs. Only when faced with medical calamities will they use their insurance, despite the fact the proactive healthcare is best.

The insurance companies will lobby for real mandatory health care(or supplementary insurance), not just mandatory basic insurance purchase.

A step in the wrong direction is just that.

Posted by: Michael7843853 on February 25, 2010 at 12:02 PM | PERMALINK

Was that Sen. Coburn admitting that he orders unnecessary procedures strictly because of malpractice concerns? -Jose

What I heard Coburn say was that he'd be more inclined to cut corners and provide sub par care and pocket the extra profit without the threat of accountability.

Posted by: doubtful on February 25, 2010 at 12:06 PM | PERMALINK

You can point out that the argument for "incrementalism" is inconsistent with previous statments by Republican figures, but we all know that it's just another cynical obstructionist tool in their toolbox so it's probably a waste of time to argue against it on it's intellectual merits.

Posted by: Kid Charles on February 25, 2010 at 1:09 PM | PERMALINK

A Dana Millbank Washington Post column had suggested that Rahm Emanuel was in favor of the incrementalism approach, and I've read others say that it would have been smart Democratic political strategy to do it that way (easier to point out victories and to show who opposed items) although I recognize that some elements need to work with others as part of a more comprehensive approach

Posted by: curm on February 25, 2010 at 2:04 PM | PERMALINK

Two very clear examples of the "inter-locking" components of reform or how health insurance reform is like an "engine"...

First, car insurance. Pretty sure if you drive a car in any state, it's mandatory that you have automobile insurance. Where's the outrage for this tyrannical, unafforable imposition upon individual liberty? How much would automobile insurance cost if you could purchase it AFTER you get in a wreck?

Second, property/flood insurance. Pretty sure if you live in a particular area that is more or less prone to floods, you're either mandated to purchase or it's optional because an event is deemed extremely rare. It's mandated in Florida. It's mandated if you live in a flood prone area. It's also impossible to purchase property insurance, at least in Florida, when there's an active storm in the Atlantic. How much would property insurance cost if you could purchase it JUST BEFORE a forecasted event or just AFTER?

These are two very crystal clear examples that everyone seems to take for granted. Two examples Congress should use in the coming weeks and campaign to hit back against opponents.

Posted by: JRinDallas on February 26, 2010 at 1:44 PM | PERMALINK
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