LEGISLATING HEATH CARE.

As the months drag on, I'll talk more about legislative dynamics in health care, but for now, I think Brian is painting far too simplistic a cosmology. First, insurers are one of many relevant interest groups, and nowhere near the most powerful. That title goes to business, whose level of activation, mobilization, and support, will be the singular variable that decides whether health reform succeeds or fails. And meanwhile, insurers are, themselves, a more complicated lot than Brain gives them credit for. In California, for instance, Blue Shield and Kaiser supported the health reform plan, while Blue Cross/Wellpoint were implacably opposed. Meanwhile, in this part of the country, Blue Shield and Blue Cross are the same. So this stuff gets tricky.

Same goes for votes. Let me put this very simply: A non-universal plan will need more Republican votes than a universal plan will. For every tick you move to the right, you lose the Bernie Sanders and Barbara Boxers and Pete Starks and Jim Dingells and John Conyers of the world. Presuming full Democratic support of any Democratic president's plan assumes a level of party unity that we haven't seen in such debates before. Now, negotiations with them will occur long before a plan hits the floor, because they will occur while the Starks and Kennedys and Wydens are writing the actual bill. But for every change you make in the plan, you have to mentally shuffle what your coalition will look like, and what demands they will have. A Democratic president will start with a plan that looks capable of garnering some level of Democratic unity. Then the question is who you lose. If it's not universal, who do you lose and who do you gain? If you trade out a public insurer for critical Republican votes, who do you lose and who do you gain? Same goes for interest groups. If you keep the old line unions, can you retain the insurers? But if you lose the old line unions, can you keep George Miller? If you keep hospitals, or the AMA, can you keep small business? If you lose small business, can you survive at all?

The legislative construction here is exceedingly delicate and, contrary to Brian, I don't think much can be said about it without pretty detailed study. Indeed, I don't even think detailed study gets you very far, as much is unpredictable, and personal. I wouldn't have thought Utah's Bob Bennett would be a possible fulcrum for a viable compromise, but I was wrong. This, incidentally, is why I give so much attention to the Wyden-Bennett process. At the moment, it's the only viable legislative coalition being built, and watching what they actually do and who they actually attract and what is actually being demanded of them is the best early information we're going to get. But much that I assumed going into this process is not, as time goes on, looking all that accurate. And one thing I'd caution liberals of is letting the insurers loom too large in our minds. They are one of many impediments to reform, but for various reasons, we tend to think of them as the primary obstacle. They're not. For reasons I'll say more about later, the Republican Party is, and the only force able to overcome their political opposition is probably business.