But if the Dems lose in November, was it worth it?
Health care reform and future uncertainty
At lunch today, I overheard a conversation about Sunday’s health care vote. The conversation began with an unexpected questions: “If the Democrats lose Congress in November, would passing health care reform have been worth it?” The question is simple enough, but determining how to answer it most certainly is not.
For the sake of this post, I will discuss the considerations those who support health care reform would make when answering this question. The same kind of considerations would apply to any other piece of legislation – conservative or liberal.
So, was it worth it?
The case in favor seems straightforward. Passing health care reform is a once in a lifetime opportunity. Presidents since Teddy Roosevelt have tried and failed to do so. Who knows when Democrats might get another chance. And the moral good of this health care reform bill is so great that it outweighs the positives that Democrats would be able to achieve from X more years of Congressional majorities.
As we can see, key to the “yes it was worth it” argument are the beliefs that 1) this health care reform bill does extraordinary moral good; and 2) that passing a bill that does such great moral good is a rare opportunity. Thus, Democrats must take advantage now, regardless the electoral consequences.
However, there is one key piece of uncertainty that makes this argument difficult to make. There is no way to know how long Democrats would have stayed in power had health care reform not been pursued. And since the argument is predicated on the good of health care reform outweighing anything Democrats could have achieved in those extra years in the majority, it is an imprecise argument to make at best.
Thus, the case for relies on two beliefs – that there are 1) rare opportunities to do 2) great good – and faces a challenge of future uncertainty that makes it difficult to argue for persuasively.
The case against health care reform being “worth it”, as we will see, struggles with a similar problem of future uncertainty; for it’s argument is basically the same, just opposite. Those who would claim that reform would not be worth it if Democrats were to lose in November would have to believe that the good of this health care reform bill would not outweigh X years less of Democratic majorities and the conservative policies or, at least, lack of movement on liberal priorities that would result.
In order to have this view one is likely to hold some combination of the following beliefs: 1) that this health reform bill did not go far enough — that it is a compromise of half measures that will simply not do that much moral good; 2) that the health care vote will leave Democrats in the political wilderness for a very long period (i.e. X is very large); 3) that there are equally important things to health care reform that Democrats could have achieved had they remained in office for X more years; and/or 4) that Republicans will do more moral bad than health care reform did moral good in the X years Democrats would have remained in office.
Of course, like the argument for, this argument suffers from the problem of an uncertain future. No one knows how long Democrats would have remained in power had they not pursued this vote, so making an argument about the negative over this period of time outweighing the positives of health care reform is tenuous. As before, an argument that includes such future uncertainty is not very persuasive.
So where does that leave us? Either answer to the question of whether health care reform was worth it if the Democrats lose in November relies on unknowables about the future. As such, neither answer is particularly strong. Of course, almost every policy debate hinges on assumptions about the future, most often, what cause and effect will look like. Those who support health care reform, do so because they think it will lead to some positive consequence — say greater coverage or lower costs. Of course, it could be just the opposite (as many Republicans argue); that, in fact, the bill will lead to greater costs and worse service. But what is important to recognize is that both positions hinge on assumptions about the future.
Often times we have empirical laws or theories that help us predict effect and, thus, help reduce uncertainty. For example, many studies suggest that preventative care will lead to lower costs. Thus we have some basis to conclude that preventative care provisions of a health care reform bill will have the consequence of lowering costs. Many beliefs about future consequences can be grounded in theories or evidence like this. However, predicting how many years the Democrats would have remained in the majority had they not pursued health care reform is not one of these. As such, it is not something we can hang our hats on in an argument.
Photo by Flickr user fibonacci_blue used under a Creative Commons Attribution license.