Today’s Unanswerable Counterfactual

Interesting question from IB:

I agree on the general point here, but don’t you think that actions by the Obama and Clinton White Houses would be a central part of any adequate explanation for why we got comprehensive health care reform in 2009-10, but not in 1993-4? Or to put this another way: had Obama not prioritized healthcare reform, the 111th Congress would never have passed comprehensive health care reform. And had Clinton played his hand somewhat differently, the 103rd Congress might have.

A few points:

• Again, to reject Green Lanternism is not to deny any presidential influence on legislation, with agenda-setting being most important.  Certainly, health care reform could have failed in 2010 — some Democrats, including Obama’s Chief of Staff, were urging him to abandon the ACA, and some are still pushing the line.  Obama playing his hand well and remaining steadfast in the face of political headwinds was one of the many necessary conditions of accomplishing the massively difficult task of comprehensive health care reform, although in most political contexts it would still have been insufficient.  (For that matter, the Civil Rights Act almost certainly would not have passed in 1964 with JFK in the White House, although had the Republicans ran Goldwater in this alternate universe most of the Great Society probably would have eventually happened anyway.)
• If Obama had played health care reform in 2010 the way Clinton did in 1993, I don’t think anything like the ACA would have passed.  Evidently, Obama had the advantage of hindsight that Clinton didn’t. (I again note the irony that most of the people who insist that Obama totally could have gotten singlepayeroratleastthepublicoption passed believe that Obama should have used the “come up with a bill and ram in right down Congress’s throat” model that was a complete disaster for Clinton.)
• It’s hard to be sure, given how badly bungled it was by the Clintons, but my guess is that as far as comprehensive health care reform in 1993 they were drawing dead anyway.  On health care, the Republican conference was already where it would be on pretty much everything in 2009; he was not getting more than token Republican support.  The Democratic caucus was both smaller and more conservative in 1993 than it was in 2009.   The Finance Committee Chair was Daniel Patrick Moynihan, who was both hostile to health care reform and a consummate preening asshole — a man, in other words, who could make you appreciate Max Baucus.  Clinton didn’t deal with him well but I doubt it mattered in the end.  We’ll never know for sure, but I think the legislative context wasn’t favorable enough even had Clinton used better tactics.