Ross Douthat joined The New York Times as an Op-Ed columnist in April 2009. Previously, he was a senior editor at the Atlantic and a blogger for theatlantic.com.
He is the author of Privilege: Harvard and the Education of the Ruling Class?(Hyperion, 2005) and the co-author, with Reihan Salam, of Grand New Party: How Republicans Can Win the Working Class and Save the American Dream?(Doubleday, 2008). He is the film critic for National Review. A native of New Haven, Conn., he now lives in Washington, D.C.


We’re been here before.

Not with this much melodrama, maybe. It didn’t take a rakish Senate candidate in a pick-up truck to stop George W. Bush’s push for Social Security reform in 2005. MSNBC wasn’t around in 1994, so we didn’t get to watch Keith Olbermann’s head explode on live TV during the defeat of Bill Clinton’s health care plan.

But the pattern is the same. Since Ronald Reagan tried and failed to purge Washington of wasteful spending, nearly every major attempt at reforming the way our government does business has found itself where the Democratic health care bill is now - losing altitude, shedding supporters and tailspinning toward defeat.

If the legislation fails, liberals will have a long list of scapegoats. They can blame Max Baucus’s delays, Joe Lieberman’s demands and Olympia Snowe’s dithering. They can blame the filibuster, Fox News and Sarah Palin. They can blame Barack Obama’s lack of passion, Harry Reid’s lack of finesse and House Democrats?lack of guts.

But they might want to save some blame for the welfare state their predecessors built.

Under Franklin Roosevelt and Lyndon Johnson, liberals created a federal leviathan that taxes, regulates and redistributes across every walk of American life. In the process, though, they bound the hands of future generations of reformers. Programs became entrenched. Bureaucracies proliferated. Subsidies became entitlements,tax breaks became part of the informal social contract. And our government was transformed, slowly but irreversibly, into a large, incoherent, often incomprehensible mass that is solicitous of its clients but impervious to any broad, coherent program of reform.

That’s a quote from Jonathan Rauch’s Government’s End: Why Washington Stopped Working,?a book that should be required reading for Democrats as they contemplate their predicament this week. First published amid the collapse of Clintoncare, and then reissued after the failure of the Gingrich Revolution, Rauch’s analysis makes mincemeat of the popular theory that sinister Special interests?are to blame for derailing reforms the common man wholeheartedly supports.

Instead, he suggests that sweeping reforms are difficult because we’re all special interests, in one sense or another. We all benefit from something (or many things) the government does, and so we all have an incentive to resist dramatic changes to the way Washington spends money.

Consider how the health care debate has played out. When people think of health-related Special interests,they think of drug manufacturers and insurance companies - and sure enough, buying off Pfizer and appeasing Aetna were among the Obama White House’s first priorities.

But that’s just the beginning of the story. Once you’re enticed Big Pharma and Big Insurance inside the tent, you still have to contend with everyone else who might stand to lose from health care reform.

This means seniors who get Medicare and hospitals that accept it. It means patients and doctors in states that spend Too much on health care, according to the Office of Management and Budget, and who would bear the brunt of cost controls. It means upper-income taxpayers who object to being singled out for tax increases. It means union members who like the current health-insurance tax deduction exactly as it is. And judging by last week’s election, it means the citizens of Massachusetts, who already pay for semi-universal health care and don’t see why they should subsidize Mississippi and Montana as well.

Chances are that you belong to at least one of these Special?interest groups. And so whatever your political views, chances are that your concerns have played a role in delaying the health care bill, warping it, and possibly killing it off altogether.

None of this means that government cannot be reformed. Rauch’s book does not counsel despair. Rather, it counsels modesty, simplicity and incrementalism in legislative efforts. You can make big changes to small programs, and small changes to big ones. But comprehensive solutions tend to produce comprehensive resistance. And the more sweeping the stakes, the greater the chance of political disaster - whether your name is Clinton or Gingrich, Bush or Obama - when your bill goes down to defeat.

The lesson for Democrats should be obvious. They wanted, admirably, to help the low-income uninsured, and Americans with pre-existing conditions. And that’s exactly what they should have done - with tax credits or vouchers or a Medicaid expansion for the poor, and better-funded risk pools for the sick.

Such a bill would have had many fewer beneficiaries - but far fewer enemies as well. It wouldn’t have transformed the system, controlled costs for the long term, or guaranteed universal care. But permanent solutions are probably beyond what any single piece of legislation can accomplish.

I am not the first president to take up this cause,?Barack Obama said of health care reform last September, But I am determined to be the last.?In hindsight, that looks like his mistake.