The Need For Specifics on Health Care Plans

Early today I gave some of my first impressions as a physician of the Edwards health care plan. The issue of whether a candidate should even release a specific health care plan was raised by Mark Schmitt at Tapped:

The main argument, as far as I can tell, for releasing a detailed health policy proposal is simply that the people should know what you would do as president about health care. Fair enough, except let’s be honest — the minute you take the oath of office, whatever health plan you put together in the middle of a campaign will be forgotten. And that is as it should be. You now have the full resources of HHS, OMB, NIH, plus every think tank and academic expert at your disposal, and you will use them — or should. You’re not going to simply implement a plan designed by a handful of (brilliant) recent college graduates in your campaign issues shop.

Further, you will be the president, but you are not, sorry to say, The Decider, at least not on health care. To get something passed, you will have to deal with the political circumstances of that moment. Will you be able to get some Republicans on your side? Do you have a filibuster-proof majority in the Senate? Will you be able to get the support of some large businesses? Will insurance companies fight any change, or are there some options they could live with? Are you able to sell the tax increase that real reform will require (and that Edwards, to his credit, was unafraid to name)? All these political circumstances will affect the shape of the actual proposal, which is why you need goals and a few non-negotiable elements, not a detailed plan.

Kevin Drum, Steve Benen, and Matthew Yglesias, also consider this question.

There certainly is a risk to providing details. The more you say, the more likely someone will get mad and not vote for you. On the other hand, I wonder if one reason voter turn out is so low is that many voters see no reason to get out to vote for a candidate who has spent the last several months campaigning but avoiding specific answers. While some voters might be lost, there are others to be gained by showing the courage to give answers–especially if they are answers the voter likes. The public will also be far more likely to back up a President who does in office what they promised on the campaign trail. This would be a true mandate–not the imaginary mandate George Bush bragged about after the 2004 election.

It is reasonable that some details may have to change considering the political realities at the time. Regardless, I want to know how a candidate views health care before I will consider voting for them. Health care is a matter which impacts the lives of people directly and therefore is of great concern to many voters. I’m sure many other share my desire to know what they are getting into before they will consider voting for a candidate. Voters deserve to know whether a candidate would push for a single payer plan or a modification of the current system. We deserve to know whether there would be mandates for businesses and/or individuals to purchase plans, as well as a rough idea as to cost. We deserve to know what types of health care plans would be offered, whether by the government or privately paid insurance. Voters who do not understand the difference between government-run health care and government-financed health care need to be reassured that the same physicians who treat them now (assuming they can afford health care) will be managing their care, as opposed to government bureaucrats as Republicans will charge.

Some see themselves more as advocates for the Democratic Party and therefore look at whether more votes would be gained or lost by providing details. In contrast, I’m considering this from the perspective of an individual who would support either party based upon their positions. Of course at the moment there’s a long list of reasons beyond health care which would make it very difficult to vote for a Republican, but it remains possible that those responsible for the party’s move to the far right might be replace by a more sane bunch in the future. For a candidate to get my vote, or contributions from me, they will need to state where they stand.

Even from a pragmatic viewpoint I do not believe Democrats can afford to promise health care reform without providing specifics. If Democrats do not define their plans, Republicans will define the plans for them. Republicans will campaign against “government take over of health care” and against “Socialized Medicine.” We will hear horror stories about plans which bear no resemblance to the plans actually being considered by Democrats. As much as Democrats risk losing votes from those who would be upset with the specifics of their plans, they will lose far more votes from those who will object to the Republican characterization as “Socialized Medicine.”

It is an uphill battle, but health care reform will only be possible when there is true public demand for it. The Harry and Louise ads will be effective until the public is made to understand the issue. If Democrats want to really receive a mandate to govern, as opposed to being elected in years that the Republicans self-destruct, they need to get the public behind their positions, which will only happen if the positions are explained. The conventional wisdom is that John Edwards and Barack Obama are far better communicators that John Kerry and Al Gore were as candidates, and that Hillary Clinton is an expert on health care. The candidate that deserves to be elected is not the one who can squeak by avoiding the tough questions, but the one who can effectively communicate a plan, and reason to change, to the voters. As David Broder wrote in this week’s column, “any presidential candidate in either party without a plan for universal coverage may be seen as falling short. And that in turn could make 2009 the long-awaited breakthrough year.”

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