Changing The Game On Health Care Reform

Patrick H. Caddell and Douglas E. Schoen warn in an op-ed in The Washington Post that the midterms will be deadly for the Democrats if they ignore the polls on health care. They over state their case but these warnings should also not be ignored.

To predict Democratic losses this fall is a safe bet without looking at any particular issues. Midterms elections such as this the one being held this year historically favors the opposition party. The Democrats have additional obstacles such as having to defend seats picked up in the last two cycles which have historically voted Republican and not having Obama on the ballot. Health care will very likely be an issue, but it is also possible that other issues might be more important by this fall. Sometimes totally unexpected events such as the 9/11 attack and Katrina have totally changed the electoral picture.

Polls are a snap shot of what is happening at present and may or may not apply several months down the road. Polls on health care can be misleading because while many polls have showed opposition to a general question about the bill, breaking down the polls has provided a different picture since many people have such a distorted view of what is in the bill:

  • People who oppose the bill often tell pollsters they do support the individual components of the bill (along with supporting the public option which is not currently in the Senate bill)
  • Explaining what is in the bill has resulted in increases of as much as twenty percent in support of the bill
  • Some polls show that almost as many people oppose the current bill because it doesn’t go far enough as to believing it does too much

Factors such as these lead many to discount the polls. Plus, as Andrew Sullivan points out, the authors over state the opposition to the poll by relying on Rasmussen which has often been an outlier. Recent polls also suggest an increase in support with Obama becoming more involved.  This does not mean there is no validity to the argument.

One problem is that many of the benefits of health care reform will not be seen for a few years after the bill is passed. We will hear the same conservative distortions, possibly leading people to think that passage of the bill was a bad thing even if they would support the bill if they understood it better. Many Democrats argue that it will be easier to defend a specific bill once passed. This assumes that after the conservatives have been so successful in winning the spin war on the current legislation since last summer that this will suddenly change, which is not a safe assumption.

Even if it is true that supporting health care reform is politically dangerous, many still support it because it is the right thing to do. This is a valid argument, but people shouldn’t be blinded into thinking that because it is the right thing to do the political calculations will change. Doing nothing after all this time also makes Democrats look weak and ineffective. Those who are angry with the Democrats because of health care reform will not necessarily be appeased by having the measure defeated. There is also a tremendous gap in intensity. Those who hate the bill hate it. Those who support the bill often do so because they see it as the only way to keep health care reform alive, even if the bill is flawed, and hope to improve upon it later.

What the Democrats really need is a game changer. If a significant percentage of voters are convinced the current bill is so awful, perhaps it is to the benefit of the Democrats to promote a new bill which concentrates on the more important issues which have the greatest support. There is some truth to the argument that each part of the bill depend upon the other parts and this cannot easily be passed incrementally. In reality a major component of the bill, the public option, has already removed. A bill with an individual mandate but no public option is already a major difference, with the mandate fueling much of the opposition (despite the fact that this was originally a Republican idea).

Craig Crawford suggests it is possible to “play it safe” starting by concentrating on elements of the bill which are popular:

  • Preventing insurers from excluding people because of pre-existing conditions
  • Tax credits to small businesses to help their workers get coverage
  • Creating a new health insurance marketplace
  • Closing the Medicare “doughnut hole” so that seniors would no longer face a period of having to pay the full cost of their medicines
  • Expanding high-risk insurance pools for individuals who cannot get coverage elsewhere

He also believes that “lots of Republicans would come on board” if these items are added:

  • Purchasing insurance across state lines
  • Malpractice reform
  • Ensuring portability

Republican voters might come on board but it is a safe bet that the party establishment will not as their goal is to prevent the Democrats from having any political successes on health care reform. After all, the current plan is very similar to the Republican counter plan to the Clinton plan in 1993 along with being similar to Republican Mitt Romney’s plan.

Proposing a more incremental approach (not necessarily exactly as suggested by Crawford), and eliminating the individual mandate, would be more politically popular but it would also be harder to pass a new plan from scratch. At this point the House and Senate have both passed health care reform bills. A bill could be sent for President Obama’s signature if the House were to pass the Senate bill (with changes made through budget reconciliation as planned). However, if we were to start over the Democrats would have more difficulty achieving 60 votes with the loss of Ted Kennedy’s old seat.

Perhaps a scaled down bill would be able to pick up the votes of one of the few moderate Republicans left. If not, another possibility might be to make this a key issue for the 2010 campaign. While the polls show that a majority do not want the current health care bill, there is one thing which an overwhelming majority oppose–maintaining the status quo. A revised bill without the mandate might allow the Democrats a chance to win the spin war if the Republicans continue to block all efforts at reform. It would also be a grand gesture in support of democratic principles, removing yet another misleading Republican talking point.


  1. 1
    pat1944 says:

    RT @ronchusid: Changing The Game On Health Care Reform–passing #hcr without commuting political suicide #p2

  2. 2
    Wellescent Health Blog says:

    Given the severe over stimulation that the health reforms have given the public and the Republican successes in making reform look like a bad thing, it is probably best for the Democrats to focus on only a few positive changes that come immediately from the bill and to then focus on improving employment figures. However, if passage of the reform bill takes too long the Democrats may have nothing else to talk about.

  3. 3
    pat1944 says:

    RT @ronchusid: Changing The Game On Health Care Reform–passing #hcr without commuting political suicide #p2

  4. 4
    Laurie Corzett says:

    If we really want immediate relief, and not an ongoing bipartisan debacle on national healthcare insurance coverage, why not legislate by reconciliation a simple Medicare buy-in for all option, sliding scale based on income, continue payroll tax but without a cut-off and at a lower rate to keep the buy-in cost low; those without means for any buy-in get government subsidy. Private insurers who want to continue in that business can give better service/coverage beyond Medicare or whatever they think the customers will buy from them with whatever conditions they choose.Since the Medicare infrastructure is already in place, it could more quickly and easily work than a whole new scheme. It could be a job booster by putting more money into low income pockets (people most likely to spend) and giving small business a break from the drag of providing healthcare. Medicare would have even more volume for cost-cutting clout and a greater income stream to stay solvent. Still, we must continue to work on the underlying problem of high medical cost: seriously look at best practices both medically and fiscally and better promote what works, including treatments that are considered nontraditional in this culture; expand access to medical education (on all levels, not just MDs); expand efforts to educate the public generally on positive health practices and self-treatment options.Let’s let our Congressional Representatives know now and  enthusiastically: We demand a strong public option; and we vote!

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