Most of the talk about health care reform in the blogs since the loss in Massachusetts has been about ways to ram through health care reform despite losing the super-majority in the Senate. While I agree with the importance of passing health care reform, both in terms of public policy and politically, such arguments often overlook what really must be done first–win over the hearts and minds of the voters. We cannot afford to fail to pass health care reform, but nothing good will come out of ramming through unpopular legislation.
Some liberals think that once the health care plan is passed everyone will see that it is nothing like what is being portrayed by the right wing noise machine and will learn to love the new plan. Most key provisions of health care reform will not take effect until after the 2010 and 2012 elections. During this time people will continue to hear scare stories about the doom we will face. These scare stories about health care reform are no more true than the scare stories of planetary doom in 2012 based upon the Mayan calendar, but they will still be believed by far too many people.
Ramming through health care reform before obtaining the support of the voters is also a mistake as it would reinforce one of the right wing’s criticisms of Democrats as being arrogant in their exercise of power. Sure, it is true as Democrats counter that the Republicans have done far worse than this when in power, but voters will respond to what they see today. Acting like Republicans is no way to convince the voters that the Democrats are any better. Fortunately the Democratic leadership decided against actions such as delaying the seating of Scott Brown or quickly holding a vote before he was seated.
There are many obstacles to selling health care reform but the distortions from the right wing noise machine could have been predicted. Polling does prove that most Americans do not really understand what is in the bills and are more willing to support them once they understand. Obama needs to to campaign for his policies as strongly as he campaigned to beat Hillary Clinton and John McCain. He is now showing that he realizes this.
As Americans do support most of the individual aspects of the health care plan I have suggested that different portions be proposed and debated separately. Pushing everything at once provides too many avenues for the right to obfuscate the real issues. A majority would be likely to support eliminating restrictions on pre-existing conditions, eliminating rescission of policies after people become sick, offering the choice of a public option, establishing exchanges to provide a choice of health care plans, eliminating the Medicare donut hole, and even paying a little more in taxes to provide coverage for those who cannot afford it. Even if there are not enough votes in the Senate to pass portions such as the public option, we should have a public debate and a vote. Sooner or later the public will figure out who it is that is blocking the measures they want. Let the Republicans try to run on such a record.
At present Democrats have far too many points to defend at once, allowing the Republican to create their distortions such as claiming the massive bill contains death panels. Democrats needed to do a better job of explaining that the Medicare Part D cuts being proposed are cuts in subsidies given to the insurance companies by George Bush, and not actual cuts in Medicare. It is astounding that the Democrats could ever wind up in the situation of allowing the Republicans to falsely portray themselves as the defenders of Medicare.
There is increased hope that a deal might be reached to have the House pass the Senate bill in return for plans to fix the problems with separate legislation. If this was the fantasy world of The West Wing I would prefer to see a series of individual battles and victories for health care reform, but a deal such as what is being discussed is more realistic in this world.
If such a deal cannot be reached, and ideally even if one can, Obama should take advantage of the State of the Union Address to explain what is actually in the health care plan and to also tell the American people that he has heard their concerns and is recommending that Congress make some changes.
One mistake which Obama can still rectify is backing away from his opposition to the individual mandate. The mandate changes how people see individual fixes they might otherwise support, and plays into the talking points of the far right. Many independents voted for Obama because they realized after Katrina that we cannot have a government which ignores the need for government action when necessary. However, while many are willing to support government helping those who need assistance at obtaining health care, they are justifiably nervous about government programs designed to help people whether they ask for the help or not.
People who see this as a more voluntary plan to help either themselves or others would be more willing to support this as opposed to a plan which is mandatory for themselves. There are many other ways around the free rider problem which would not lead to opposition from many on both the left and the right as has occurred as a result of the individual mandate.
There are many other details I would change but this is already far too long for a blog post. I will end by repeating one of my other objections to the course the health care debate has taken even if, in this case, it might not be politically feasible to change course.
The Democrats have fallen into a trap of accepting the Republican dogma that taxes should never be raised, as most forget that even Ronald Reagan did raise taxes. They are forced to find ways to limit the people who pay for the health care reform measures, leading to opposition from certain groups and an overall impression that they are trying to sneak something by the American people. Everyone benefits from health care reform in the long run and far more money can be raised less painfully if there is a broad based tax. If Barack Obama had used his oratory skills from the start to explain to people exactly what they must pay and what they get in return I wonder if Americans would have understood this. Or perhaps I’m returning to the fantasy world of The West Wing on this argument.