Drew Westen does a solid job of summing up the mistakes President Barack Obama and the Democrats made on health care in this article, The Way Forward on Health Care. He’s right that biggest mistake beyond the horrible messaging was the fact that they made it about cost and not care. He does an excellent at the beginning of show how the 2008 mandate was wasted on trying too hard for bipartisanship.
With all the talk of hope and change, the American people were expecting something very different from the new Democratic majority. The president insisted on bipartisan solutions for problems Republican “solutions” had created, for which the imaginary bipartisans on the other side have not, and will not, cast a single vote. Making matters worse, at a time when Americans are — and should be — deeply suspicious of big business, these “bipartisan” solutions consistently seem to gravitate toward that golden mean between the public interest and the special interests (in this case, of the health insurance and pharmaceutical industries).
The American people watched as Democrats insisted on 60 votes for every piece of legislation, despite the fact that the Republicans “jammed down our throats” (to use a current Republican talking point) one substantial piece of legislation after another for eight years when they had far less than 60 votes in the Senate. The result of what looked to Americans (fairly or unfairly) like a cross between cowardice and dysfunction was what George Will aptly called the “serial bribery” of senators. All of them could step up and demand whatever they wanted to water down the bill or load it with pork for their state whenever it was their turn to become the 60th senator.
It’s what I call governing like Clinton in a time of FDR. Westen is right about the cost issue in that logically it didn’t play well:
But third and perhaps most importantly, if a key goal was to insure another 40 million people, the idea that you could do that and simultaneously cut costs simply bends the curve of imagination too far. Sure, there will be cost savings if 40 million people get preventive care, don’t end up in emergency rooms, and aren’t already having the tab picked up for much of their medical care by the rest of us. But someone is going to have to make up the difference, and that someone could be the health insurance and pharmaceutical industries (who the public would be happy to see cough up something other than phlegm in this debate), the upper 1% of the population (whose share of our national wealth has skyrocketed in the last decade, and who polls consistently show are popular people to look for revenue by an electorate hungering for fairness after years of declining median wages), or the middle class.
People could have been made to understand that insuring everyone will cost more, but in the long run it will be cheaper for everyone. But as Westen points out there was a great way to explain this, that was already figured out. Obama just decided to try Rahm’s way instead.
Having led the messaging efforts for the major nonprofits working on health care reform during the primary election campaign season of 2008, we didn’t know whether Obama, Edwards, or Hillary Clinton would be the nominee, but they were all offering variations on a theme. We learned, however that what appealed to Americans were essentially two things.
The first was a clear aspirational statement of what we wanted to accomplish with “health care reform” (or its latest rendition, “health insurance reform” — two phrases that have about as much emotional resonance with voters in the center as “universal health care,” “single-payer,” or “reconciliation”). One statement stood out, because it appealed both to what people want for themselves (their interests) and to their moral sense (their values): “I believe in a family doctor for every family.” That, after all, is what this debate is really about.
If you start with an aspirational statement of that sort, it serves not only as a positive message but as a powerful weapon against any moral reprobate who opposes it. In fact, Republican leaders in Congress do oppose it, and it would be a lot harder to squirm out of opposing the simple value statement that people who work for a living ought to be able to take their kids to the doctor when they’re sick, or that Americans should have a human connection to someone who is taking care of their health, than to “health insurance reform.”
The second thing that appealed to Americans was a relatively simple set of principles. If you offer voters a set of legislative provisions (whether 12 or 2400 pages), they will argue with you about each one, particularly when those provisions include things like taxing and ultimately eliminating high-quality insurance plans, particularly when no one knows whether that provision applies to their plan.
If you find yourself arguing at that level of detail to the American people, you have already lost the battle. Ours is not a direct democracy. We have a representative democracy (or republic) for a reason: Things are complex. Except for a handful of people, none of us is a fulltime legislator, and what we choose every two to four years at the ballot box are people we trust to take our values to Washington (or the state house) and to let them work out the details as to how to implement those values, with the expectation that they will be informed about the details in ways we simply cannot be.
The research my colleagues and I conducted in the run-up to the election of 2008 pointed to three principles that led Americans to agree that it was time for comprehensive health care reform rather than a band-aid:
(1) If you like your doctor or your current health care plan, we will never take it away from you.
(2) Americans know best what’s good for their families, and so they should have more choices rather than less, including the choice of at least one plan the insurance companies don’t control, which will keep plans competitive and comprehensive, including preventive care like cancer screening.
(3) We will no longer tolerate 40 million Americans without health insurance and rising, with insurance companies arbitrarily deciding who should be denied coverage because they have a “pre-existing condition” or who should be cut off because their current treatment for some current condition is costing the insurance company too much money.
The simple aspirational statement — “I believe in a family doctor for every family” — and those three simple principles — beat anything the other side could say by a 2:1 margin. That should have been the Democrats’ message. And it should be their message now.
As TPM is reporting today Obama may finally be learning, Obama Goes On The Offensive With His Health Care Stump Speech.
Obama has promised Democrats he will be the chief booster for the reform legislation, detailing how it will help everyone, not just the uninsured. As I reported recently, Senate Democrats have been given a set of talking points that directly deal with how people with insurance will be helped by the measure, something that aides believe is critical to boosting public support for the plan.
Aides say that today Obama will use recent reports about insurance company profits and more massive rate hikes expected from the top insurers. He’ll offer a similar message Wednesday in St. Louis.
Every year, insurance companies deny more people coverage because they have a pre-existing condition. Every year, they drop more people’s coverage when they’re sick and need it most. Every year, they raise premiums higher and higher. Just last month, Anthem Blue Cross in California tried to jack up rates by nearly 40%. In my home state of Illinois rates are going up by as much as 60%. And you just heard from Leslie, who was hit with a 100% rate increase. 100%. One letter from her insurance company and her premiums doubled. Just like that.
You see, these insurance companies have made a calculation. The other day, on a conference call organized by Goldman Sachs, an insurance broker told Wall Street investors that insurance companies know they will lose customers if they keep raising premiums. But since there’s so little competition in the insurance industry, they’re ok with people being priced out of health insurance because they’ll still make more by raising premiums on the customers they have. And they will keep doing this for as long as they can get away with it.
So how much higher do premiums have to rise until we do something about it? How many more Americans have to lose their health insurance? How many more businesses have to drop coverage? How many more years can the federal budget handle the crushing costs of Medicare and Medicaid? When is the right time for health insurance reform?
Westen shows how Democrats are between a rock and hard place, and shows how there only hope to stave off disaster in November is to pass health care and then use it to win in November. The President is all in, now it’s time for the Democrats in Congress to get on board.