Tuesday, January 26, 2010

The Health Care Follies Continue

As Peter Suderman notes, Democrats are currently going through the five stages of grief regarding the reported death of the health care reform package. It would be funny, except for the fact that several liberals in the blogosphere refuse to get past denial.

The left wing really wants the Democrats to commit electoral suicide and pass the health care bill. Nate Silver tries really hard to make the case for the bill, after an earlier emotional appeal was effectively debunked by Megan McArdle. As usual, Silver is an interesting read...

What we see is that most individual components of the bill are popular -- in some cases, quite popular. But awareness lags behind. Only 61 percent are aware that the bill bans denials of coverage for pre-existing conditions. Only 42 percent know that it bans lifetime coverage limits. Only 58 percent are aware that it set up insurance exchanges. Just 44 percent know that it closes the Medicare donut hole -- and so on and so forth.

"Awareness", by the way, might be a forgiving term in this context. For the most part in Kaiser's survey, when the respondent doesn't affirm that the bill contains a particular provision, he actually believes that the bills don't include that provision. 29 percent, for instance, say the bill does not contain a provision requiring insurers to cover those with pre-existing conditions; 20 percent think it does not expand subsidies.

How would public opinion change if people were fully informed about the content of the bills? It's hard to say for sure, but on average, the individual components of the bill are favored by a net of +22 points. An NBC poll in August also found that support went from a -6 net to a +10 when people were actually provided with a description of the bill.

Obviously, it's not as though this is going to do much to help the bill's popularity in the immediate term. But in the long term, once people actually see the go bill into effect, their perceptions are liable to improve, in ways that might help the Democratic party. Although there are a few things like the individual mandate which the public obviously does not like, most of the other components of the bill are things they are liable to be quite pleased with and to find quite reasonable.

Lastly, it's much harder to read the opinion polls as a "mandate" against the health care bill when much of that opinion is based on demonstrably false beliefs, some of which have been perpetuated deliberately by opponents. And it's much harder to know how the Democrats ever expect to pass a health care bill or similarly complicated policies like cap-and-trade if they wither in the face of polls that reflect less a disparity of opinion and more a poverty of accurate information.
Silver is trying to be very analytical, but at its most basic, the case for the bill seems to be that Democrats should pass the thing, then explain to the public why they're wrong about it; effectively, we're smarter than you and know what's good for you. This is a strategy that parents have to resort to with children. Unfortunately for Democrats, the citizenry isn't a big fan of being treated like children. More to the point, it ignores the fact that the Democrats have been trying to sell some version of this piece of legislation to a skeptical public for the better part of six months (and in truth longer than that), and have failed to do so. Perhaps at some point, one should consider that it's not the other side's misinformation or inadequate communication on your part -- maybe the public really doesn't want to buy it.

Steve Benen tries a similar tack, drafting a memo outlining the reasons for passing the health care bill. His ten point memo is set up as political advice to be be strong and fight back hard, but I'm not sure that any of the points are ones that the Democrats haven't already heard. Put simply, Benen seems to believe a skeptical public can be won over after the bill has passed, and that the Democrats political future is more tenuous if they fail to pass the bill. These were the same points used to support the passage of the bill prior to the Massachusetts special election, and the fact that the Democrats had moved the ball down to the one-yard line and passed a bill in each House didn't improve the public's views on the bill -- they actually got more skeptical, and Scott Brown's promise to be the 41st vote against the Senate bill played no small part in his victory. Jon Cohn tries a similar tack, trying to spotlight the allegedly good things the bill will provide; again, he seems to think that this time, the public will listen to the sales pitch, when it hasn't done so for the past several months.

So will Democrats make the last-ditch attempt? David Plouffe, one of Obama's key campaign lieutenants, is back in the White House now, and argued on Sunday in a Washington Post op-ed for passing the bill. His argument on this point was similar to the one outlined above...

Americans' health and our nation's long-term fiscal health depend on it. I know that the short-term politics are bad. It's a good plan that's become a demonized caricature. But politically speaking, if we do not pass it, the GOP will continue attacking the plan as if we did anyway, and voters will have no ability to measure its upside. If we do pass it, dozens of protections and benefits take effect this year. Parents won't have to worry their children will be denied coverage just because they have a preexisting condition. Workers won't have to worry that their coverage will be dropped because they get sick. Seniors will feel relief from prescription costs. Only if the plan becomes law will the American people see that all the scary things Sarah Palin and others have predicted -- such as the so-called death panels -- were baseless. We own the bill and the health-care votes. We need to get some of the upside. (P.S.: Health care is a jobs creator.)
I don't know where the data is to back up the idea that health care will create jobs (perhaps in the public sector, but on balance, I'm not seeing how it will create private sector jobs), but the rest of it is a rehash of the same ideas that the other writers outlined and that the public hasn't bought. The President and Congress have tried to make this case for months, and failed to do so. Some of that failure can be attributed to effective counter-argument (which Dems would probably claim was false demagoguery, but it's still effective and needs a decent response), some of it can be attributed to bad messaging by the supporters of the bill, and some of it can be attributed the public's disgust with the Congressional process -- but some of it can also be attributed to portions of the public that don't want the bill. Heck, I'm not the only one saying it -- look at these statement from House Rep. Bill Pascrell...
“The people in Massachusetts sent a clear message,” he said. “If we didn’t get it in New Jersey or Virginia, we should’ve gotten it, certainly, Tuesday.”

The white-haired New Jersey Democrat isn’t known for taking on his own leaders. His past high-profile causes have focused on entertainment. He blasted the HBO hit show “The Sopranos” for degrading Italians. He took on Ticketmaster for allegedly withholding tickets and redirecting buyers to a pricier subsidiary during Bruce Springsteen’s 2009 tour.

But now he’s turning his fire on his own party.

...Pascrell can get away with being the tough guy. Since 1998, he hasn’t won an election with less than 62 percent of the vote. He is a relatively safe Democrat who is trying to grab hold of a process that he sees as having gone awry.

“It’s so complex; we made it complex,” Pascrell said of the health care debate. “And we knew this from the very beginning.”

Pascrell is not a disloyal Democrat — he voted for the House health care bill, public option and all. After the bill passed in November, he was seen on the floor hugging House Speaker Nancy Pelosi (D-Calif.) and exchanging pleasantries with House Majority Leader Steny Hoyer (D-Md.).

But now he’s proclaimed that both the House and the Senate bills are dead. And from someone of Pascrell’s ilk, that cannot be good for Pelosi and Hoyer.

...“We are arrogant when we say, ‘Well, as soon as the public understands what we’re doing, they’ll like it,’” he told a clutch of reporters. “That is not only arrogant, it’s BS.”
The article reveals that Pascrell is trying to get a more moderate bill, or series of smaller bills, on track, but the left still yearns for the Senate bill. Can the President make the case in the SOTU? Perhaps, but this assumes people will be listening and that their opinions haven't hardened. Remember, Obama tried to take back the initiative in September with a prime-time speech, and he failed. He tried to direct the process with a prime-time news conference in July, and he failed. Why should he get bogged down on this same idea again? David Frum notes that it's possible to rally the public to fight on behalf of the President against Congress, but with one very big caveat...
There’s always one reliable way to over-ride a filibuster: mobilize public opinion. In February 1917, when isolationist senators filibustered legislation to arm merchant ships, President Wilson crushed them by direct appeal to the public: “A little group of willful men, representing no opinion but their own, have rendered the great government of the United States helpless and contemptible,” he said in a March 4 address. A month later, the U.S. had gone beyond arming merchant ships – it was at war. But you can only appeal to the public if the public supports the underlying cause. Obamacare’s problem is ultimately not the Senate, but the country.
And there's the rub. The country hasn't bought the product, and indeed, a majority is now repulsed by it. Megan McArdle makes a related point while responding to Nate Silver's analysis...
Health care's popularity drops any time Congress discusses it. With respect to Nate Silver, who argues that the bill would be popular if they ever passed it and could discuss what's in it, you cannot "prove" that voters like a bill because various bits of it poll well on their own. Do I want a sous vide machine? Certainly! I could take a poll that would show nine or ten wonderful things I would love about owning a sous vide machine. Am I going to buy one? No I am not, because it costs hundreds of dollars I need for other things.

Almost everything polls well on its own, except tax increases. But as in my example, deciding whether you want something is not a matter of simple addition of positives and negatives. Some negatives, like price tag, can outweigh even a stunning array of positives. The things that poll badly: price tag, excise tax, individual mandate. These are crucial components that can't be gotten rid of.

Moreover, many of the pieces that poll well, like deficit reduction, are things that voters like, but don't believe this bill will achieve. They're not going to believe it any more after you pass the bill through a process that involves buying off every special interest group in sight.
Megan links to Matt Yglesias' lament about the process, where he wonders whether moderate Democrats really wanted health care reform. I think there's something to this -- change is really hard and risky, and the American people began signalling that they didn't want the change that the President and Congress were (incompetently and incoherently) advocating. Rather than polishing their advocacy or strategizing for smaller reforms, the President and Congressional leaders gambled on the politics of raw power to try and pass a major reform. When that political power was exposed as ineffectual at the ballot box (in Massachusetts!), Democrats began heading for the hills.

Bottom line? When the left is busy writing the equivalent of letters to their Congressman to try to convince them that the public can be convinced that health care reform is a good idea, if only they'd pass the bill... well, in D.C., nothing is really dead and buried. But health care reform may need its last rites. As to the Democrats who are frustrated... there's a great episode of the Simpsons from 1995 that might well cover the issue beautifully.

Early in the episode, a couple of fighter jets are fired upon by Groundskeeper Willy with a shotgun (don't ask). When they launch missiles to try to kill him, the missiles instead hit the planes themselves. As the pilots parachute to the ground, the following conversation is heard...

Pilot 1: [parachuting] This is what happens when you cut money out of the military and put it into health care!

Pilot 2: [parachuting]
It's a good program! Just give it a chance, that's all I ask. [their parachutes fail; they crash to the ground]

However, the episode is better known for this later quote -- as a comet discovered by Bart bears down on Springfield and will likely destroy the town, newscaster Kent Brockman cuts in with news that the federal government may try to save the town...
Kent: With our utter annihilation imminent, our federal government has snapped into action. We go live now via satellite to the floor of the United States congress.

Speaker: Then it is unanimous, we are going to approve the bill to evacuate the town of Springfield in the great state of --

Congressman: Wait a minute, I want to tack on a rider to that bill: $30 million of taxpayer money to support the perverted arts.

Speaker: All in favor of the amended Springfield-slash-pervert bill? [everyone boos]

Speaker: Bill defeated. [bangs gavel]

Kent: I've said it before and I'll say it again: democracy simply doesn't work.
That last line probably summarizes how the left feels right about now.

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