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How to Change Health Care When Many Like What They Have

5 years ago
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John Marttila has been a leading strategist and pollster for the Democratic Party for decades. He's close to Vice President Joe Biden, having advised him ever since helping Biden win his initial (and improbable) election to the Senate in 1972. He was a senior adviser to Sen. John Kerry's presidential bid. He has worked for numerous Democratic senators, House members, governors and mayors, as well as nonprofit groups and trade associations, several focusing on health care. And he's concerned that the Obama White House has not fashioned a winning message for its health care reform effort.

Last month, Marttila sent out a memo to Democratic leaders in which he distilled the extensive polling available and offered advice on how to advance health care reform. As I've often stated, anyone who second-guesses Obama and his political team must do so with a certain humility, for these guys and gals have compiled a pretty good track record. But Marttila's memo presented a series of strong points.

His first was sort of a "duh," but a rather important one: "many Americans simply don't know enough [about Obama's health reform plan] to have an opinion." This means, Marttila wrote, that "a huge chunk of the electorate is up for grabs." It also means this huge chunk is susceptible to demagoguery and disinformation. Politics, as the cliche goes, is often about defining a candidate or an issue. If many Americans do not have a strong grasp of Obama's plan -- or the legislation now under (painful) construction in Congress -- its foes have a better chance of winning the critical battle of definition. After all, if someone doesn't know the details of the plan, it's easier for him or her to end up believing the legislation actually does force Medicare doctors to tell patients to kick the bucket. As for the partisan divide, Marttila pointed out that because Republican voters are overwhelmingly dead-set against Obama's reform, "House and Senate Republicans from the Red States will feel increasingly empowered to hammer away." And independents "will remain problematic throughout the debate," given that they are fiscally conservative and could be swayed by the predictable GOP talking points that the Obama plan is too costly and too risky.

Marttila noted that assorted polls show that support for Obama on health care "is too generalized" and that "too many Americans . . . see health reform benefiting others but not them." Perhaps more important, large majorities of voters tell pollsters that they are generally satisfied with their health insurance coverage and consider their own insurance affordable. (One poll Marttila conducted found that 88 percent had insurance coverage and 85 percent were satisfied with it.)

None of this is good for the White House. By sitting back and letting Congress draft health care reform legislation -- in a messy and unruly process -- Obama has placed himself in the position of having to rally popular support for a thing not yet made and not entirely of his own making. At a prime-time press conference a few weeks ago, he did try to spell out what's in the plan for you. But that did not provide a discernible boost for him or the Dems. And if most Americans are not dissatisfied with their health care coverage, why would they want to see a major change in the system?

But all is not lost for the White House. In his memo, Marttila identified what he called "blockbuster issues" that could provide Obama and the Democrats some of the juice they need to enact reform -- most notably, stopping insurance companies from denying coverage on the basis of preexisting conditions and removing the possibility of medical bankruptcies. He wrote:

High levels of [insurance] coverage and satisfaction have helped to weaken the political salience of health care reform. And, in our view, if the effort becomes too complicated or is seen as imply too expensive or undoable, the lack of salience could become a barrier.

So preventing medical bankruptcies and combating the insurance industries on preexisting conditions ought to be front and center in the White House effort. The Obama administration, Marttila advised, also has to depict the public insurance option better: "Too many voters believe it is the centerpiece of the President's plan -- rather than just one element among many to improve our health care system." Above all, he recommended, the president has to sell the plan with an emphasis on values:

All of our research -- and virtually all of the recent national polling -- indicates that universal coverage remains a dominant, top-of-mind reason to support the President's plan. While some Democrats favor a more pragmatic set of arguments to support reform, we believe this overarching moral vision has real power -- and should remain an essential argument for reform.

So Obama has to describe the plan more specifically, emphasize the elements that play best with those who already have coverage but desire "stable, enduring health insurance protection," and sell the moral imperative of providing coverage to those who cannot obtain it -- while also explaining that the proposed reforms will be implemented steadily over a course of several years and that it's best to fix the health care system now before it becomes even more troubled.

I can imagine a White House aide reading Marttila's memo and saying, "But we are doing all this." And to some degree, that's true. But Marttila seems to believe that the White House has not gotten the mix right.

The most important point he raises is the challenge of changing the status quo when many people are telling pollsters they are generally satisfied with their own personal status quo. Commentators in recent weeks have asked where are the angry mobs demanding comprehensive and effective congressional action? Where's the grassroots fervor that a year ago fueled Obama's presidential campaign? Health care reform is a complicated and knotty issue (or set of issues), and such complexity may prevent people supportive of reform from grabbing for their pitchforks. (And who among us can really explain what a health insurance co-op is?) But it's clear that Obama not only has to win over more Americans; he has to motivate those who back him on this front to fight for a comprehensive overhaul. (He can't rely on $150 million in drug industry ads backing his effort.) Given that Obama has yet to succeed in stirring a mass uprising, he and his aides ought to consider all the advice from outside experts they can get.

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