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HEALTH CARE ENDGAME

Which Party's Risky Health Care Bet Will Pay Off in November?

4 years ago
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Republicans have been betting, and in some cases hoping, that President Obama and his party would fail on a spectacular scale in their drive to achieve near-universal health coverage in America. But it turns out the GOP will be running in 2010 and 2012 against a historic success and the possibility that the "new normal" on health might turn out to be popular.

Remote though it seems at the moment, that prospect cannot be ruled out. Obama and the Democrats have made one of the riskiest gambles in American political history. There will be many changes phasing in between now and 2018, and some will be far less welcome than others. Still, the sweeping health package has features with guaranteed appeal, such as consumer protections against insurance companies. And there's simply no way it could live up -- or down -- to the Republicans' doomsday rhetoric.

What a journey it has been, from last July when Sen. Jim DeMint of South Carolina envisioned health reform as Obama's Waterloo, to just this past weekend, when House Republican Leader John Boehner asserted that it will usher in the end times. "We are 24 hours from Armageddon," he said. "This health care bill will ruin our country."

Disciplined soldiers that they are, Republicans have stuck to their talking points for months on end. (The bill is a government takeover, it will kill freedom, we can't afford it, Americans don't want it, "kill the bill" and "start over.") The latest twist, born of necessity, is to run fall campaigns -- and win back a House majority -- on a repeal platform.

It's all a time-honored GOP tradition. Here's Ronald Reagan in 1961, in a recording for the American Medical Association: If Medicare isn't killed, "one of these days you and I are going to spend our sunset years telling our children, and our children's children, what it once was like in America when men were free." And here's Rep. Geoff Davis (R-Ky.) on the House floor Sunday night: "My heart is heavy with grief" at this "headlong rush toward socialism" and "idolatrous statism."

Democrats prefer to stress protections for people with insurance, coverage for 32 million people who don't have it, steps to curb rising costs, and nonpartisan projections that their bill will cut the deficit. There were giddy bursts of applause on the House floor on the way to their landmark victory. Yet it will be difficult to transmute this win into electoral magic.

For one thing, Democrats are up against rampant voter ambivalence about taxes and the role of government. I had to wonder what country Rep. Doris Matsui had in mind when she said on Saturday: "We're talking about taking care of each other here. And that's really an American tradition." The far more dominant (and more conservative) American narrative is of rugged individualism and self-sufficiency -- to the point where you sometimes hear anti-government sentiments even from seniors in the federal Medicare program or farmers who receive subsidies from the U.S. Department of Agriculture.

The Obama-era health-care push was predictably long, hard, and ugly. In the view of such seasoned political analysts as Charlie Cook, it was also badly mistimed, given voter concern about jobs and deficits. On top of that, the trend is for the president's party to lose seats in midterms. And that trend could easily be magnified this year, given the controversial nature of health reform, the continuing economic doldrums and the dozens of Democrats who won in 2006 and 2008 in conservative or swing districts.

Cook told me that a district-by-district analysis suggests Democrats will lose up to 30 seats and keep their House majority (they now have a 75-vote edge). But he also said that type of analysis is irrelevant in "wave election years," like 1994 and 2006, and 2010 could be that type of year.

He rates the Democrats' health achievement as a political "wash" and dismisses the idea they could turn it into an asset by fall. "Democrats have lost every single aspect of the health messaging fight for the past year," he said. "It's like a team that's lost 20 games in a season. Why do we think they're going to suddenly start winning?"

It's true that it's never safe to bet on Democrats rising to the occasion. But it is safe to say success will help them more than failure, with this win at the very least bolstering the enthusiasm level among Democratic base voters. For that and other reasons, it is premature for Boehner to be planning his speakership, just as it is premature for Democrats to count on a health care bump. It's unclear how their effort will poll after passage, and there are conflicting results in polls this month. A Kaiser poll, for instance, found 46 percent in favor of the Democrats' bill and 42 percent opposed, while a Fox News poll found 55 percent opposed.

One thing Democrats can count on, though, is consistent support for several individual elements of their package. "Which benefits would they repeal?" House Majority Leader Steny Hoyer's office asked of Republicans in an e-mail. (Eliminating discrimination against people with pre-existing conditions? Closing the Medicare prescription drug "doughnut hole"? Setting up a competitive insurance marketplace? Requiring employers to offer coverage? Preventing insurance companies from dropping you if you get sick? Letting you keep dependent children on your policy until age 26?) Each item linked to a poll showing large majorities in favor. And some will start this year.

Still, Hoyer's office left out unpopular provisions, such as higher taxes on high-income people and the end of subsidies to private Medicare Advantage plans, part of how Democrats will pay for the 10-year, $940 billion plan. The office also left out a requirement that almost everyone buy insurance or else pay a penalty -- a step experts say is needed to widen the pool and make it possible to stop discrimination by the insurance industry.

Obama didn't mention any of that, either, in a pep rally Friday at George Mason University. But people will want the goodies, which include aid to small businesses and middle-income families to help them buy policies, so Democrats have an opening to persuade them the trade-off is worthwhile.

Rep. Paul Ryan (R-Wis.) has been the fiscal point person for his party. He has railed at "double counting" of savings and what's left out of the bill -- chiefly an adjustment in Medicare reimbursements to doctors that Congress makes every year -- as evidence that it would swell the deficit rather than trim it, as the nonpartisan Congressional Budget Office has said it would. Manipulating numbers, Ryan said, is "the oldest trick in the book."

Well, not quite the oldest. The oldest might be not bothering to pay for a new benefit at all. That's what the GOP did in 2003 with its new Medicare prescription drug program -- and Ryan voted for it, twice.

Granted, "at least we're paying for it" is not a winning bumper-sticker argument for Democrats on the campaign trail. As usual, the National Republican Congressional Committee has a much more direct approach, exemplified by its "Code Red Alert" vote-tracking on health. The "alerts" condemned Democrats who decided to vote yes as sellouts, rubber stamps and losers, and happily quoted the reservations of Democrats who concluded they would be voting no. A typical Sunday offering targeted Rep. Earl Pomeroy, D-N.D.: "Pomeroy Ends His Silence – and Career – By Backing Government Health Care Takeover."

Former Obama campaign manager David Plouffe said Sunday on ABC that Republicans who are predicting big gains in November are jumping the gun and "ought to break out that 'Mission Accomplished' banner they put on the USS Abraham Lincoln." Maybe that's what Obama and his party should do. They have notched a policy achievement for the ages -- a true "mission accomplished."
Filed Under: Health Care Endgame

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