Advocacy Consultant
Health care reform passed on Sunday night. On Monday, health care stocks soared – including shares of insurance companies. It might seem counter-intuitive – after all, the talk of Washington has been that the health care overhaul would put patients ahead of “special interests.”
As with any Washington, DC mystery, the rhetoric is pointless and the real answers stem from who has their hands in the cookie jar.
On Friday, Barack Obama was a one-term President. The Democrats were swimming upstream against the political current, weighed down by an unpopular health care bill. Scott Brown’s election meant that the Republicans would sweep the fall elections.
Today, the details of the health care bill are quite inconsequential: despite the fact that many Americans are saying they’d support a candidate who pledged to repeal the deal, Obamacare is now the law of the land.
If you can get past the needless potshots at conservative talk radio and other efforts to prove he’s really one of the cool kids, David Frum’s piece on CNN makes a few tidy points about how hard a straight repeal is:
Some Republicans talk of repealing the whole bill. That’s not very realistic… Will they vote to reopen the “doughnut” hole for prescription drugs for seniors? To allow health insurers to deny coverage to people with pre-existing conditions? To kick millions of people off Medicaid?
Kudos to Frum for the correct spelling of the word “doughnut” – and for laying several policy proposals to fix the bill that was passed last night.
He gets some of the policies wrong, but he gets the big point right: that the one-word campaign of “Repeal!” just won’t cut it. Republicans will need to have a plan in place to do things Obama promised to do with his health plan – especially reducing cost and expanding access.
Obamacare’s opponents can no longer arguing against an unpopular proposal; they now must argue against an existing entitlement. Polls may show that many voters opposed the health care overhaul last week, but those who would change the policy must now fight a different battle altogether.
Sunday looks like D-Day for President Obama’s push to overhaul health care. There is plenty of speculation flying around about votes in the coming days and what those mean for votes in November.
How will health care affect the political environment over the coming eight months? Some humble predictions:
1. Health care will only be a short-term political liability for Democrats if it doesn’t pass – if it does, it will be a short-term benefit.
The bitter battle over health care is one reason that voters are souring on everybody in Washington. The sooner that debate is over, the sooner Democrats can focus on things like regulatory reform and passing out money like Jack Nicholson’s Joker in Batman ’89 while asking, “Who do you trust?” – both of which are much easier to craft messages for.
But there’s more than that. The opposition to Obamacare (both official and unofficial) has highlighted long-term effects for the American health care system and federal budget – unfavorable comparisons to British and Canadian health care systems, excessive cost, and even shortages of care and care givers. These won’t take effect by November 2010 or even 2012.
If the health care overhaul passes – and the expected state challenges are quick and quiet – Democrats will trumpet their progress for the next three years while accusing Republicans of lies and scare tactics. Obama is right to link the passage of health care and his party’s political fortunes.
2. It’s probably going to pass, and it doesn’t matter how.
As Dan Flynn opines, the reason there hasn’t been a vote already is because there aren’t enough votes. Until Nancy Pelosi can amass 216 Democrats to support whatever parliamentary gymnastics she has to do to get a bill through the House, there will not be a vote. When the vote comes up, bet the house – it’s getting through.
3. The “Repeal Obamacare” movement will get less traction than one might expect.
Entitlements are the gifts that keep on giving. They don’t actually help end poverty, they don’t give people a comfortable retirement, and they don’t help people who have lost their jobs find new ones. They do provide platforms for politicians to promise even more entitlements. When entitlements fail to fix the problem they were meant to solve (or make it worse), the answer is generally to dump more funding into the failed program.
Even failed programs can be elevated to third-rail status. Remember the left-wing backlash against President George W. Bush’s Social Security reform? You can expect a similar reaction to future attempts to roll back Obamacare.
Like Social Security reform, real health care reform – that involves doing more than just getting more people into a broken system – will require a long-term, sustained effort that changes how our culture views our government.
Bonus prediction: By the way, whatever the outcome of the vote on Sunday, people with money will always get the health care they need and want.
The official logo of Conan O’Brien’s upcoming Legally Prohibited from Being Funny On Television tour is based on the now-familiar illustration of a stoic O’Brien standing against the American flag, gray but for the bold orange pompadour rising from his head like a mighty wave rising from the ocean. It may be the icon of Team CoCo, but it didn’t come from Team CoCo: the graphic was created by Mike Mitchell, an enthusiastic artist who had nothing to do with O’Brien other than being an avid fan with an idea and some spare time.
Largely on the back of the massive outpouring of support he enjoyed in the final weeks of his Tonight Show run, O’Brien stands to make a lot of money wherever he lands this fall. O’Brien will be rewarded for embracing that organic excitement. It’s similar to the smart moves made by the 2008 Obama Campaign, which enjoyed the creation of a similar iconic image created by Shepherd Fairey – an enthusiastic artist who had nothing to do with the campaign, but had an idea and some spare time.
A technical term for this is “advocate-generated content.” Even that mouthful is easier said than done. You can’t force people to identify with a cause, let alone feel so strongly about it that they are willing to make art. Both Team CoCo and Obama 2008 benefited from a simple, direct, and resonant message. The fancy artwork was just a symptom.
The Carly Fiorina campaign has released a follow-up to their much-lampooned “Demon Sheep” web video. In this one, Barbara Boxer turns into a giant blimp because she’s full of hot air. (Getcha popcorn ready, because it’s almost eight minutes long.)
Despite the ribbing from Fiorina’s primary opponents, ad maker Fred Davis claimed victory for the viral hit, pointing to its high number of YouTube views. Davis might have a point. The funny part of the Demon Sheep video – the campily costumed and Keds-clad sheep – came at the end, after the video had railed on fellow Republican candidate Tom Campbell’s fiscal street cred. The Boxer Blimp wouldn’t attract nearly as much attention if it hadn’t been for its fluffy forefather.
Still, the video is as unfocused as it is comical and over the top. The message shifts from the Senator being arrogant to incompetent to out of touch, and discusses taxes, environmental policy, financial restraint, national security, and Boxer’s personality with clumsy or non-existent segues. The imagery is often uneven; at one point, the announcer accuses Boxer of being progressively “less and less effective” during her Senate tenure just as her image is smashing through the Capitol dome.
It does, however, tell a good story about Carly Fiorina – but unlike the Demon Sheep, the story comes after the CGI blimp attack.
But regardless of what anyone thinks of the style of the ads or how many viewers they attract, the one measure of effectiveness is at the polls. That’s an area where Fiorina still lags behind.
(By the way, if you look closely, I’m pretty sure the shots of San Francisco include Alamo Square – more notably known as “Full House Hill” for its inclusion in the opening credits of the legendary and classic sitcom.)
USA Today wonders about Barack Obama’s base being “disengaged” come 2012. That may make the presidential election closer than it would have been otherwise, but it won’t tip the scales in favor of a Republican challenger.
George W. Bush had a similar problem in 2003. Conservatives were grumbling about education reforms and the prescription drug benefit; there was even a healthy dose of disagreement on the Iraq war. For many, it meant sitting on their hands – and one conservative writer even told me he voted for John Kerry because he felt anyone would be better than Bush.
Bush did, however, have a brilliant campaign apparatus in place and enough excited activists to overlook some specific policy disagreements. Initially, it seems Obama can boast the same.
If Dick Cheney is to be turned into a prophet, it will not be due to former loyalists losing faith; more likely, it will be because independent voters don’t buy what those loyalists are selling, Obama may join the ranks of the unemployed. A GOP version of John Kerry – or, to avoid crossing party lines, a re-enactment of Bob Dole’s uninspired 1996 campaign – will still run into a buzz saw.
Washington is still buzzing about the RNC’s leaked fundraising presentation, especially the use of the word “fear” as a means to win support.
Why couldn’t the Republicans be more like our President, who speaks in rational terms about ideas, just like he did in Pennsylvania today:
Every year, the problem gets worse. Every year, insurance companies deny more people coverage because they’ve got preexisting conditions. Every year, they drop more people’s coverage when they get sick right when they need it most. Every year, they raise premiums higher and higher and higher.
See the difference?
In an upcoming appearance on the Matt Lewis Show, Matt and I discuss the Coffee Party – the ragtag band advocating for the expansion of government in opposition to the Tea Party’s ragtag band advocating for less government. The American electorate has therefore been delineated into two camps: “Gimme, Gimme, Gimme, I Need, I Need!” and “Relax, I Got This Under Control.” “Democrat” and “Republican” have run their course.
I mistakenly thought the Coffee Party was a clever invention of DailyKos or some other established leftward organization, but the Washington Post proved me wrong – it was a clever invention of a grassroots activist. But the main challenge they face is evident in their name. They have defined themselves more through who they are not than who they are.
“The conservative answer to [BLANK]” has been the movement’s white whale for years. “Conservative answers” to Facebook, YouTube, DailyKos, the Barack Obama Campaign, the New York Times, Digg, and countless other online and offline institutions have been launched and, at best, met with limited success. In contrast, groups like the Tea Parties and Top Conservatives on Twitter have used existing infrastructure to accomplish something unique.
If the Coffee Party seeks to be the liberal answer to the Tea Party, they may be mimicking the conservative movement more than they know.
Eighteen months ago, Vice Presidential nominee Sarah Palin was roundly criticized for being unable to answer Katie Couric’s question about what newspapers she read frequently to get her news. Palin’s answer was “most of them.”
It’s actually a good answer poorly worded. According to a report from the Pew Internet and American Life Project, 92% of American’s “graze” on news from multiple sources and on multiple platforms. Only 35% even have a “favorite” source. So even if the dinosaurs of traditional media – such as the CBS Evening News – are losing viewers, it doesn’t mean the public is less informed. Actually, it probably means the opposite.
Perhaps Palin should have responded to Couric’s ridiculous question with something like: “Well, Katie, even up here in Alaska it’s a digital age. The morning newspaper and the evening news are important, but you can’t stop there, and we have access to news sources from all over the world. I don’t limit myself to a single source or a small group of media outlets. What well-informed person would?”
Indiana Governor Mitch Daniels – one of the potential GOP contenders for 2012 – made a case for consumer-driven health care reform in today’s Wall Street Journal. Daniels calls for the incorporation of Health Savings Accounts, or HSAs, into health care reform efforts. So does Michael Tanner, a senior fellow at the Cato Institute. Though both are ostensibly arguing for the same thing, check out the subtle differences in how they do so.
(This is, by the way, a new and different type of call for health care reform than we have seen from most voices from either party in the past few years, and it’s a positive development.)
Daniels talks about his experience implementing an HSA-based health care program for his “co-workers” employed by the state of Indiana. Recognizing public concern not only over health coverage but also cost, Daniels points out savings to employees as well as the state. But the thrust of his argument is the benefit to the patient:
State employees enrolled in the consumer-driven plan will save more than $8 million in 2010 compared to their coworkers in the old-fashioned preferred provider organization (PPO) alternative. In the second straight year in which we’ve been forced to skip salary increases, workers switching to the HSA are adding thousands of dollars to their take-home pay. (Even if an employee had health issues and incurred the maximum out-of-pocket expenses, he would still be hundreds of dollars ahead.) HSA customers seem highly satisfied; only 3% have opted to switch back to the PPO.
Buried towards the end of Daniels’s piece is the argument that patients are more frugal when face with spending their own money – which is true, but not the strongest argument on behalf of HSAs. Tanner, however, makes that a central part of his case.
If everyone were to receive a CT brain scan every year as part of their annual physical, we would undoubtedly discover a small number of brain cancers much earlier than we otherwise would, perhaps early enough to save the patient’s life.
But given the cost of such a scan, adding it to everyone’s annual physical would quickly bankrupt the nation. But, if they are spending their own money, consumers will make their own rationing decisions based on price and value. That CT scan that looked so desirable when someone else was paying, may not be so desirable if you have to pay for it yourself. The consumer himself becomes the one who says no.
Tanner’s point is strong an irrefutable, but it’s an academic argument rather than a political argument. It’s as callous as it is true – saying, essentially, “Pay for your own doctor, Chet.” When was the last time logic won a political debate?
Daniels’ vision of consumer health care isn’t a shift in burden, but about trusting the patient to steer their own course – without government or, for that matter, the vilified insurance companies.
It may not be an idea the American public is ready to accept quite yet, but the more people make the case as Daniels has, the more palatable patient-driven health care will become.
Jim Eltringham 