Selling Reform

The strategizing of how to sell health care reform does kind of fascinate me. The Obama Administration has learned - perhaps too well - the lessons of 1994, and have repeated the mantra of "You can keep what you have, you can keep what you have". But that doesn't offer a stake for that group of people in any reform.

Current bills would expand the number of insured — but 90 percent of voters already have insurance. Congressional leaders say the bills would cut costs. But experts are dubious. Instead, they point out that covering the uninsured would cost billions.

So the typical person watching from afar is left to wonder: What will this project mean for me, besides possibly higher taxes [...]

Our health care system is engineered, deliberately or not, to resist change. The people who pay for it — you and I — often don’t realize that they’re paying for it. Money comes out of our paychecks, in withheld taxes and insurance premiums, before we ever see it. It then flows to doctors, hospitals and drug makers without our realizing that it was our money to begin with.

The doctors, hospitals and drug makers use the money to treat us, and we of course do see those treatments. If anything, we want more of them. They are supposed to make us healthy, and they appear to be free. What’s not to like?

The immediate task facing Mr. Obama — in his news conference on Wednesday night and beyond — is to explain that the health care system doesn’t really work the way it seems to. He won’t be able to put it in such blunt terms. But he will need to explain how a typical household, one that has insurance and thinks it always will, is being harmed.

This is a vexing problem, and buying off stakeholders so that they could protect some of their profits doesn't help. But there is a way to sell this to the public. First of all, we can say that the current system is broken. With no reform, premiums will continue to rise, with lower and lower quality. The second point is one of security. When people lose their jobs, they in many cases lose their health care. COBRA is too expensive to be a fix. You cannot move from one job to another seamlessly and keep your health care. You are at the mercy of employers in an inefficient system for delivering insurance. Providing stability to the system, so that you know you are covered, and you know the costs won't rise so much that they'll break you - 60% of all bankruptcies are from medical bills - is deeply sought. Nancy Pelosi stressed this today.

Do you need more time?

You don't need more time. The time is now. People have been waiting so long for this. I had a friend who was getting married, I said "You're getting married, I didn't know about all this!" She said, "I need health benefits."

And the third way is to show Republicans as simply going about obstruction for political purposes. You hate to go back to the "accountability moment," but that's pretty true. Voters asked for change last November, and they did not want their President to face a "Waterloo" within the first year. Particularly because of the dangers of the status quo. Pelosi, again:

We have to assume that the Republicans share our value that all Americans should have health-care coverage. But the Republicans know that passing real health-care reform that is meaningful to the American people is politically powerful. And they must stop it. It's the most noticeable initiative Congress can take to improve the lives of the American people, and they must stop it [...] I would imagine there were some Republicans who felt some discomfort at [Jim DeMint's comments that this could defeating health-care reform could "break" Obama], because he blew their cover.

I think if the President goes out tonight and adds all that into his formulation of a pitch, we'll have something. And a speck of righteous anger wouldn't hurt.

...and of course, the idea of choice should be foregrounded:

Of course, then you're in a place where you need to explain exactly how the reforms will make health care cheaper. And the answer is that they won't in the next few years. Take-home pay will not increase in 2014 because of health-care reforms. But they're a start. That's the correct answer. But it's not an exciting answer. And it asks people to endure a measurable short-term harm in the hopes of a speculative long-term gain. That doesn't work out so well.

For that reason, I keep coming back to this idea of choice. When even RNC Chairman Michael Steele doesn't have a choice in health-care insurance, you're dealing with a world in which you could really help them out by giving them access to options. That's why I'm so enamored of Ron Wyden's idea. But there are no silver bullets. It's taken a long time to get health care to this place. It'll take at least a bit of time to get it to a better place. But patience is not one of the political system's virtues.