In the 1992 presidential election campaign, Democratic strategist James Carville famously unveiled the wedge issue that would decide the election by stating, “It’s the economy, stupid.” It was a simple and efficient message targeting an electorate concerned about job losses and slow economic recovery. George H.W. Bush, who had a 90-plus per cent approval rating after the Gulf War, would end up a one-term president, ceding the reins to Bill Clinton.
Right now, the healthcare messaging from the White House has none of the clarity nor the simplicity of Carville’s slogan. And while Barack Obama remains the best salesperson for healthcare reform, he is having to defend different bills in both Houses of Congress and is not connecting in the way we have become accustomed to. True, opponents of reform have been scaremongering, but that was to be expected. Complicating matters is the sluggish economic recovery and the rising deficit due to the stimulus package and bailouts. One can argue that governing and campaigning are two distinct operations, but if Obama is feeling the heat this August, it is to some extent self-inflicted.
After listening to the last two presidential town hall meetings in Montana and Colorado, I have concluded that the debate has become utterly confusing to many Americans and unnecessarily polarizing. Healthcare reform was a major issue in last November’s election and Obama was given a clear mandate to act on it. While he has not hesitated to do so, the ensuing debate has resulted in a serious loss of momentum at a crucial moment in the process.
In recent days, the cable news shows have focused on political conjecture, like whether Republicans will continue to stonewall any possibility of bipartisan reform, or whether Blue Dog Democrats will do to Obama what was done to Clinton in 1993 and defeat the reform package, or whether Obama will have the votes to enact any significant reform. Obama, with his recent retreat on the public option (he dismissed it as only a “sliver” of the larger reform package), has upset his liberal base without making any noticeable gains for his package. The speculation among the talking heads has turned to the impact all this will all have on the Obama presidency if he fails to deliver on his number one domestic priority. The trouble right now is that Americans are losing sight of why this debate was launched in the first place—for many years, that the healthcare system was in need of fixing was a near-consensus view.
The president and his party need to take a page out of Carville’s playbook and focus on the KISS principle—”keep it simple, stupid.” Right now, it is anything but simple. The debate has been centered around spiraling healthcare costs, which would continue with or without reform, and whether a public option, which is seen as a novel idea even though it is not, is an essential ingredient to the reform package. On some occasions, Obama has presented health insurance reform as a way to emphasize competition and choice. At other moments, he stresses the importance of universality and the need to provide for the 47 million without insurance as well as protect the 14,000 Americans who are losing their healthcare protection every day. Meanwhile, opponents allergic to any tax increase or any government intervention have produced their own KISS strategy—the bogus reference to “death panels” and the claim treatment options will be rationed—and it is forcing the Democrats off their game. When it comes to healthcare, it is easy to scare people.
The latest polemic on the public option provides a glimpse at the incoherence that has marked the debate. It has divided Democrats, pitting those who see it as the “line in the sand” against those naively obsessed with getting some bipartisan support. The proponents of the status quo, including Republicans, claim they are opposed to the so-called public option. However, these same opponents of the public option would fight to the finish to protect current public programs like Medicare, Medicaid, Veterans’ Affairs, and the State Children`s Health Insurance Program, which cover millions of Americans. See the contradiction?
Put simply, the United States spends more on healthcare than any other advanced industrial nation in the world, yet lags behind them in many indicators of good health such as life expectancy and infant mortality. No real bang for the buck! The fear of losing a job in America is compounded by the attendant loss of health insurance. Beyond its impacts on overall health, the loss of insurance can put a family’s financial security at risk. Moreover, the profit-driven health insurance companies have been known to make up their own rules on crucial issues such as the portability of healthcare or whether care can be denied due to pre-existing conditions. And yet, a recent Time magazine poll shows a nearly 90 per cent satisfaction rate among those covered by their employer’s plan. At the end of the day, it is not surprising that people are fearful the reforms might reduce their benefits.
Obama and the Democrats must zero in on the two major areas of reform if they are to win the debate—the need to change critical health insurance practices and provide universal coverage. Yes, costs must be controlled, but all indicators show that the status quo will only lead to higher costs while doing nothing to fix the existing flaws. People will end up with decreasing levels of service and have little choice but to endure them. Meantime, the number of uninsured will only increase, leading to higher overall costs because of uncontrolled charity care costs. Prevention will continue to be a secondary consideration in an nation suffering from an already high rate of obesity. Correcting unacceptable health insurance practices and insuring those currently without protection were the two crucial components of the healthcare reform effort that was discussed throughout the primary season and the presidential campaign. Obama solicited and eventually received a mandate to act on these two priorities.
Democrats have a clear-cut choice in the matter: they can bring in a new public option to compete with private health insurers or they can reform existing programs like Medicare to broaden their scope. I know it sounds simple and, to some, simplistic, but the degree to which a plan can insure the currently uninsured should be the yardstick in this debate and in the eventual legislation. After the August recess, the Obama administration should build a consensus around one of the two options. Applying the KISS principle will improve the Democrats’ odds of being able to sell real reform to a skeptical public.