"Politico Fails The Politics Of Health Reform"
In a provocative story published yesterday in Politico, Ben Smith claims that Democratic allies close to the White House are suddenly “dramatically shifting” their health care messaging, “abandoning claims that it will reduce costs and deficit, and instead stressing a promise to ‘improve it‘”:
The messaging shift was circulated this afternoon on a conference call and PowerPoint presentation organized by FamiliesUSA — one of the central groups in the push for the initial legislation. … Democrats are acknowledging the failure of their predictions that the health care legislation would grow more popular after its passage, as its benefits became clear and rhetoric cooled. Instead, the presentation is designed to win over a skeptical public, and to defend the legislation — and in particular the individual mandate — from a push for repeal. …The presentation also concedes that the fiscal and economic arguments that were the White House’s first and most aggressive sales pitch have essentially failed.
You can read the entire slide show presentation here, but Smith’s claims of a “dramatic” or secret change in messaging is anachronistic and misleading. They ignore the shifts in message that occurred throughout the reform period and suggest, incorrectly, that Democrats are abandoning previous claims to save a sinking ship, a notion that’s not supported by recent polling data. As Michael Crowley points out, “a late-July Kaiser Family Foundation survey found that 50% of the public views the new law favorably, up 9 points from May, while the proportion of Americans who view reform unfavorably has dropped from 44% to 35% in the same period. In late June, more Americans (49%) told Gallup that the law’s passage was ‘a good thing’ than those who disapproved — the first time the law showed a positive result in Gallup’s survey.”
Democrats certainly opened the health care debate with an economic argument developed by Peter Orszag and his staff. They talked about health care bending the cost curve and eliminating unnecessary spending and ultimately lowering the percentage of GDP dedicated to health care. These arguments may have wooed moderate Democrats like Kent Conrad or Ben Nelson, but they did little to sell the American public on the idea of reform.
As early as the summer of 2009 (even before the August town halls), prominent Democrats began weaving personal narratives about premium increase, the public option and insurance company abuses into their public remarks and stressed the bill’s consumer protections and market place reforms. In August of 2009, the Star Ledger — a NJ newspaper — noticed a “shift in Democratic tactics,” brought on by decreased support for reform. After months of bringing all of the stakeholders to the table, Democrats began describing insurers as “villains” and arguing that reforms like the public option could break their private monopolies and provide Americans with more choice and competition. “They are the villains in this. They have been part of the problem in a major way,” Pelosi said of the insurance industry.” “They are doing everything in their power to stop a public option from happening, and the public has to know about it.” In October of 2009, Politico also reported on the Democrats’ embrace of this more populist message. Under a headline titled, “Dems Change Focus in Health Debate,” Manu Raju wrote, “Democrats have succeeded in changing the terms of the debate, redirecting focus to the merits of a public option, and attempting to create a sense of momentum that the bill is moving forward.”
Obama adopted a hands off approach throughout the health care debate, but even his final pitch eschewed broad economic messaging and focused on how reform would help individual Americans. “So you want to know why I’m here, Ohio?” Obama asked during a campaign-like stop in Strongville, Ohio on March 15, 2010. “I’m here because of Natoma [a woman who had to give up her individual health insurance coverage because she could no longer afford it]. I’m here because of the countless others who have been forced to face the most terrifying challenges in their lives with the added burden of medical bills they can’t pay. I don’t think that’s right.”
At that rally, Obama laid out “three things” he was hoping to change with his health care proposal and listed cost control last: 1) “It would end the worst practices of the insurance companies” 2) “For the first time, uninsured individuals, small businesses, they’d have the same kind of choice of private health insurance that members of Congress get for themselves,” 3) “my proposal would bring down the cost of health care for families, for businesses, and for the federal government.”
It’s not that Democrats completely abandoned the economic message of health care reform — they simply moved it down on the list of messaging priorities. Intervening events like WellPoint’s 39% premium increase in California provided Democrats with an opportunity to make their case in terms that better communicated the intent of the legislation and naturally pushed the party away from esoteric terms like “deficit,” “bending the cost curve,” and “percent of GDP.”
Since the bill was signed into law, HHS and the White House have hosted almost weekly web chats, conference calls, and cut commercials and brochures to educate the public about the new regulations and changes. The messaging about economics and cost control is now less prominent because it is less immediate. Savings from the law will accrue only after it’s fully implemented and regulators are appropriately focusing on ensuring that those savings actually materialize through proper implementation.
The Politico article incorrectly assumes that reform is hanging on for dear life and that Democrats and their allies are making one last ditch effort — a sudden message switch –to resuscitate it. The reality is that Democrats are having trouble convincing certain sectors of the public on the merits of the law and are relying on past messaging efforts to close the sale.