The political case for national health reform

A positive brand image. That’s what every successful company seeks, and what unsuccessful companies don’t have – and which the Democratic party, despite its recent successes, is sorely lacking. Yes, the 2008 elections were a rousing success for the Democrats, but that success was driven more by the astonishing incompetence and jaw-dropping corruption of the opposition than by a noticeably smarter/better/more accomplished Democratic party.
The Democrats now have eighteen months to become a real political party again, something that is not merely an alternative to the GOP. Sure, there will be new regulatory bodies and enhanced oversight, better personnel selection procedures and more open government, fewer signing statements and more regulations that will affect workers and protect savings and the environment, but how do you put that on a bumper sticker? How does that translate to a message for the masses?
For the past sixteen years, Democrats have attempted to claim the mantle of the advocate for the working man, all the while passing NAFTA, cutting taxes for the wealthy and big business while enabling offshoring. rolling over and being rolled by their more aggressive political opponents. No wonder blue collar voters ditched the Dems; instead of opposing the Republicans’ business-friendly agenda, to a large extent Dems went right along, even if it cost their old core constituency big-time. For the newly-ascendant Democratic Party, significant health reform may be the key to re-establishing the Party’s brand among middle-class and blue-collar voters. Guaranteeing every American access to affordable health care would, in one stroke, regain the party’s tattered reputation as the supporter of the working man, the party of the middle class.
As Thomas Frank notes, “Any kind of national medical program would be so powerfully attractive to working-class voters that it would shift the tectonic plates of the nation’s politics.” Mr Frank, a deep student of the phenomena wherein so many Americans vote against their economic betterment, is referring to the Republicans’ power within middle America, the so-called Red States, where the middle and lower socio-economic class voter consistently supports the GOP’s candidates, driven primarily by social issues. The candidates elected by these voters push positions that end up benefiting big business while reducing wages and the power of labor. Yet the Republican candidates are able to win and stay in office largely on the strength of positions on abortion, guns, school prayer and choice, homosexual rights; issues that appear to be far more important to many Red State voters than economic concerns.
Not only have most Democratic candidates consistently been on the wrong side of many of these social issues (from the perspective of most Red State voters). The Dems have failed to make political hay out of issues as compelling and obvious as declining wages, job losses, and economic blackmail on the part of big business (tax breaks or we’re out of here). These bread-and-butter issues, the ones that land on the kitchen tables of working people, are precisely where the Democrats used to earn their keep.
Right now, those workers with health care know their health care is subject to the whim of their employer, and while they may feel ‘safe’, they know more than a couple people who have lost their insurance and suffered mightily as a result. Bob Laszewski notes that most workers with coverage are pretty satisfied with their health insurance. But my sense is there is something deeper here too; as middle class, white blue and pink collar workers watch the economy slide out from beneath their feet like sand on a beach, there is a just-under-the-surface-anxiety, a nibbling fear that their coverage may not be as rock-solid as they thought.
The Democratic Party would put itself in a very strong position entering the mid-term elections in 2010 if it passes national health reform (or something close enough for political advertising). By actually delivering something of obvious and significant value to the vast majority of voters – for those with coverage today a sense of security, of protection, of solidity; for those without affordable, comprehensive insurance; the party would plant its flag deep in the heart of Red State Republican country.
Passing some form of national health reform, one that includes a guarantee of access to care and protection from financial devastation would blow this gloomy cloud right off the shoulder of the middle class. It will take a masterful job of cat-herding, as the Democrats in Congress are a remarkably diverse lot. This diversity, from southern Blue Dog to Bay Area liberal, is both the strength and weakness of the Dems. While it enables the party to compete and win in diverse areas, now that the party has solid majorities in both houses of Congress, that diversity is a problem. The Democrats task is to find a major “win” to coalesce around, a goal that will clearly and loudly resonate among voters wondering who exactly these Democrats are and what they stand for.
A compelling case can be made that universal health care addresses the issues of concern to each member in the Democratic caucus: a universal plan
– is good for business, as it alleviates employers’ burden of health care selection (possibly) and financing (possibly at least in part) while improving the health of the workforce.
– is good for providers as it eliminates the risk of uncompensated care, allowing providers to concentrate on treatment while (potentially) addressing the problem of under-compensated care
– is good for patients because they will have access to good care regardless of their employment or marital situation
– is good for society as it will lead to an overall improvement in the nation’s health status.
A universal health plan also addresses the single biggest issue in the Party today – solid evidence that it can actually deliver on its promise to fight for the middle class.
Most importantly, passing universal health care would give the Democratic Party a hugely valuable head start on the 2010 election battle, one that may actually give Red State voters reason to consider voting “D”.
No doubt, Republicans will dust off the “socialized medicine” meme and play those old “Harry and Louise” recordings yet again. But I’m not so sure those messages will scare voters, at least not enough to overcome the pervasive anxiety felt by many families throughout middle America. And if the Republicans are able to block health reform, my sense is voters will see them as on the wrong side of the issue. Recall last summer’s battle over raising physician reimbursement; GOP Senators were crucified by voters after the Senators blocked a physician payment increase, a move that may well have helped their Democratic opponents in the fall.
What does this mean for you?
I don’t think Congress is ready for national health reform in 2009. There’s just too much to do and not enough time to do it all.
But politics trumps all.
Now that adults appear to be once again heading up the Democratic Party, they may well seize this political opportunity and press for reform in 2010. Win or lose, it’s a winning move.

4 thoughts on “The political case for national health reform

  1. Universal coverage for preventive care, defined boradly (e.g. blood pressure medicine to prevent complications of hypertension)was recently adopted as the policy of the AMA, and may prove a politically acceptable middel ground that gets everyone into a single system; efficiency of the entire system could be improved by reorganized around this preventive care core. The net cost to the Nation of early desease detection and good disease management would be small, due to the reduced need for more expensive care, e.g. treatment of strokes, and due to the improved worforce productivity.
    George Anstadt

  2. Which is why if you are a physician or healthcare worker and don’t share democratic views, we will have to do every thing we can to make health care reform if it is enacted fail and fail in spectacular fashion, to kill an albatross to hang around the democrats. Prolonged slowdowns and testing twice as much twice as often on those that do come through the door. Incredible wait times and massive costs, but hey it’s free and I have this shiny new insurance card. You might say “we already have the most expensive system in the world”, I say you ain’t seen nothing yet.
    See what happens when you make healthcare reform a partisan position?

  3. “The Dems have failed to make political hay out of issues as compelling and obvious as declining wages, job losses, and economic blackmail on the part of big business (tax breaks or we’re out of here). These bread-and-butter issues, the ones that land on the kitchen tables of working people, are precisely where the Democrats used to earn their keep.”
    “Mr Frank, a deep student of the phenomena wherein so many Americans vote against their economic betterment, is referring to the Republicans’ power within middle America, the so-called Red States, where the middle and lower socio-economic class voter consistently supports the GOP’s candidates, driven primarily by social issues. The candidates elected by these voters push positions that end up benefiting big business while reducing wages and the power of labor. Yet the Republican candidates are able to win and stay in office largely on the strength of positions on abortion, guns, school prayer and choice, homosexual rights; issues that appear to be far more important to many Red State voters than economic concerns.”
    Or maybe red state voters are to smart to fall for democrats’ “talk”. Anyone can look and see real world examples of the outcomes of democrat control versus what they claim. I’m spending Christmas outside Cleveland, for decades democrats have run the city and it’s terrible, high unemployment and taxes and terrible education. Drive 20 miles outside the city to the red state suburbs and unemployement is points lower, schools are great and taxes reasonable.
    This also applies to Detroit, Philly and most cities ran by democrats. Why in the world would any educated person vote for a democrat who claims they will do X, Y, Z to make their lifes better when they can look at any major city and see how much of a complete failure Democrats are. There is no possible way you can blame any of Cleveland’s or Detroit’s problems on Republicans. Just as there is no way you can credit Democrats for the successes of the suburbs and rural areas.
    The real world question is who in their right mind would trust their benefits to liberals? If your employer doesn’t have a good plan or a plan at all or cuts benefits you have a possibility of changing jobs and finding coverage you like. When Democrats cut or change your government provided benefits you have no recourse. You can’t pick a new government and have better benefits next month.

  4. I think the middle class can have universal health insurance anytime it wants it. All it has to do is clearly communicate to politicians from both parties that it is ready, willing and able to pay European level taxes. Democrats who try to convince the middle class that universal health insurance can be theirs if we just raise taxes substantially on a small sliver of high income people will be exposed frauds. Even some liberals are starting to admit that there simply aren’t enough rich people to tax (more heavily), especially in the aftermath of the current crisis plaguing the financial system and the economy.