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The Politics Of Health Care Reform

On the front page of today's Washington Post, I read that health care reform is dying:

Health Reform Deadline In Doubt

Process Could Be Slow And More Contentious

Senate Majority Leader Harry M. Reid acknowledged Thursday that his chamber is unable to pass health-care reform before its August recess, a move that highlighted internal Democratic divisions on the legislation and is likely to result in significant changes to the shape of the final bill.

Meanwhile, turning to page two, I read in Dana Milbank's sketch column that health care reform is dying:

In the Hart Building, Reform's Pulse Weakens

Is this where health-care reform goes to die? 

A thunderstorm rumbled over the Hart Senate Office Building on Thursday afternoon. Rain leaked in and dripped in the atrium to the ground floor. On a fifth-floor landing, 35 journalists and more than 50 lobbyists formed a gantlet as half a dozen senators filed into Senate Finance Chairman Max Baucus's office to try to salvage health-care legislation.

And on the op-ed page I read in Charles Krauthammer's column that health care reform is already dead:

Why Obamacare Is Sinking

What happened to Obamacare? Rhetoric met reality. As both candidate and president, the master rhetorician could conjure a world in which he bestows upon you health-care nirvana: more coverage, less cost. ...

These blindingly obvious contradictions are why the Democratic health plans are collapsing under their own weight -- at the hands of Democrats. It's Max Baucus, Democratic chairman of the Senate Finance Committee, who called Obama unhelpful for ruling out taxing employer-provided health insurance as a way to pay for expanded coverage. It's the Blue Dog Democrats in the House who wince at skyrocketing health-reform costs just weeks after having swallowed hemlock for Obama on a ruinous cap-and-trade carbon tax.

As I explained recently, I think these predictions are pretty overwrought. But the fact of the reporting/commentary to this effect is significant in shaping the legislation that will come out. The reform effort is necessarily getting unpopular. Why? because the health care story people are getting is about haggling, backbiting, and legislative morass. The Republican message is that health care reform is evil big government that will raise your taxes and ration your care while exploding the deficit. The Democratic "message" these days is all about process -- if you see a Democrat quoted, he's probably saying that we can still pass a bill, or castigating his colleagues for moving too slowly or too quickly, or simply bolstering the Republican critique. In this context, it's literally impossible for public opinion to move in a friendly direction for reform. People -- even supporters of reform -- just get angry.

Matthew Yglesias had an oversimplified but pretty solid point about how public opinion is likely to react:

One way of looking at how congress, the White House, and public opinion interact goes like this. The President offers a health care plan and arguments in favor of it. His critics offer opposing arguments. Both sides are more or less persuasive. And depending on which side is more persuasive, public opinion tilts for or against the plan. And depending on how public opinion tilts, members of congress will vote and the plan either passes or fails.

Another model would look quite different. In this model, most members of congress have a great deal of latitude to vote however they want. They’ll decide what they want to do. And if all the Democrats decide to back the president, probably a few moderate Republicans will join in. And if the public sees basically the whole Democratic Party joining with a few Republicans to pass a health care plan, then self-identified “independents” or “moderates” will conclude that it’s probably a good plan and generally approve of it. Thus, the plan will be popular. Alternatively, if moderate Democrats decide to vote “no,” then Republicans will offer uniform opposition. And if the public sees all Republicans joining with some Democrats to defeat a health care plan, then self-identified “independents” or “moderates” will conclude that it’s probably a bad plan and generally disapprove of it. Thus, the plan will be unpopular.

Personally, the second model seems more plausible to me.

People do not pay close attention to details. The broad message is likely to shape their ultimate view. And the biggest single driver of that opinion is whether health care reform passes. If it does, then it will have a Rose Garden ceremony, lots of commentary about the historical import, liberal celebrations and conservative apoplexy. If it fails, then the plan will be described as a "failure" -- a designation intended to describe the political prospects but which is certain to bleed into the public's estimation of the plan's substantive merits -- and produce endless commentary about liberal overreach, all of which will make people more prone to believe that the plan was a disaster.

Democrats simply have to accept that health care reform is going to be polling badly when they vote on it. There's no mechanism in the current media configuration that would allow them to convey the details of the plan in a positive way without getting overrun by negative process stories. It's just not possible. What they have to focus on is which alternative is likely to make them better off: reform passing or reform failing. t's an easy call, which is why I think reform will pass.

--Jonathan Chait