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Just Words?

The typical voter may not pay much attention to partly platforms these days, but activists certainly do. And at the Democratic Party platform hearings held in Pittsburgh just over a week ago, advocates for health care reform made their presence felt, proposing--and obtaining--revisions to the platform proposed by Obama and the party. The final platform proposal, which the full party will consider in Denver next week, now states that “every American man, woman, and child [should] be guaranteed affordable, comprehensive health care. ... with everyone in and no one left out.” The word “guarantee” didn’t appear in the previous draft; that was the activists’ doing. The phrase “everyone in and no one left out” is also significant: It’s a slogan liberal health care activists frequently use, and they’re hoping that its adoption signals that Obama is serious about reform.

But while supporters of these positions were pleased with their victories, they weren’t entirely satisfied. And it wasn’t simply because the platform fell short of endorsing government-run, single-payer health insurance, which is the option activists strongly favor. The other source of concern was an uncertainty about Obama himself. Health care was never as central to his campaign as it was to Hillary Clinton’s or John Edwards’s. And since the primaries ended, the issue has virtually disappeared from his advertisements and broad messaging. “I’m not sure that Obama will actually pursue the same kind of idea that we had inserted in the platform,” Donna Smith, spokesperson for Progressive Democrats of America, told columnist Marie Cocco.

It’s a legitimate concern. High gas prices may have displaced health care in the public’s mind, but the crisis remains as serious as it was six months ago. Last week, actuaries released predictions that health care costs would rise by 10 percent next year. That will mean more people struggling to pay for health care and more people giving up insurance altogether. Add to this the fact that even the most level-headed analysts now concede that addressing health care is essential to the country’s long-term fiscal and economic health, and the case for health care reform remains as strong as ever.


Does Obama grasp this? There are good reasons to think he does--starting with the fact that the platform language was strong even before the activists introduced their amendments. The original platform, whose principal author was veteran Obama advisor Karen Kornbluh, specified that everybody should have health coverage on a par with what members of Congress have. That’s no small matter, since members of Congress get relatively generous coverage. It’s the right thing to do: without a promise of sufficient benefits, universal coverage is meaningless. But following through on this promise would require passing a bigger, more expensive reform. If Obama wanted to downplay his commitment to health care, he wouldn’t have made this vow so explicit.

The same goes for another potentially controversial element of his health care proposal: Making sure everybody has the option of enrolling in a public insurance plan that looks something like Medicare. A viable public plan would help keep private insurance plans honest, by setting a benchmark for affordability, benefits levels, and responsiveness. And if a public plan proved to be more efficient than private alternatives, it might eventually lure most Americans as enrollees, effectively becoming a single-payer plan by acclamation. That’s why liberals love the idea--and conservatives hate it. If Obama were going to back away from some of his primary-race promises on health care, that’s another place where he might do so. But the public plan, like the promise of generous benefit levels, was always in the platform--again, even before the amendments in Pittsburgh.

Most striking of all, perhaps, is the sheer amount of attention--and apparent priority--health care gets in the platform. Health care is the first policy issue the document takes up in depth. No other platform in recent memory dealt with health care so prominently--or in such detail. Even in 1992, the last year in which a Democratic nominee seriously proposed universal coverage, the platform relegated health care to lesser status: It appeared ninth in a long list of measures to improve economic security. Priorities like deficit reduction, public investment, and agriculture all came before it.

Skeptics will note, correctly, that the whole point of party platforms, for Democrats and Republicans, is to appease the activist base. By themselves, they mean nothing. But conversations with people in and around the campaign suggest that the platform language is more than just rhetorical pandering. Several sources have told me that Obama has explicitly instructed staff to keep plugging away at health care reform, even though other issues may be dominating the polls right now, because, as one senior campaign aide put it, “it will be a top priority for him as president” and “we’ll need to build support for it among the public in order to get it done if we win.” Campaign insiders also insist that the promises of relatively generous benefits and a public plan option are meaningful. Heather Higginbottom, the campaign’s policy director, has told me that Obama considers the public plan “an elemental pillar” of his proposal--one he is prepared to defend this fall even if, as expected, Republicans attack it (falsely) as a “government takeover” of medicine.

Of course, what Obama tells his staff (and what his staff tells reporters) is less important than what Obama tells the public. If he’s serious about building support for health care reform, he has to give it a higher profile than he has already. But the political logic for emphasizing health care is almost as clear as the policy logic: As my colleague Nate Silver has pointed out, it would allow Obama to broaden the conversation about economic security, so that it includes an issue on which John McCain's philosophy and proposals are highly unpopular. And while I'm not sure David Axelrod and the rest of Obama's strategic advisors think this way, the platform is one sign that Obama does.

Jonathan Cohn is a senior editor at The New Republic and the author of Sick: The Untold Story of America’s Health Care Crisis--And the People Who Paid the Price.