Sunday night’s House vote on health reform clarified the contours of the mid-term elections. The contest has been nationalized, with two dominant issues—the economy and health care—and one overriding theme: the proper role of government.
The administration and Democratic congressional leaders should not believe that the new health care legislation will speak for itself. In fact, the debate over the next eight months may well be as robust and consequential as was the debate during the past eight months. If the public can be persuaded to modulate its doubts about the wisdom of health reform, House Democrats may be able to minimize their losses, as the Republicans did in 1982. If not, the results could resemble the catastrophe of 1994.
Three recent surveys define the challenge Democrats face between now and November. In a Pew Research Center survey released last Thursday, only 38 percent of the respondents said that they favored the health care bills currently in Congress, while 48 percent were opposed. A CNN survey made public on March 22 showed an even more negative reaction: 39 percent in favor and 59 percent opposed. Although the March Kaiser Health Tracking poll found somewhat more support for the pending congressional legislation, it showed that only 42 percent of the people wanted an up-or-down vote on that legislation; 36 percent said Congress should go back to the drawing board, and 20 percent wanted Congress to drop the topic entirely. A plurality of 45 percent favored a bipartisan approach over a Democrats-only bill. Forty-one percent believed that the proposed bill would force them to change their existing health care arrangements. Only 35 percent thought it would make them and their family better off; 32 percent said worse off, and 28 percent said no difference. (Again, the CNN survey was even more negative: 47 percent of respondents thought it would make them and their families worse off, and only 19 percent expected to be better off.) Fifty-five percent of the Kaiser respondents and 70 percent of the CNN respondents thought the bill would increase the budget deficit—a significant finding in light of rising public concern about our fiscal future.
A Gallup survey released this Tuesday, after the bill’s passage, paints a somewhat rosier picture for Democrats: 49 percent said it was a “good thing” the bill passed, with 40 percent calling it a “bad thing.” Democrats were overwhelmingly satisfied (82 to 11), Republicans dissatisfied (79 to 16), while independents were split down the middle, 45 satisfied to 47 not. Nonetheless, there were signs of a continuing gap in motivation between the bill’s proponents and detractors. Only 29 percent of Democrats described themselves as “enthusiastic” about the bill’s passage, versus 41 percent of Republicans who said they were “angry.” Among independents, 20 percent were angry, versus 10 percent enthusiastic.
So where is the opening for the Democratic counterargument? There are four areas of opportunity. First, the Kaiser poll has long shown a strong plurality (often a majority) supporting the proposition that the country as a whole would be better off if Congress passed health reform, and voters often ask “How are we doing?” not just “How am I doing?”
Second, both surveys suggest that the public regards the congressional legislation as superior overall to the status quo. Pew reports that while 51 percent think that health care costs would increase if the proposal passed, 63 percent think costs would increase if it didn’t. And according to Kaiser, far more think that key areas—health care costs, access to insurance, and quality of care—would improve with reform than with the status quo.
Third, there are appealing features of health reform that begin quickly and will make a tangible difference in the lives of individuals and families—among them, allowing young adults to remain on parents’ policies until age 26 and eliminating preexisting conditions as grounds for denying coverage to children.
And finally, despite their current adverse judgment about the health reform bill, Americans continue to trust President Obama and the Democrats on this issue more than they do the Republicans. Even the CNN survey, while strongly negative about the politics of the bill overall, found President Obama more trusted than congressional Republicans by a margin of 51 to 39 percent, and congressional Democrats more trusted than congressional Republicans by 45 to 39 percent.
Half a century ago, political scientists Lloyd Free and Hadley Cantril observed that while Americans are ideologically conservative, they are operationally liberal. If the debate between now and November is generic—about the role of government—Democrats will probably lose. If the debate is more specific—comparing the bill to the status quo and pointing out its concrete advantages—the public’s view may well become much more favorable.
One thing is clear: Democrats will have to be more focused and effective in the next eight months than they were in the past eight months. Their wobbly, ever-changing rationale for health care reform nearly undermined the entire effort. To raise their game, the White House and congressional Democratic leadership would be well advised to take a page from the standard Republican playbook: decide on the key points to emphasize, agree on punchy language to describe them, and stick to that script between now and November. In electoral politics, repetition is a necessary condition of persuasion.