Compromise Needed To Pass Health Insurance Reform

by SheriAllan on June 21, 2009

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Try telling conservatives that Barack Obama is no liberal and you just get blank stares. Reading their own talking points, they will never understand how one could possibly suggest that the president who has tripled the deficit and wants to socialize everything could be anything other than a liberal unless you want to call him a socialist.


But liberals are certain Barack Obama is not a socialist and they are just starting to realize he is no liberal either.   Progressives are just now finding out who they elected president last fall, and he is just as he campaigned, a remarkably audacious pragmatist. Audacious for everything he is trying to get done in his first year, but there is so much compromise in getting each element that the true left is wondering if the core kernel of progressive goals is getting bargained away.    


An aggressive agenda full of compromise to get it done

After the stimulus bill and several bailouts, and in addition to new overtures to countless international allies and adversaries, the domestic agenda for 2009 includes health care reform and climate change and a host of other issues that only seem small by comparison — but in each case, don’t be surprised if compromise is the order of the day.


For instance, earlier this month, Congress passed and the President pledged to sign legislation that for the first time allows the Food and Drug Administration authority to regulate cigarettes – once thought a liberal dream – but some liberals are complaining that in crafting the Bill that Phillip Morris supported, so many compromises were introduced that the FDA is blocked from doing many of the things; such as regulating the dosage of nicotine or banning existing tobacco products; that might have the greatest impact on public health.


Our point is not to criticize the progressives who will view this and other compromises as inadequate to the task of solving our most pressing problems. What they are saying is true and important, and this is America — everyone has the right to voice opposition to a proposed piece of legislation. To a degree, principled voices on the left help move policy toward the left. The stronger the support for the left position the greater the leverage Obama has to get the best deal he can for his compromise position – one that has the peculiar benefit of being passed by Congress, signed by the President of the United States, and therefore the law of the land.


But taken too far, these progressive voices can become an impediment to progress. This happens when some leftists start to see the center-left compromise-to-get-the-deal-done style Obama represents as an adversary of progress rather than as a means to achieve it. When the true believers on the left stand in opposition to the center-left, the right wing celebrates. The right wing has just been soundly defeated by the coalition of the left and center left, but it could gain new life if this coalition splits.


We live in a Democracy and a Democracy is not about being right, it’s about having a majority. Barack Obama (and Hillary Clinton) campaigned as a pragmatic center-left Democrat and Dennis Kucinich campaigned as the true representative of the far left. Obama won the nomination and we all rallied around him. He was not for “single-payer” national health insurance in the campaign and he is not for it now. There has been no sellout.


Passing health insurance reform is going to be very, very hard.

Bill Clinton’s Pollster for the 1993-1994 health care reform effort Stan Greenberg wrote an article in this week’s New Republic that is basically a repeat of what we wrote four months ago here. Greenberg has been looking at his own polling in 2009 compared to the polls he took in 1993, and he concludes (just as we did) that public views are not very different now than they were then, but to the degree they have changed, current attitudes are less supportive for reform.


The big problem is, the views that undercut reform in 1994 – the majority’s satisfaction with their own coverage, the public’s desire for reform that saves them money (covering more people is just a bonus unless you don’t have coverage now), and especially the public’s rejection of any new taxes on themselves – are stronger now than then.


Casual readers of the polls may miss this because healthcare polling is fairly confusing. In the abstract, the public strongly supports the idea of “health reform,” but this is because they hope it will save them money, so they are just as passionate in rejecting any mechanism to pay for it if it might mean that they would pay additional costs.


The most recent release from the Diagio/Hotline poll is typical. The headline: “High Public Support for Major Overhaul of Health Care” but this is followed by the sub-headline; “Taxing Health Benefits Strongly Opposed.”


Like most other polls, this one finds a strong majority (62%) supporting “a major overhaul of the U.S. health care system.” But when they tested the current best idea anyone has come up with so far to pay for it, taxing employer paid health benefits as income, by 26% to 62% an equally strong majority says “no way.”


The latest NBC News Wall Street Journal poll finds little difference when the proposal is more clearly defined and limited to people with the most expensive plans. When their list of possible elements of reform includes “require people with expensive health plans with more generous benefits than a standard plan to pay taxes on a portion of that plan’s costs” 33% find it acceptable but 59% say it is unacceptable.


People understand that health care reform will mean sacrifices but they want the sacrifices to fall on someone else, not them, and health care reform cannot pass until someone comes up with a politically viable way to pay for it. 


Obama’s Going to Need Room to Maneuver Not Lines in the Sand:

So far progressives have drawn two lines in the sand on this issue, one is certainly not going to be in the final bill, and the other may take a disappointing form if it does not get bargained away all together. Some see “single payer” national health insurance as the only legitimate goal for health care reform, while others like are defining the “public option” as the sine qua non for reform.


The President and most of Congress have rejected single payer as politically unfeasible, dismaying supporters who claim that the proposal has the backing of a majority of Americans. The president is right on this point, and the selective poll results are meaningless. If the question included the counter arguments – the cost, the bureaucracy, that many people who like their current arrangement would have to change to something new, etc., etc. – and still received majority support, well that would mean something.  


The existence of a “public option” (vaguely defined as a health insurance plan available from the government) is as much a line in the sand for Republicans who oppose it as a form of back door path to single payer. There is plenty of room for debate but also plenty of room for compromise. As Health Editor Jim Jaffe has pointed out here, a lot of different things could be arguably called a “public option.” If the Deal-Maker-in-Chief needs to accept something less than the perfect definition in order to get “Health Insurance Reform” signed this year, we should all be ready to celebrate the achievement.


  • DavidV

    All polls have built in biases. This subject is so complex, that framing really affects outcomes.

  • jim jaffe

    Compromise is again the key. There seem to be some folks out there who say that inaction would be better than a proposal they find flawed. Would be interesting to see how many of them are uninsured. Easy for the comfortable to make non-negotiable demands

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