As you probably know if you’ve been following the presidential campaign news, Barack Obama released his long-awaited health care reform proposal earlier this week, and it’s getting decidedly mixed reviews from the chattering classes. Two progressive blogger/journalists with pretty good street cred on health care issues, Ezra Klein and Jon Cohn, have published quite similar takes, praising many of the details of the plan but decrying its timidity in challenging the health care status quo–most particularly its failure to provide universal coverage (other than for children). On the positive side, it does indeed seem that Obama’s plan represents sort of a greatest hits collection of incremental health care reform ideas. It picks up John Kerry’s underappreciated 2004 proposal for federal reinsurance of catastrophic health costs, which could have a big impact on rising insurance premiums. It adopts the federal employee health plan model for a national insurance purchasing pool, which makes abundant good sense substantively and politically. It calls for a federally-driven shift towards prevention and chronic disease management, along with IT investments to help control costs and improve quality, which ought to be a point of agreement among those who may disagree on financing mechanisms and/or the role of public and private sectors. It includes a direct assault on health care industry abuses through federal regulation, instead of treating such abuses as an unavoidable byproduct of for-profit involvement in health care. It does cover all kids, which makes sense if you aren’t going to cover everybody. And it provides very robust subsidies to make voluntary health insurance affordable to as broad a segment of the uninsured as possible, along with an employer mandate to avoid erosion of existing coverage. Those are a heap o’ positives, but the negatives, most especially the plan’s failure to include a universal individual mandate for health insurance, and its complexity, are likely to get more attention, on both substantive and political grounds. Substantively, the plan obviously fails to fundamentally overhaul the current system, with its patchwork of public and private programs, its heavy reliance on economically damaging and arguably regressive employer-based coverage, and its failure to cover everyone. And politically, the plan will reinforce claims that Obama isn’t quite the transformative, great-leap-forward progressive so many have seen in him. One particular problem for Obama is that his plan superficially resembles the Massachusetts initiative signed by Republican presidential candidate Mitt Romney, with the crucial exception that Massachusetts did include a universal individual mandate for coverage (underfunded, to be sure, but still in place). Another is that Obama’s plan achieves less than universal coverage at a pretty steep price tag, given its lavish subsidies to tempt rather than force individuals into obtaining insurance. Beyond the initial reactions, perceptions of Obama’s plan will be crucially influenced by his rivals for the Democratic presidential nomination. John Edwards is already in a position to exploit Obama’s incrementalism on health care, given his own comprehensive universal plan, which not only embraces an individual mandate for coverage but also provides a stronger Medicare-style public option attractive to Democrats who favor a single-payer system. Given Edwards’ competition with Obama for the support of left-leaning Democrats, this could become an important point of distinction between the two candidates, at least among activists. But the other shoe that will soon drop is Hillary Clinton’s; she’s slowly rolling out a very thorough and comprehensive health care reform proposal, building on her unquestioned expertise in this field. Still under wraps is what she would do to achieve expanded coverage. If she goes for a universal plan (which is quite likely), then Obama will begin to look like an incrementalist outlier among those who care about policy details.
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Editor’s Corner
By Ed Kilgore
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February 12: 2024 Lessons for Democrats That Are Relevant Right Now
I’m on record as suggesting that Democrats not waste too much time on recriminations over 2024 while the wolf of Trump 2.0 is at the door. But there are some lessons relevant to the challenges right before them, and I tried to discuss at few at New York:
The ritualistic “struggle for the soul of the Democratic Party” that ensued after the Republican election victory of 2024 was cut somewhat short by the brutal realities of the real-life consequences of letting Donald Trump regain power with a Republican-controlled Congress and all sorts of ridiculous claims of an absolute mandate to do whatever he wanted. But, in fact, while factional finger-pointing might have been are a self-indulgent luxury an opposition party living under the MAGA gun can’t afford, there are some lessons from the election results that are important to internalize right now. Here are a few.
Mobilizing the Democratic base isn’t enough to stop Trump
For much of the 2024 campaign, a lot of observers believed that the only way Trump could win was if Democrats failed to mobilize their party base, either out of complacency or because key constituencies were disgruntled with Joe Biden (and, to a lesser extent, with Kamala Harris once she became the presidential nominee). An enormous amount of money, time, and effort went into securing maximum turnout among young, Black, and Latino voters on the theory that if fully engaged, they’d win the day. And in the end, these constituencies did turn out reasonably well (a bit less than in 2020, but more than in 2012 or 2016). Trouble was, too many of them voted for Donald Trump.
No, Trump didn’t win Black, Latino, or under-30 voters overall, but his performance in all those groups improved significantly as compared to 2020. Among Black voters (per AP Votecast, the most reputable exit poll), he doubled his percentage of the vote, from 8 percent to 16 percent. Among Latinos, his percentage rose from 35 percent to 43 percent. And among under-30 voters, his share of the vote jumped from 36 percent to 47 percent. Meanwhile, the GOP advantage in the Donkey Party’s ancient working-class constituency continued to rise, even among non-white voters; overall, Trump won 56 percent of non-college-educated voters. The Democratic base fractured more than it faltered. And there were signs (which have persisted into early 2025 polling) that defections have made the GOP the plurality party for the first time in years and one of the few times since the New Deal.
While rebuilding the base (while expanding it) remains a crucial objective for Democrats, just calling it into the streets to defy Trump’s 2025 agenda via a renewed “resistance” isn’t likely to work. Many former and wavering Democrats need to be persuaded to remain in their old party.
Trump really did win the two most essential arguments of the 2024 election, on inflation and immigration
Republicans have massive incentives to pretend that all their messages struck home, giving them an argument that they enjoy a mandate for everything they want to do. But the honest consensus from both sides of the barricade is that demands for change to address inflation and immigration were the critical Trump messages, with doubts about Joe Biden’s capacity to fulfill the office and Kamala Harris’s independence from him exacerbating both.
What we’ve learned in 2025 is that Trump has considerable public backing to do some controversial things on these issues. A 2024 poll from Third Way showed a majority of swing voters agreed that excessive government spending was the principal cause of inflation, a huge blow to Democratic hopes that rising costs could be pinned on corporations, global trends, supply-chain disruptions, or, indeed, the previous Trump administration. But this wasn’t just a campaign issue: Trump took office with some confidence that the public would support serious efforts to reduce federal spending and make government employees accountable. And the fact that (so far) his approval ratings have held up despite the chaotic nature of his efforts to slash federal payrolls is a good indication he has some wind at his back, at least initially.
If that’s true on inflation, it’s even truer on immigration, where solid majorities in multiple polls support (in theory, at least) the mass deportation of undocumented immigrants. If the administration was smart enough to limit its deportation campaign to those convicted of violent crimes, it would have overwhelming public support. But Democrats should fully accept they didn’t just lose votes on this issue in 2024: They lost an argument that persists.
That is why it is critical that Democrats point to evidence that Trump’s own agenda (particularly his tariff policies) will revive inflation that had largely been tamed by the end of the Biden administration, while focusing their immigration messaging on vast overreach, inhumane excesses, and ethnic profiling of Latinos by Team Trump in its efforts to deport immigrants.
Swing voters are not moved by constitutional or “threat to democracy” arguments
Joe Biden in his 2024 presidential campaign (and, to a slightly lesser extent, Kamala Harris as his successor) put considerable stock in playing on public concerns about the threat to democracy posed by Trump as evidenced by his conduct on January 6, 2021, and his lawless behavior generally. While these arguments found traction among voters already in his corner, there’s little evidence they mattered much at all to the voters who decided the election in Trump’s favor. Indeed, a considerable percentage of voters worried about a broken political system viewed Trump as a potential reformer as much as an insurrectionist or autocrat.
At the moment, most office-holding Democrats and (more quietly) many Republicans are aghast at how Trump has gone about pursuing his agenda early in 2025, with a blizzard of executive orders, a federal funding freeze, and a blank check issued to eccentric billionaire Elon Musk to disrupt federal agencies and intimidate federal employees. Again, Trump is drawing on long-standing public hostility toward the federal government and to the size and cost of government as a spur to inflation and a burden on taxpayers. Fighting him with alarms about his violation of legal and constitutional limitations on presidential power is unlikely to work with an electorate unmoved by Trump’s earlier scofflaw attitude. Voters must be convinced in very concrete terms that what he is doing will affect their own lives negatively. As with tariffs and the immigration policy, Trump’s tendency to overreach should provide plenty of ammunition for building a backlash to his policies.
The desire for change in an unhappy country is deep-seated
In 2024, as in 2016, Trump managed to win because unhappy voters who didn’t particularly like or trust either presidential candidate (or their parties) in the end chose to produce a change in party control of the White House and of Congress. In office, Trump and his allies will try to perpetuate as long as they can the illusion that they are still fighting for “change” against powerful interests aligned with the Democratic Party, even though it’s Republicans who control the executive and legislative branches of the federal government and also dominate the U.S. Supreme Court. The idea that Team Trump is a brave band of insurgents speaking truth to power is undermined very specifically by the fact that its chief disrupter, Musk, is the richest man in the world and the first among equals of a large band of plutocrats surrounding the president.
As the New York Times’ Nate Cohn observed during the transition to the second Trump administration, many of the same anti-incumbent tendencies that put a thumb on the scale for the GOP in 2024 will now work for the opposition:
“The president’s party has retained the White House only once since 2004, mostly because voters have been unsatisfied with the state of the country for the last 20 years. No president has sustained high approval ratings since [George W.] Bush, in the wake of Sept. 11 …
“Looking even further back, the president’s party has won only 40 percent of presidential elections from 1968 to today. With that record, perhaps it’s the winning party that really faces the toughest question post-election: How do you build public support during an era of relatively slow growth, low trust in government and low satisfaction with the state of the country?”
Based on his conduct since returning to the White House and his well-known narcissism, it’s not all that clear that the 47th president even cares about building public support as he ends his political career. That may give him the freedom of the true lame duck, but it also means Democrats can batten on his broken promises and the disappointments they will breed. The 2028 presidential candidate who may be in real trouble is the Republican who succeeds the 2024 winner.