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The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

Pundits Mull Health Care Reform Strategy for August Recess

Oscar Wilde said that “the best thing to do with advice is to pass it on; it is never of any use to oneself.” And pass it on we do, hoping that it will be of some use in the struggle for health care reform. And, judging by the surfeit of health care reform strategy advice from all points of the political spectrum, few advocates can fairly complain that their views are not being heard. Here follows some of the more interesting nuggets from recent editorials, articles and blogs:
The Editors of The New York Times forum on”Selling Health Care Reform to Voters” included contributions from seven diverse opinion leaders. In one article, Julian E. Zelizer, a professor of history and public affairs at Princeton University, voices an oft-heard concern these days:

President Obama has allowed Congress to work out the details of the legislation…The problem is that he has neglected to keep working on the message. As Congress deliberates, reports inevitably emerged about the potential costs of the program and the limitations of the expected impact. Opponents of reform have steadily gained ground by warning of a government takeover. Support for reform has diminished. A coalition of centrist Democrats and Republicans are pushing legislation that falls far short of President Obama’s promise.
During the most successful struggle for health care reform — the passage of Medicare and Medicaid — Presidents Kennedy and Johnson were never shy in talking to the public about what they hoped to accomplish…Both of these presidents delivered speeches about what health care reform could accomplish. This was an era when liberals were comfortable talking to Americans about why government worked. At a rally at Madison Square Garden in May 1962, Kennedy rebutted every argument of his opponents and said, “This bill serves the public interest. It involves the Government because it involves the public welfare. The Constitution of the United States did not make the President or the Congress powerless. It gave them definite responsibilities to advance the general welfare, and that is what we are attempting to do.”

Most Dems will disagree with the forum contribution of GOP strategist Michael Murphy, but he may have a point or two worth mulling over nestled in his predictably partisan screed:

…When you do anything in Washington of such size that it directly touches the lives of most Americans, you had better be authentically bipartisan. Big changes are scary and difficult. Their fragile nature can only survive politics if both parties are chained together in a lifeboat of mutual survival. Otherwise one party will certainly torpedo the other.
True bipartisanship is difficult. It demands real compromise, an anathema to the drunk with victory ideological partisans who lead the Democrats in the House and Senate. Unfortunately, these are the people that President Obama has outsourced his health care plan to…Measures that only make broken things bigger and more complicated, without fixing or reforming core problems are an easy kill in Washington.

Harold Pollack, faculty chairman of the Center for Health Administration Studies at the University of Chicago, says of President Obama

…He should puncture complacency about an unsustainable status quo. You may believe that you have good insurance. Absent effective regulation, you have no real way to know. You certainly can’t know that it will remain affordable for you or your employer. As costs escalate and financial insecurity moves up the economic ladder, this really matters.

Robert Blendon, professor of health policy and political analysis at the Harvard University JFK School of Government and the School of Public Health, adds

…For about half of Americans, the critical issue is ensuring that their health premiums go down, not up. At the moment, people are worried that the trend is up. The president has to stop talking about the national problem of “bending the curve” — and instead talk specifically about how he will lower insurance premiums for average families.
…The president has continually talked about cutting back on Medicare to save money for health reform. He has to reassure seniors that the cutbacks won’t affect the benefits they are currently getting. Some of the problem is how people absorb the message. When they hear President Obama talking about “cutting back Medicare,” they think “benefits” when he means to aim his savings at paying physician, hospitals, and nursing homes less money.

Also in the New York Times, Carl Hulse has a revealing article about the difficulties involved in Dems using the ‘reconciliation’ process to pass health care reform by a simple majority vote. Hulse sees a possibility of a sort of hybrid strategy for Dems:

…Democrats are envisioning an unusual two-track approach. Under this strategy, some of the most contentious elements of the health plan — new taxes and fees as well as savings from Medicare, Medicaid and other federal programs — would be packaged in one bill that could be passed by a simple majority.
A second measure would contain the policy changes and program expansions and would be treated like an ordinary bill, subject to filibuster and amendment. But the thinking is that this legislative sidecar would contain enough popular programs to attract the 60 votes needed to overcome a filibuster. Voilà — a health care bill.

In the Sunday L.A. Times, Doyle McManus joins the chorus of pundits decrying President Obama’s “bend the curve” (slow the rate of increase) on health care spending as a yawner unlikely to excite popular support. McManus offers an alternative strategy:

Obama and his aides know they need to win this debate; they’ve known that all along. So what can they do?
First, reframe the issue — not as an arid fiscal question of “bending the curve” but as a moral and economic imperative to provide reliable coverage to those who have insurance as well as those who don’t. Obama began to do this last week when he unveiled an eight-point “bill of rights” for health insurance consumers and promised “stability and security.”
Second, endorse a specific plan — even though that means making someone unhappy. Obama hamstrung himself by allowing centrists in the Senate to attempt to fashion a genuinely bipartisan proposal… The goal was to see whether an earnest show of bipartisanship could win a few Republican votes. As long as Montana Democrat Max Baucus and Iowa Republican Chuck Grassley were negotiating — and it has been a very long time — Obama didn’t want to get too specific with his own “red lines,” lest he drive Grassley away. The time to jettison Grassley is near.
Third, mobilize Obama’s Democratic supporters. That won’t be as easy as it sounds. Many liberal Democrats would prefer the single-payer model that was never seriously debated in Congress this year. Many more will find fault with parts of whatever plan Obama finally settles on — for example, if he accedes to the Senate centrists’ proposal for health cooperatives instead of a single federally administered “public option” insurance plan. But the president can explain to the faithful that the Republicans would love to “break him” and that liberals shouldn’t make the perfect the enemy of the good.


In his web-only article in The American Prospect, “How the Battle Over Health Care Will Be Like the Battle Over the Stimulus,” Tim Fernholz urges the Obama Administration to exert,

…Greater discipline over reluctant centrist senators and Blue Dog representatives, especially convincing them to abandon their refusal to consider even the most commonsense tax increases. It will require a willingness to jettison most of the Republican support the administration covets (although not ignoring their ideas or their lackluster participation in the legislative process) during the all-important conference negotiations to reconcile the two final health-care bills. Ultimately, Obama must convince Democrats in Congress that his paradigm of long-term thinking, decoupled from the defensive crouch of Democrats past, is a winning one.

Christopher Hayes writes in his article, “Bend it Like Obama” in The Nation

But the rhetoric of “fiscal conservatism” also empowers the enemies of reform…The policy argument the president is making is sound: more government intervention, a public option and broader coverage will reduce costs in the long run. But this causes so much cognitive dissonance that mainstream media figures are incredulous. And that skepticism, along with industry propaganda claiming that a public option will limit choices, is, not surprisingly, showing up in public opinion…So what to do? If there’s a silver lining to the fact that Congress will enter its August recess without a bill, it’s that the White House and advocates of real reform will have a chance to modify their pitch. If there was ever a time for Obama’s vaunted and much-anticipated grassroots army Organizing for America (OFA) to do its thing, it’s now. Since it’s closer to the actual lived experience of voters, OFA may have superior instincts about what kinds of messages resonate.

In his political notes blog at The New Yorker, Hedrick Hertzberg urges President Obama to tap the experience of “the Big Dog”:

Given the horrific structural hurdles health care has to surmount (which I go on about at length in this week’s Comment), this President needs all the help he can get. And it’s hard to think of anyone whose help would help more—especially since, as Tina notes, nobody has thought more about how to avoid the mistakes that were made last time than Mr. Clinton. Except maybe Mrs. Clinton.

The Politico Pulse’s ‘Insider Intelligence on Health Care Reform‘ reports that the House Democratic leadership has sent out a memo “Strategic Communications Plan for August: Health Insurance Reform“ (read the whole memo here) calling for,

“Our message is simple. It is in sync with the White House. And it counters the Republican ‘government takeover’ message. Hold the insurance companies accountable. Remove them from between you and your doctor. No discrimination for pre-existing conditions. No dropping your coverage because you get sick. No more job or life decisions made based on loss of coverage. No need to change doctors or plans. No co-pays for preventive care. No excessive out-of-pocket expenses, deductibles, or co-pays. No yearly or lifetime cost caps on what insurance companies cover.”
The effort includes: District Health Care Events, Telephone Town Halls, Weekly Events, Radio/TV Booking for Members, Print Press Outreach, Hispanic Media, Rapid Response, Health Care Hotline for Members, Daily Myth-buster E-mail, Truth About Health Reform Website, Daily E-mails from Leadership Offices, Regular Health Care Update Calls, Health Care Clearinghouse & DemCom intranet, Coordination with outside groups and social networking.

Oppo researchers will find Alex Simendinger’s “The GOP’s Health Care Echo Chamber” in The National Journal of interest. Among Simendinger’s observatiions:

Republican senators strategize about health care during their regular Tuesday policy luncheons and at meetings of McConnell’s working group, which gathers every Wednesday afternoon just off the floor to discuss the issue. The working group has brought in outside advisers and opinion leaders, including the Lewin Group consulting firm, which is owned by health insurer UnitedHealth Group; several GOP pollsters; policy experts from the Heritage Foundation (a Lewin client) and AEI; and conservative luminaries such as former House Speaker Newt Gingrich, R-Ga., and former Sen. Phil Gramm, R-Texas.
Stuart Butler, Heritage’s vice president for domestic and economic policy studies, said that congressional Republicans have been able to “break through” to the public with their concerns about Democrats’ proposals and the costs, as well as the revenue measures required to cover those costs. “They are beginning to frame it better,” he said, adding that the GOP traction is notable because “as a party, they haven’t laid out a comprehensive alternative — what it would look like if Republicans were running things.”
Butler, who regularly confers with lawmakers and staff on both sides of the aisle, said that congressional Republicans were reluctant to “go first” with any alternative before House and Senate Democrats settled on a plan, because they didn’t want the minority’s ideas to become “the punching bag.”

Robert Creamer channels a little Drew Westen in his HuffPo article “Fear, Anger, Hope and Inspiration Will Decide Health Care Battle,” explaining why Dems must understand the role of four emotions in formulating a winning strategy. On tapping the power of anger, Creamer explains,

…In politics, anger is almost always a necessary precursor to change and hope. American voters would not have been willing to take a chance on the change and hope offered by the Obama campaign in 2008 if they were not already furious with the administration of George W. Bush and its failed stewardship of our economy and foreign policy. That anger stemmed from the sense that everyday people could no longer look forward to better lives in the future. Obama resolved that anger into the hope that change could bring them a better life.
The powerful elements that dominate the Republican Party and the Conservative Movement also focus the anger of people who feel they are losing control or have been passed by, but instead of resolving that anger into hope, they resolve anger into fear of change — and fear of people who “aren’t like them.”
To win the battle over health care — and all of the other major battles required to fulfill the promise of change — progressives must engage the anger of most Americans and do a better job mobilizing that anger than our right-wing opponents.

Creamer counsels coupling real-life stories about care denied and unaffordable with accounts of C.E.O’s obscene pay, bonuses and golden parachutes, setting the stage so President Obama can more effectively deploy his “enormous political asset” — the ability to inspire.

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