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The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

TDS Co-Editor William Galston: Health Reform and Trust in Government

As we get down to the lick-log on health care reform, a lot rides on how reform supporters frame the debate. There’s a lot of support among progressives for going after private health insurers in a big way, and for pointing to Medicare to show the relative competence and efficiency of government.
In a post at The New Republic, TDS Co-Editor William Galston agrees the first tactic might work, but warns against the second. Mistrust of government, which naturally increased during the incompetent-government Bush years, has not much revived, which is a real problem for the health reform agenda:

Mistrust of concentrated power is part of America’s cultural DNA. Most Americans regard government as at best a disagreeable necessity. Even this March, at the low point of the recession and confidence in the future, and at a time when a majority of Americans favored more government control of the economy to stave off disaster, only 40 percent opted for a bigger government providing more services, versus 48 percent who preferred a smaller government providing fewer services. In this context, health reform must be spoken of by its defenders not as a positive good, but rather as medicine needed to arrest a disease—namely, the erosion of wages and the employer-based insurance system—that will eventually damage even the healthy parts of the body.

Skepticism of government, says Galston, is an even bigger problem because big majorities of Americans are actually pretty happy with their current health insurance. Adding it all up:

Today, fully 51 percent are more worried about the health reform bill they expect Congress to pass than by the possibility that reform will be delayed beyond this year. On the other hand, only 6 percent believe that the ills currently afflicting the health care system as a whole will get better with no government action, versus 54 percent who say it will get worse.

That’s a prettty big obstacle to the idea that reform needs to happen this year. And that needs to be taken into account when the administration and congressional Democrats plot their strategy for the autumn. Those unhappy with the current health care system should be mobilized; those relatively happy with it should understand how ittle reform effects them now, and how much it benefits them in the future. And the federal government should not be lionized as the indispensable health care provider–just as the indispensable catalyst for making sure the system works for everyone.

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