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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July 11: If Biden “Steps Aside” and Harris Steps Up, There Should Be No Falloff in Support
At New York I discussed and tried to resolve one source of anxiety about a potential alternative ticket:
One very central dynamic in the recent saga of Democratic anxiety over Joe Biden’s chances against Donald Trump, given the weaknesses he displayed in his first 2024 debate, has been the role of his understudy, Vice-President Kamala Harris. My colleague Gabriel Debenedetti explained the problem nearly two years ago as the “Kamala Harris conundrum”:
“Top party donors have privately worried to close Obama allies that they’re skeptical of Harris’s prospects as a presidential candidate, citing the implosion of her 2020 campaign and her struggles as VP. Jockeying from other potential competitors, like frenemy Gavin Newsom, suggests that few would defer to her if Biden retired. Yet Harris’s strength among the party’s most influential voters nonetheless puts her in clear pole position.”
The perception that Harris is too unpopular to pick up the party banner if Biden dropped it, but too well-positioned to be pushed aside without huge collateral damage, was a major part of the mindset of political observers when evaluating Democratic options after the debate. But now fresher evidence of Harris’s public standing shows she’s just as viable as many of the candidates floated in fantasy scenarios about an “open convention,” “mini-primary,” or smoke-filled room that would sweep away both parts of the Biden-Harris ticket.
For a good while now, Harris’s job-approval numbers have been converging with Biden’s after trailing them initially. These indicate dismal popularity among voters generally, but not in a way that makes her an unacceptable replacement candidate should she be pressed into service in an emergency. As of now, her job-approval ratio in the FiveThirtyEight averages is 37.1 percent approve to 51.2 percent disapprove. Biden’s is 37.4 percent approve to 56.8 percent disapprove. In the favorability ratios tracked by RealClearPolitics, Harris is at 38.3 favorable to 54.6 percent unfavorable, while Biden is at 39.4 percent favorable to 56.9 percent unfavorable. There’s just not a great deal of difference other than slightly lower disapproval/unfavorable numbers for the veep.
On the crucial measurement of viability as a general-election candidate against Trump, there wasn’t much credible polling prior to the post-debate crisis. An Emerson survey in February 2024 showed Harris trailing Trump by 3 percent (43 percent to 46 percent), which was a better showing than Gavin Newsom (down ten points, 36 percent to 46 percent) or Gretchen Whitmer (down 12 points, 33 percent to 45 percent).
After the debate, though, there was a sudden cascade of polling matching Democratic alternatives against Trump, and while Harris’s strength varied, she consistently did as well as or better than the fantasy alternatives. The first cookie on the plate was a one-day June 28 survey from Data for Progress, which showed virtually indistinguishable polling against Trump by Biden, Harris, Cory Booker, Pete Buttigieg, Amy Klobuchar, Gavin Newsom, J.B. Pritzker, Josh Shapiro, and Gretchen Whitmer. All of them trailed Trump by 2 to 3 percent among likely voters.
Then two national polls released on July 2 showed Harris doing better than other feasible Biden alternatives. Reuters/Ipsos (which showed Biden and Trump tied) had Harris within a point of Trump, while Newsom trailed by three points, Andy Beshear by four, Whitmer by five, and Pritzker by six points. Similarly, CNN showed Harris trailing Trump by just two points; Pete Buttigieg trailing by four points; and Gavin Newsom and Gretchen Whitmer trailing him by five points.
Emerson came back with a new poll on July 9 that wasn’t as sunny as some for Democrats generally (every tested name trailed Trump, with Biden down by three points). But again, Harris (down by six points) did better than Newsom (down eight points); Buttigieg and Whitmer (down ten points); and Shapiro (down 12 points).
There’s been some talk that Harris might help Democrats with base constituencies that are sour about Biden. There’s not much publicly available evidence testing that hypothesis, though the crosstabs in the latest CNN poll do show Harris doing modestly better than Biden among people of color, voters under the age of 35, and women.
The bottom line is that one element of the “Kamala Harris conundrum” needs to be reconsidered. There should be no real drop-off in support if Biden (against current expectations) steps aside in favor of his vice-president (the only really feasible “replacement” scenario at this point). She probably has a higher ceiling of support than Biden as well, but in any event, she would have a fresh opportunity to make a strong first or second impression on many Americans who otherwise know little about her.