There’s very little question that two basic decisions by the Obama administration on health care reform have significantly complicated efforts to mobilize public support for actual legislation. The first, which was actually made during the early stages of the 2008 presidential campaign, was to adopt a relatively complicated approach to reform that involved competing public and private plans, health insurance “exchanges,” and subsidies, among other technical-sounding features. The second, after the election, was to promote reform generally through the congressional committee system, without issuing a detailed blueprint the President would insist that Congress follow.
There were very good substantive and political reasons for both these decisions, but inevitably, they have made it harder for Americans who only vaguely want health care reform to embrace Obama’s approach, and easier for reform opponents to cherry-pick provisions in various bills that can be blown out of proportion or demonized, and to simply lie about features that are difficult to explain.
This has created a gap in public opinion between what people might support if they understood it, and what they support in the absence of any understanding. In a new post at The Atlantic on recent polling, Ron Brownstein takes a closer look at that gap:

The NBC/Wall Street Journal national survey also released this week…found that just 31 percent of independents now approve of Obama’s handling of health care, while 54 percent disapprove, according to crosstabs from the poll provided by Public Opinion Strategies, one of the pollsters. Asked their view of Obama’s health care plan, just 28 percent of independents said they consider it a good idea, while 43 percent described it as a bad idea, and the rest said they didn’t know.
Yet when the pollsters read a description of the Obama proposal to respondents, the attitude among independents sharply shifted. Opposition among them remained roughly the same at 44 percent. But support jumped to a 52 percent majority. The gap between potential and actual support for Obama’s plan among independents suggests two things: that the White House is losing the struggle to define the plan so far, and that they may have room to increase their support if they can regain the initiative.
Obama faces a formidable gap between potential and actual support even among Democrats in the NBC/WSJ poll. Just 62 percent of Democrats described his plan as a good idea; but after hearing the explanation, 78 percent of them said they would support it. (Even among Republicans, support jumped from just 9 percent to 23 percent when they were provided a description of the plan.)

So voters need to hear this explanation, from the President and every available ally, the moment the White House decides on a reasonably clear vision of what can be ultimately wrested from Congress. There won’t be a lot of time for this to happen, and in the end, some congressional Democrats from competitive districts or states will need to vote for reform in hopes that constituents will like the results even if they are doubtful about what they understand to be the plan. After all, most of the fears being fed by reform opponents will not actually materialize if a bill is enacted; the seniors who are so negative about reform will discover that little or nothing has changed in Medicare; death panels will not be convened; doctors will not lose their right to control treatments.
Reality ought to count for something in the health reform debate; reform proponents need to explain what they can, and also count on the consequences of the legislation to make its enactment a political plus.

This item is cross-posted from The New Republic.
As the Dog Days of August descended upon us, there developed across the progressive chattering classes a deep sense of malaise bordering on depression, if not panic–much of it driven by fears about the leadership skills of Barack Obama. The polling numbers seemed to weaken every day, and Democratic unease was matched by growing glee on the airwaves of Fox and in Republican circles everywhere.
Within ten weeks, however, Obama was elected president and joy returned to the land.
Yes, dear reader, I am suggesting that this August’s sense of progressive despair feels remarkably similar to last August’s. This week last year, the Gallup Tracking Poll had McCain and Obama in a statistical tie. The candidates were fresh from a joint appearance at Rick Warren’s Saddleback Church, which was widely viewed by progressives as a strategic error by Obama. More generally, Democratic confidence, so high earlier in the year, was sagging. “Liberals have been in a dither for several weeks now over Barack Obama’s supposedly listless campaign performance following his return from Europe,” influential blogger Kevin Drum summed up sentiments at that time, “and as near as I can tell this turned into something close to panic.”
These doldrums dissipated by the time of the Democratic convention later in the month, but reemerged in September, when McCain actually moved ahead in some polls. And the diagnosis of the problem was typically that Obama was too passive, and wasn’t articulating a clear enough message. This should sound familiar to connoisseurs of contemporary progressive concerns about Obama.
Now, this deja vu sensation I’m having obviously doesn’t guarantee that the current struggles over health care reform and climate change will have as happy an ending as the presidential contest. But it may well provide a plausible argument for giving the president the benefit of the doubt today as we should have done a year ago.
Part of the psychological problem now may be a matter of unrealistic expectations. Much of the trouble Obama has encountered in promoting his agenda has been entirely predictable. His approval ratings are gradually converging with the 2008 election results. Health care reform is a complicated challenge that threatens a lot of powerful interests and unsettles people happy with their current coverage. Major environmental initiatives lose steam in a deep recession. A new administration gradually begins to assume blame for bad conditions in the country. Republicans, adopting a faux populist tone, are fighting Obama tooth and nail. Democratic activists are frustrated by compromises and sick of having to put up with the Blue Dogs. The Senate is still the Senate, a monument to inertia, pettiness, and strutting egos.
Progressives are waiting for Barack Obama and his team to work the kind of political magic they seemed to work in 2008–except when they didn’t. Cutting through all the mythologizing of the Obama campaign, the real keys to his stretch-run success last year were his legendary calm (“No Drama Obama”); his confidence in his own long-range strategy; his ability to choose competent lieutenants and delegate to them abundantly; and his grasp of the fundamentals of public opinion and persuasion. There was zero sense of panic in the Obama campaign itself late last summer, because they stuck with their strategy and organization and didn’t let the polls or news cycles force them off the path they had chosen.
The administration’s demure approach should thus not be terribly surprising, nor a sign that it has lost its heart or its mind. Obama has not, presumably, lost the qualities he showed in the tougher moments of the 2008 campaign. As it planned its legislative agenda for 2009, Team Obama knew health care reform was going to be challenging, and also knew they could probably get away with blaming the economic emergency for paring it back or slowing it down. They decided this was the right time to act, and it’s far too soon to assume they were wrong.
This particular moment might be more endurable if, as it used to be, August was a political and legislative dead zone. We’d all get a breather, maybe calm down and look ahead to the real deal going down in the fall. But the “August Doesn’t Matter” era has ended–perhaps dating back to the grand jury testimony in the Clinton/Lewinsky scandal in August 1998, if not earlier. (It arguably began to fade when Washington got air-conditioning.) Now, even if nothing substantive is actually happening this month, the absence of action is itself painful, and feels like defeat.
While I certainly don’t know if the Obama game plan for the next couple of months is going to be successful, I’m reasonably sure a game plan exists. On the issue most on everyone’s mind, I certainly don’t know how to reconcile the sharply contrasting demands of House Democrats and Senate “centrists” on sticking points like the public option. But the odds remain good that the House will pass a bill, the Senate will pass a bill, and then we will find out if the White House and the Democratic congressional leadership have the skill to make something happen that we will be able to recognize as “change,” and perhaps even a victory for progressives. Until then, it’s probably a good idea to drink a tall glass of cold water and wait out the August political heat.

If you’re wondering why the so-called “public option” in proposed health reform plans is such a line-in-the-sand non-negotiable requirement for so many progressives, you should definitely read Mark Schmitt’s brief item for The American Prospect explaining the history of this concept.
It all started, Schmitt explains, among single-payer advocates who had been convinced by pollster Celinda Lake that their approach just didn’t have enough popular support to carry the day:

One key player was Roger Hickey of the Campaign for America’s Future. Hickey took UC Berkley health care expert Jacob Hacker’s idea for “a new public insurance pool modeled after Medicare” and went around to the community of single-payer advocates, making the case that this limited “public option” was the best they could hope for. Ideally, it would someday magically turn into single-payer. And then Hickey went to all the presidential candidates, acknowledging that politically, they couldn’t support single-payer, but that the “public option” would attract a real progressive constituency.

John Edwards signed on, and then Obama and Clinton, and a hybrid proposal that added the public option to the prevailing concept of a competitive system of private insurance plans became the standard Democratic approach.
But baked into the cake was a subtle but important difference in perspective between single-payer fans who viewed the public option as the sine qua non, and other progressives who viewed it as just one of many moving parts in a comprehensive system.
That division continues today. Here’s how Schmitt describes the passion of single-payer advocates for a “robust” public option, as many House Democrats call their demand:

So now this energetic, well-funded group of progressives is fired up to defend something fairly complex and not necessarily essential to health reform. (Or, put another way, there are plenty of bad versions of a public plan.) The symbolic intensity is hard for others to understand. But the intensity is understandable if you recognize that this is what they gave up single-payer for, so they want to win at least that much.

So hard-line defense of the public option is about substance, but it’s also about emotion, and about people who think they’ve already compromised enough by accepting a system built around private health insurance. This is all worth remembering when the final deals get cut in Congress on health reform.

Robert Novak, who died today of brain cancer at the age of 78, had such a long and varied journalistic career that different people probably remember him in different ways. Some younger readers may completely associate him with the Plame saga, or with his career as a conservative gabber on cable. Others may recall the many years in which his syndicated newspaper column was (as David Stockman once put it) a “bulletin board” for movement conservatives who wanted to make their views known to members of the Washington establishment–or sometimes, vice versa. And a few of us oldsters will remember his earlier days, when he was actually a Democrat and an old-fashioned shoe-leather muckraking reporter, in association with his Odd Couple co-columnist (and co-participant in his pioneering cable television show) Rowland Evans.
The book Evans and Novak wrote about LBJ, Lyndon Johnson: The Exercise of Power, remains one of the best political biographies around, particularly if you are interested in the arcane operations of either the U.S. Senate or the White House. I haven’t read his recent autobiography (entitled, in a reference to his longtime nickname in Washington, The Prince of Darkness) but through other obituaries I am hearing that it’s a fascinating book even if you deplore the author’s politics, and intend to go out and buy it directly.
I only met Novak once, just a few years ago, when I had the strange experience of being on a political panel seated between the Prince and another right-wing legend, Paul Weyrich. I found Novak to be smart, cynical, and appropriately scary. By then he had undergone a late-life conversion to Catholicism, reportedly via the agency of the mysterious conservative organization Opus Dei. That, too, was fitting, given his long association with the Cultural Right. I gather his final illness was characterized by excrutiating pain. Much as I dislike large elements of the man’s journalistic and political legacy, I hope his faith gave him comfort, and may he rest in peace.

Believe it or not, it’s becoming possible to get a feeling for how the health care reform struggle may play out this fall.
The House will almost certainly pass a bill that includes a “public option.” The Senate won’t; any Senate bill will almost certainly be based on some version of the “health care cooperative” idea. Votes in both Houses will be very close, leaving little room for error. In the Senate, vast concessions will have to be made, on the bill in question and on other issues, to get to 60 votes, and even then, a couple of Democrats will vote “no” and a couple of Republicans will have to be pulled across the line. Perhaps a couple more Democrats will vote for cloture and then vote against the bill itself.
Then the real fun will start, in a House-Senate conference where the White House will be a very active player. As Jane Hamsher reminds us, enough House Democrats have pledged not to vote for any bill that doesn’t include the public option to sink a conference report. And Sen. Kent Conrad is probably right that there aren’t and never have been 60 votes for a plan with a public option in the Senate.
So somebody will have to flinch, and that’s where it will become important to pay close attention to all the less-prominent, but potentially critical, issues that will be at stake.
At TAPPED today, Dana Goldstein has a good list of those issues, including the size and strength of cooperatives, the breadth of a Medicaid expansion, coverage of legal immigrants, and the adequacy of subsidies.
It’s possible, of course, that House progressives and Senate centrists will get so dug in on the public option issue that no conference report can be crafted that can get a majority in the House and 60 votes in the Senate, and nothing at all will happen this year even if there is substantial agreement on other issues. That’s why it’s pretty important that the White House and the congressional leaders tell Members from all factions to stop issuing public threats that this or that provision is a deal-breaker. They should also strongly discourage participation by Democrats in any bipartisan “gangs” that purport to control the outcome (e.g., the one that has already formed to control the Senate Finance Committee markup). A deal that works in one House probably won’t work in the other, and promises to impose provisions on one House or the other in a conference committee aren’t worth a whole lot. So it makes abundant sense to push back the ultimate bargaining to big barbecue that will be held at the very end of the tunnel.

The remarkable 2008 presidential election isn’t that far in the rear-view mirror. But as many arguments about alleged contradictions between Barack Obama’s campaign message and his current agenda show, memories fade quickly, and history quickly becomes spin.
So it’s a very good thing that Dan Balz and Haynes Johnson have published an old-fashioned, Teddy-White-style Big Campaign Book that captures what actually happened in 2008, enriched by lots of insider interviews and some sure-footed analysis of events as they occurred.
I’ve written a review of the book (The Battle for America 2008: The Story of an Extraordinary Election) for the Washington Monthly, which in advance of their print edition is available online here.
I offered a lot of praise for the book’s command of details and its handling of several key issues, from Hillary Clinton’s fateful decision to go for broke in Iowa, to John McCain’s vetting process for Sarah Palin. I had a few criticisms as well, but the more I hear people mangling the facts about this election, the more I am grateful for Balz’s and Johnson’s efforts to set the record straight.

One of the best-known ironies of the health care reform debate is that beneficiaries of the government-run Medicare program are perhaps the least likely category of Americans to support universal health reform. There are many jokes and anecdotes about Medicare beneficiaries angrily telling Members of Congress to “keep the government out of my Medicare.” And unsurprisingly, some reform proponents suspect that folks on Medicare have an “I’ve got mine” attitude about health insurance based on indifference to the plight of the uninsured or a general antipathy towards Obama or “liberals.”
But I’m guessing there’s something more than sheer ignorance or selfishness at play here: a sense that Medicare, unlike the insurance that would be offered along with subsidies under the proposed reforms, is an earned benefit, while government-provided or -financed health insurance for non-retirees is welfare.
That’s at best partially true. Current payroll taxes and premiums cover a little over half of Medicare expenditures (though even there, it’s important to understand that it’s current workers’ payroll taxes, not “banked” payroll taxes from retirees, that we are talking about); the rest comes from general federal revenues. Moreover, only the poorer beneficiaries of a new system would get anything like full federal subsidies for their premiums. So Medicare’s not fully an earned benefit, and the new benefits won’t be fully “welfare.”
But these are powerful perceptions, and not the sort of thing that pollsters have been looking at lately, so far as I can tell. And the idea that many of the currently uninsured will be given something that Medicare beneficiaries don’t have–not the insurance itself, but the means to pay for it–helps explain why lots of retirees feel no particular solidarity with the uninsured, and are open to right-wing arguments that health reform is an exercise in “socialistic” big-government “redistribution.”
Now I do not recommend that reform proponents deal with these perceptions by lecturing Medicare beneficiaries that they are themselves “on welfare,” though it remains important to remind them that Medicare is a government program, and that government’s role in the new system will be more as a catalyst than as an owner-operator. But the better approach is probably to stress the fundamental idea of universal insurance against medical circumstances beyond anyone’s control, and the injustice of losing access to health care because you get sick, your employer drops coverage, or your premiums keep going up. The truth is that most beneficiaries of health reform will be middle-class working folk with bad luck; that reform is the best way and the only way to get costs under control; and that everyone will benefit from a country where everyone has health insurance.

Political junkies naturally like to project current trends in public opinion as far into the future as they can, joined by hacks and spinmeisters when the trends seem positive for their cause. So it’s no surprise that Republicans are already debating how big a win they’ll have in 2010. And more than ten weeks before the off-year elections in New Jersey and Virginia, you’d think the GOP had already banked victories in both states.
If only to confound those who think every political sparrow that falls to the ground is about national politics, it’s interesting ro report that a new poll from Greenberg Quinlan Rosner for Democracy Corps shows often-left-for-dead Democratic Gov. Jon Corzine of New Jersey beginning to significantly close the gap with Republican nominee Chris Christie. As voters get closer to an actual decision between candidates instead of a resolution on how they feel about life under the Corzine administration, Christie’s lead has dropped to five percentage points in a three-way race involving independent candidate Chris Daggett, and six points in a two-way race. Christie’s negatives are definitely moving up, which also augers a tightening race.
I’m not predicting that Corzine will win, but it is important to remember that late, counter-intuitive trends in political campaigns happen all the time, and those who count their electoral chickens before they hatch may be eating crow on when voters weigh in.