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Political Strategy for a Permanent Democratic Majority

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Cost Concerns Drive Opinions Favoring Public Option

In his latest ‘Public Opinion Snapshot’ at the Center for American Progress web pages, TDS Co-Editor Ruy Teixeira explains why the “public option” for health care reform is drawing strong support in opinion polls:

…A recent CBS/New York Times poll showed 72 percent favoring “the government offering everyone a government administered health insurance plan—something like the Medicare coverage that people 65 and older get—that would compete with private health insurance plans,” compared to just 20 percent who were opposed.
Why is support for a public plan running so high? The chief reason is the public’s overriding concern with health care costs. Polls consistently show that people are most dissatisfied about health care costs, both for themselves and for the country as a whole.
This pattern is nicely illustrated by data from a March CNN poll showing 17 percent dissatisfied with the quality of the health care they receive, 26 percent dissatisfied with their health care coverage, 48 percent dissatisfied with their total health care costs, and 77 percent dissatisfied with the country’s total health care costs.

Distrust of private insurers plays a major role in shaping public opinion, as Teixeira notes:

…They have little faith that private insurance companies, left to their own devices, can deal with this problem. In fact, they believe by a wide 59-26 margin that the government—and not private insurance companies—can do a better job holding down health care costs.
…In an April Kaiser Family Foundation survey, the public, by 57-39, said the “better way to encourage health insurance companies to provide the best product for the lowest price” is to have private insurance companies and a public plan compete with one another instead of private insurance companies competing amongst themselves.

In building a health care reform consensus, Dems would do well to base a good part of their pitch on the public option’s advantage in containing costs — which Teixeira terms “both good policy and good politics.”


Securing Health Care Reform Left Dems Can Support

Katrina Vanden Heuvel’s thoughtful ‘Editor’s Cut’ piece “Time to End False Bipartisanship” in The Nation is an important contribution to shaping the debate on health care reform. As America’s most venerable progressive magazine, The Nation is read by many of America’s tough-minded left of center social critics, a vitally-important constituency for securing meaningful health care reform. In her editorial, Vanden Heuval provides what may be the best case yet made for urging left Dems to support a health reform plan anchored in a public option, as a step toward a universal, single-payer system down the road:

…Like 59% of the Americans surveyed in January 2009 by CBS News and the New York Times, I would prefer, as would my colleagues at The Nation, to see Congress respond to this country’s healthcare crisis by scrapping a failed-for-profit system and replacing it with a comprehensive national health insurance program.
But for now, the calculus of political viability has taken single-payer off the table. That doesn’t mean we cease fighting to get it back on –but it probably means we need to balance our short and long-term goals. Let’s assume some compromise in our political system is inevitable. The hard question is whether the compromise opens the door to greater progress or forecloses opportunity. A weak public plan will make it harder to get healthcare expenses under control while extending care to all. A weak plan may discredit healthcare reform for a generation. Real reform will cement strong attachment to the party which has shown it can pass legislation truly improving the condition of people’s lives…

Vanden Heuvel opposes coddling centrist Dems, who are backing away from the public option and warns of the need to get them to “pay more attention to the broad majority favoring a strong public option than to the wads of dough lavished on them by big Pharma and insurance lobbyists.” She is clear also that the acceptable compromise does not include pandering to Republicans who oppose even a public option:

It’s time to part ways with obstructionist Republicans and pass a strong healthcare bill with a majority vote, which is possible if efforts cease to get a handful of Republicans to cross over. Redefining bipartisanship at a time when the GOP has become a male, pale and stale party committed to deficit demagoguery and fearmongering is the common sense and, I’d even argue, pragmatic course. Instead of wasting time on recalcitrant GOP holdouts, do what Drew Westen, author of the terrific book “The Political Brain,” advises to pass meaningful healthcare change: “Focus on principles, tell compelling stories, move people emotionally and send clear messages.”

Many liberal Democrats are still fiercely supportive of single-payer reform as the best possible alternative. But Vanden Heuvel’s editorial is a signal that the broad outlines of health care reform being advocated by the Obama Administration and other progressive Democrats provide a credible stepping stone toward an all-inclusive, single payer system. As she asks “…With a President with high approval ratings and an historically unpopular GOP–if this isn’t a time to pass sweeping reform with a strong public plan, then when is?”


Public Supports ‘Activist Government’

Conservatives hoping to get traction from the “Obama’s government activism is bad” meme are not going to like Alan I. Abramowitz’s latest column at Larry J. Sabato’s Crystal Ball. In his column “Who’s Afraid of Big Government? Not Us,” Abramowitz explains:

Do Americans, despite the current economic crisis, continue to oppose governmental activism and prefer reliance on the free market to solve the country’s problems as the President’s conservative critics argue? Some of these critics have selectively cited results from recent media polls to support this claim. However, this conclusion is not supported by the best available evidence about attitudes toward the role of government in the American public-evidence that comes from the 2008 American National Election Study.
The 2008 ANES is the most recent in a series of election surveys that have been conducted in every presidential election year and most midterm election years since 1948. These surveys have provided much of the data used by political scientists to study elections and voting behavior in the United States. The 2008 survey involved in-depth personal interviews with a representative sample of more than 2000 eligible voters touching on a wide variety of issues and other election-related topics. Among the questions included in the survey were three that dealt directly with the role of government. Each question asked respondents to choose between a pair of statements about the proper role of government in dealing with the nation’s problems.

Among the findings of the survey, Abramowitz notes,

…A majority of Americans came down on the side of governmental activism. Fifty-six percent said that government had gotten bigger because the country’s problems had gotten bigger, 68 percent said that we need a strong government to handle complex economic problems, and 59 percent said that there were more things government should be doing.
…64 percent of eligible voters came down on the activist side of the scale and almost 40 percent were consistent supporters of activist government. In contrast, less than 20 percent of eligible voters were consistent opponents of activist government. These findings clearly contradict the claims of conservative pundits that Americans today have more faith in the free market than in government programs for dealing with the country’s problems. They indicate that support for activist government is alive and well in the American public.

Interestingly, most of the respondents made a distinction between government activism in addressing economic issues and “intrusion into the personal lives of Americans,” as Abramowitz explains:

…According to the data from the 2008 ANES, support for government regulation of personal conduct was associated with opposition to government intervention in the economic sphere. For example, 80 percent of respondents who consistently opposed governmental activism wanted to maintain a government ban on same sex marriage while only 53 percent of respondents who consistently supported governmental activism wanted to maintain the ban.

Abramowitz concludes that President Obama is in synch with the views of a majority of voters on the topic of ‘government activism.”

…Fully 80 percent of Obama voters came down on the pro-government side of the governmental activism scale and over 50 percent consistently took the pro-government side. It remains to be seen whether the President will succeed in convincing Congress to enact his policy agenda and whether those policies will actually work. However, in proposing to use the power of the federal government to address the nation’s problems, Mr. Obama is clearly doing what a majority of Americans voted for in 2008.

Clearly, after 8 years of impotent government and corporate looting of taxpayers financial assets, “activist government” to serve the interests of working people, for a change, doesn’t sound like such a bad idea to most voters.


National Security: Edge to Dems

Ruy Teixeira’s latest ‘Public Opinion Snapshot’ post at the Center for American Progress strongly suggests that the conservative wing of the GOP has lost its cred with voters on one of their party’s most reliable issues, national security. As Teixeira explains:

In a May Democracy Corps poll, 57 percent said they supported Obama’s national security policies, compared to just 30 percent who were opposed…In the same poll, 58 percent endorsed the idea that America’s security depends on building strong ties with other nations, compared to 37 percent who believed America’s security depends on its own military strength.

And when it comes to former VP Dick Cheney’s broadsides against President Obama’s national security policy, the Republicans have little to smile about:

…When asked in an early June Democracy Corps poll whether Obama or Cheney has better ideas for keeping the country safe, they chose Obama’s ideas over Cheney’s by 54-39.

Teixeira credits the tanking of the conservative’s national security cred to President Obama’s “progressive approach to our nation’s foreign policy that provides a sharp break with the belligerent, go-it-alone practices of the Bush administration.” Perhaps progressives should also give a pat on the back to Cheney, for providing a timely reminder of the failed policies of Republican rule.


Prevention Now a Top Health Care Reform Priority

Al Quinlan, president of Greenberg Quinlan Rosner Research has a post up at gqrr.com on their new survey (PDF here), which reveals overwhelming public support for investing in illness prevention as a leading priority of health care reform. Among the findings of the Greenberg Quinlan Rosner/Public Opinion Strategies bi-partisan report, which was commissioned by the Trust for America’s Health and the Robert Wood Johnson Foundation:

When we asked people whether or not we should invest more in prevention , a big majority (76 percent) said yes, against just 16 percent who said no. This is truly an overwhelming level of support for any initiative—it’s rare to get three-quarters of the country to agree on anything these days (much less on something that involves spending more money)—and it underscores the importance Americans place on prevention as part of their health care and their lives.
Now for those of you who would ask if it is just certain parts of the population who support this, our answer would be, “No.” At least 65 percent of every demographic subgroup supports increasing our investment in prevention. From coast to coast (79 percent in the Northeast, 78 percent in the South, 76 percent in the West, and 72 percent in the Midwest) and across the political spectrum (86 percent of Democrats, 71 percent of Republicans, and 70 percent of Independents), people believe we should invest more in prevention. Even two-thirds of the least healthy among us want a greater investment in prevention.
The importance the country places on prevention represents a real change in attitudes toward health in this country over the past couple decades. In 1987, 45 percent of the country believed we should be giving more emphasis to prevention (11 percent wanted more emphasis on treatment). Today, 59 percent say we need more emphasis on prevention, an increase of 14 percentage points in the prevention column (a real shift, albeit occurring over 20 years).

And the public views prevention as a highly cost-effective investment, as Quinlan notes:

No good discussion of any type of program would be complete without discussing the always-burning question—what about the costs? Does the cost associated with investing in prevention dampen support for it? It doesn’t appear to. By a wide margin (77 – 16 percent), Americans believe that prevention will save us money, rather than cost us money. But saving money isn’t the real reason they want more prevention—health is. Seventy-two percent say that “investing in prevention is worth it even if it doesn’t save money, because it will prevent disease and save lives,” while only 20 percent feel that investing in prevention is not worth it if it doesn’t save money. When it comes to prevention, it’s less about cost and more about reducing disease, keeping people healthy, and improving quality of life.

When it comes to building a consensus in support of health care reform, it appears that investing in prevention as a central priority may be the focus that can unite Americans.


Complex Public Attitudes Dog Health Care Reform

Anyone who thinks that public opinion about health care reform is any less complicated than our health care system should give TDS Co-editor William Galston’s article on the topic in The New Republic a slow read. On policy-holders self interest:

I take as my point of departure a survey Kaiser conducted in October of 2008, on the threshold of the presidential election. It shows that twice as many voters cared about making health care and health insurance more affordable as about expanding coverage for the uninsured, and that only one in ten gave high priority to improving the quality of care and reducing medical errors. Not surprisingly, voters were very concerned about increases in their health insurance premiums and other out-of-pocket costs–indeed, more concerned about this than about increasing employer, government, and national spending combined. It is hard to avoid the conclusion that in evaluating proposed health reform legislation, voters will be looking first and foremost at its impact on their own pocketbooks, with broader issues trailing well behind.

On funding:

…58 percent believed that “if policymakers made the right changes, they could reform the health care system without spending more money to do it.” If the people mean what they say, they are likely to regard requests for additional funds as evidence that Congress has made the wrong changes–that is, unless President Obama and congressional leaders explain why health reform cannot succeed without substantial upfront investments.
…As for financing options, majorities support increasing taxes on cigarettes, alcohol, and “unhealthy snack foods” but not soda and soft drinks, which experts regard as major contributors to the rising tide of obesity. (When those who favored this approach heard the argument that so-called “sin taxes” would hit low-income people the hardest, however, six in ten changed their minds and opposed it.) As for taxing employer-provided benefits, a solid majority are opposed, even when they are told that only the “most generous” benefits would be affected.

On health care as a national priority:

This brings me to the April tracking survey. It showed that respondents think reforming health care is only the fourth most important priority (on a list of eight), behind improving the economy, stabilizing Medicare and Social Security, and reducing the federal budget deficit. It is hardly surprising that partisans divide sharply: Democrats rank health reform second from the top, Republicans second from the bottom. Independents, whose ranks have swelled since the election, place it fifth.

Galston has an interesting section on the experts opinions vs. public opinion, with this nugget about the proposed compulsory purchase of health insurance:

Consider, finally, the proposition that all individuals, including those who are young and healthy, should be required to purchase health insurance. Most experts and policymakers agree that without this “individual mandate,” insurance companies will continue to screen out prospective beneficiaries with preexisting conditions and other discouraging health profiles, and the linchpin of current reform proposals will snap. Unfortunately, the people don’t agree: A Rasmussen survey published in late May indicates that only 31 percent of Americans favor requiring everyone–including young adults and those in good health–to purchase insurance. And when they were asked what should happen when those who choose not to buy insurance end up in emergency rooms, three quarters say they should receive treatment even if they can’t pay.

Galston concludes with a warning to political leaders to level with the American people about “the choices they face if we are finally to achieve universal health insurance with meaningful cost containment.” He urges bringing the public into the discussion to help avert “another catastrophic failure.” Such a buy-in can increase public confidence in the reforms that are enacted — and help strengthen the Obama Administration and congressional Democrats.


Health Care Reform: The Price of Inaction

Progressives preparing to engage in the battle for health care reform can get a little basic training at the Center for American Progress web pages, where two articles make it clear that taxpayers bear a hefty burden as a result of inaction on health care reform. In “The Cost of Doing Nothing on Health Care,” Peter Harbage, CAP health care policy advisor and CAP Research Associate Ben Furnas explain:

Our analysis shows that the broken health care system will cost us between $124 billion and $248 billion in lost productivity this year alone due to the almost 52 million uninsured Americans who live shorter lives and have poorer health. In fact an analysis by the Institute of Medicine found that, “the estimated benefits across society in healthy years of life gained by providing health insurance coverage are likely greater than the additional social costs of providing coverage to those who now lack it.”
These findings are based on a 2008 analysis by the New America Foundation, which found that the national economic cost from lost productivity in 2007 was between $104 billion and $207 billion. Economic costs from lost productivity have increased by about 20 percent during the two years since the New America Foundation conducted its analysis. The low bound of this estimate represents just the cost from uninsured Americans’ shorter lifespan. The high bound represents both the cost of shortened lifespan and the loss of productivity due to the reduced health of the uninsured.

The authors source their data from Institute of Medicine’s report on the economic cost of uninsurance, the Congressional Budget Office and the Cecil G. Sheps Center for Health Services Research and North Carolina Institute of Medicine.
In the second CAP article David M. Cutler, Otto Eckstein Professor of Applied Economics at Harvard University, offers some interesting statistics in his summary report “Health System Modernization Will Reduce the Deficit

Health care modernization involves four broad steps: investing in infrastructure; measuring what is done and how well it is performed; rewarding high-value care, not just high-volume care; and realigning consumer incentives to encourage better health behavior.
This report (PDF here) analyzes how such reforms would affect the federal budget over time. It shows that health system modernization could increase productivity growth in health care by 1.5 to 2.0 percentage points annually starting in four to five years. The impact of such productivity improvement would be substantial. The federal government would save nearly $600 billion in health spending over the next decade, and $9 trillion over the next 25 years. Over time, these savings would more than offset the cost of providing insurance coverage to all Americans and put the United States on a path to long-term fiscal balance.

Of course the human costs of not enacting meaningful reforms would be absolutely staggering. As the debate over the economic costs of health care reform intensifies this summer, however, reform advocates would do well to note these figures in marshalling their arguments.


‘Money, Boots on the Ground, and the Passion to Win’

Yesterday, J.P. Green concluded his post on health care reform politics with a warning to fellow Dems to get their act together to confront the coming ‘tidal wave’ of propaganda from health care providers. Bernie Horn reports in his post “We’ll Win Health Care in 2009 with a Strong, Coordinated, Progressive Movement” at the Campaign for America’s Future ‘Blog for Our Future’ that progressives are doing just that. As Horn notes,

This year, progressive organizations are ready to fight. They have the money, boots on the ground, and the passion to win.
First, the money: Progressive groups are poised to spend more than $82 million this year to enact legislation guaranteeing quality, affordable health care for all. This includes campaign funding that has been committed by Health Care for America Now; the two main labor federations, AFL-CIO and Change To Win; and mobilization groups such as MoveOn.org and Democracy for America. For progressives, that’s an unprecedented financial effort.
Second, the organizing: The Health Care for America Now (HCAN) coalition started last year with a bit more than 100 organizations. Today, it includes 1,000 groups that collectively represent over 30 million members. HCAN’s national campaign manager, Richard Kirsch, emphasizes that “the heart of this campaign is not inside the Beltway.” HCAN now has more than 140 paid organizers in 40 states working exclusively to build support for federal health care reform while other organizations, such as SEIU and CWA, have hundreds more organizers in the field.

Horn, Senior Fellow at Campaign for America’s Future and author of the book, “Framing the Future: How Progressive Values Can Win Elections and Influence People,” also quotes Eli Pariser, president of MoveOn.org:

The Bush years have taught progressives how to do political campaigns in a different way. It’s not enough to state your argument and hope for the best. You have to get out into the country and build constituencies in key districts and have the apparatus and enforce discipline.

Horn’s concluding cri du coeur:

Enough is enough! We will not allow the health care crisis to continue. We will not stand by as thousands or even millions of Americans inevitably die because they can’t afford health insurance. We will not calmly watch our friends and neighbors, and sometimes our families, be bankrupted by health care costs. We will not say it’s okay for private health insurance companies to enrich themselves at the expense of our wellbeing and our lives. We lost in 1994, but will not lose again.
This is our time. This is our chance.


Lakoff: GOP ‘Stealth’ Attack Seeks to Reframe Empathy

Today Alternet gives George Lakoff the lead article, “Conservatives Are Waging a War on Empathy — We Can’t Let Them Win.” Lakoff’s concern here is what he sees as an attack on one of the Democratic Party’s defining values, through “reframing.” As Lakoff explains:

The Sotomayor nomination has given radical conservatives new life. They have launched an attack that is nominally aimed at Judge Sotomayor. But it is really a coordinated stealth attack — on President Obama’s central vision, on progressive thought itself, and on Republicans who might stray from the conservative hard line.
…Empathy is at the heart of progressive thought. It is the capacity to put oneself in the shoes of others — not just individuals, but whole categories of people: one’s countrymen, those in other countries, other living beings, especially those who are in some way oppressed, threatened, or harmed. Empathy is the capacity to care, to feel what others feel, to understand what others are facing and what their lives are like. Empathy extends well beyond feeling to understanding, and it extends beyond individuals to groups, communities, peoples, even species. Empathy is at the heart of real rationality, because it goes to the heart of our values, which are the basis of our sense of justice.

Lakoff sees the GOP reframing of empathy as a sort of code for the feelings of the ‘bleeding heart liberal.’ As Lakoff puts it:

Empathy in this sense is a threat to conservatism, which features individual, not social, responsibility and a strict, punitive form of “justice.” It is no surprise that empathy would be a major conservative target in the Sotomayor evaluation.
But the target is not empathy as it really exists. Instead, the conservatives are reframing empathy to make it attackable. Their “empathy” is idiosyncratic, personal feeling for an individual, presumably the defendant in a legal case. With “empathy” reframed in this way, Charles Krauthammer can say, echoing Karl Rove, “Justice is not about empathy.” The argument goes like this: Empathy is a matter personal feelings. Personal feelings should not be the basis of a judicial decision of the Supreme Court. Therefore, “justice is not about empathy.” Reframe the word “empathy” and it not only disqualifies Sotomayor; it delegitimizes Obama’s central moral principle, his approach to government, his understanding of the nature of our democracy, and progressive politics in general.

Lakoff goes on to discuss the spins on empathy by various conservatives, David Brooks, Charles Krauthammer, Newt Gingrich and G. Gordon Liddy. But Lakoff feels it’s important to understand the subtext of their attacks:

The real target here goes beyond Sotomayor. In the last election, conservative populists moved toward Obama. Conservative populists are working people, mostly white men, who have conservative views of the family, of masculinity, and of the military, and who have bought into the idea of the ‘liberal elite” as looking down on them. Right now, they are hurting economically, losing their jobs and their homes. Empathy is something they need. The racist card is an attempt to revive their fears of affirmative action, fears of their jobs — and their pride — being taken by minorities and women. The racist attack has a political purpose, holding onto conservative populists. The overt form of the old conservative argument is made regularly these days: liberalism is identity politics.

But the real danger, according to Lakoff is Democratic complacency in underestimating the power of the Republican echo chamber:

Radical conservatives know that Sotomayor will be confirmed. They also know that their very understanding of the world is being threatened by Obama’s success. But they have a major strength. They have their message machine intact, with trained spokespeople booked on TV and radio shows all over the country. Attacking Sotomayor, even when they know she will win, allows them to rally their forces and get swing-voting conservatives thinking their way again.

And the needed response by Dems — to confront the challenge head-on:

Democrats should go on offense. They need to rally behind empathy — real empathy, not empathy reframed as emotion and personal feeling. They need to speak regularly about empathy as being the basis of our democracy. They need to point out that empathy leads one to notice real social and systemic causes of our troubles and to notice when and how judicial decisions and legislation can harm the most vulnerable of our countrymen. And finally that empathy is the reason that we have the principles of freedom and fairness — which are necessary components of justice…Above all, Democrats should be aware that the attack on Sotomayor is not just about Sotomayor. It is an attack on the basis of our democracy and must be answered.

A worthy challenge, and one which Dems should meet, lest we cede the ability to define our core values to our adversaries.


Public Support for Immigration Reform Rising

In his latest Public Opinion Snapshot at the Center for American Progress website, TDS Co-editor Ruy Teixeira reports on an encouraging development regarding public attitudes toward immigration reform. Reports Teixeira:

…We might have expected tough economic times to inflame cultural prejudices, thereby promoting intolerance of immigrants. Instead, the reverse seems to be taking place, as confirmed by new polling from the Pew Research Center.
Their just-released 2009 Values Survey shows that 63 percent favor “providing a way for illegal immigrants currently in the country to gain legal citizenship if they pass background checks, pay fines, and have jobs,” compared to just 34 percent who are opposed. That’s up from a 58-35 split on the issue in December of 2007.

Teixeira adds that the Pew survey indicates that “moral values” in general seem to be “declining precipitously” as a voting issue., with only 17 percent now saying moral values is their “most important voting issue,” down from 27 percent in a Pew poll conducted in November 2004. Teixeira notes that “the economy/jobs is up 29 points as a voting issue, health care is up 8 points, and education is up 6 points.” He concludes,

Perhaps the decline of moral values voters has allowed the immigration issue to emerge from the shadow of the culture wars and be considered on its own merits. If so, that’s a very good thing for our country and for sound public policy.

And not a bad omen for Democrats who support immigration reform.