A fine piece last Wednesday by Politico’s Carrie Budoff Brown dissects what political prognosticators from Bill Clinton to Obama pollster Joel Berenson had predicted about the ultimate acceptance of health reform legislation. “Rarely have so many political strategists been so wrong about something so big,” she writes. “At the six-month mark, the law remains a riddle for political analysts, lawmakers and the White House.”
Riddle? Not really. Months ago the public sensed a bait and switch, and the media weren’t helping them out. The seeds of the public schizophrenia over reform were sown during the presidential campaign, when candidates Obama and Clinton talked about universal health care, making it seem that the country was on the verge of adopting a true national health insurance system like the rest of the developed world.
That’s not what they had in mind, and universal health care morphed into universal coverage provided by private carriers. Then the pols and the press discarded that term when the rationale for reform became insurance market reform—a snoozer for sure.
The constant bashing of insurance companies by the president, his health secretary Kathleen Sebelius, and advocacy groups did not compute with the public. Many Americans have had wicked experiences with insurers—but if they are so evil, why give them twenty-five million new customers? At the gut level, that didn’t make sense, and media explanations about bringing everyone into the risk pool didn’t resonate. But probing further would bring up the nasty, controversial subject of the individual mandate—the requirement that everyone have insurance. The pols were not eager to talk about the central feature of the legislation, and the press didn’t discuss it much either.
If they did, that might have raised another better-to-ignore topic, affordability: whether middle income folks would really be able to afford a policy they will be required to buy, even with government tax credits to help pay the premium. Last week I interviewed twenty-eight-year old Michelle Zywicki in the Waupaca, Wisconsin public library. She doesn’t earn much working twenty hours a week at Dollar General, and can’t find a full time job. She has no insurance. Zywicki heard she would have to pay a fine for not buying insurance which she cannot afford.
Because her income is low, I told her, she probably would get large subsidies when the mandate took effect. “Why hasn’t anyone told me that?” she shot back angrily. “I’ve tried to read articles and they put me to sleep.” Somehow, dear colleagues, we’ve missed with her—and probably millions more in her shoes.
The president’s equivocation on the public option allowed its large number of supporters to believe it was possible to create an alternative to private insurance, only to have their hopes dashed when it became clear the mighty stakeholders didn’t want it, and so the pols threw it under the bus. Nancy Pelosi herself kept telling reporters that the House bill would have a strong public option, perhaps knowing all along it wouldn’t make the final cut. To the public, Pelosi’s remarks came across as just another politician’s flimflam.
A month ago in Columbia, Missouri, holding one of my periodic town hall meetings, I talked to fifty-six-year-old Charles Paxton, who told me: “When they started it, I was for the law. By the time they got it done, I thought it was not a good idea. There were way too many compromises made to get it passed. You know it’s not going to do what it should.” What news there was of the president’s deal making with insurance companies, doctors, hospitals, and drug companies didn’t sit well with people who thought those days were over.
Republicans have exploited this distrust that is likely to intensify as more people learn about the mandate. “I don’t like the fact people will be forced to buy insurance,” said Hannah Spratt, a University of Missouri sophomore who is not spending her time watching Glenn Beck. Robert Hanna in Lincoln, Nebraska, told me he would never vote for a Democrat ever again, because the president “said he wouldn’t sign a bill that would increase the deficit and include illegal aliens which the bill does.” The GOP message had gotten through.