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Thursday, July 30, 2009

Looking for the Health Care Silver Lining

Obama's down in the polls on health care. This is the big news coming out of the health care debate. MSNBC's headline on the subject -- "Poll: Obama loses ground on health care" -- is typical. The lede is even more gloom-and-doom.

Despite his public-relations blitz over the past two weeks to promote his plans to reform the nation's health-care system -- including holding two town halls on Wednesday -- President Barack Obama has lost ground on this issue with the American public, according to the latest NBC News/Wall Street Journal poll.

Pluralities now say that the president’s health care plan is a bad idea, and that it will result in the quality of their care getting worse. What’s more, just four in 10 approve of his handling on the issue.

The poll also finds that Obama's overall job-approval rating has dropped to 53 percent. And it shows a public that has grown increasingly concerned about the federal government's spending as the administration defends its $787 billion economic stimulus and supports a $1 trillion-plus health-care bill.

Clearly, just six months into his first term, Barack Obama's is a failed presidency. We've got three and a half years of lame-duckitude to look forward to, as Caretaker-in-Chief Obama keeps the chair warm for the next president. And he had so much promise too...

Of course, if you keep reading, you find that things might not be quite that awful for the president. We're told that the "good news for Obama, however, is that he remains the most popular politician in country, and Democrats continue to lead Republicans in the handling of several key issues, although the GOP has gained ground from a year ago." Things are so bad that Obama is now the most popular politician in America. You can go ahead and feel sorry for him now.

For the record, I'm among those who disapprove of President Obama's handling of health care reform. Obviously, this doesn't mean I don't support the effort, just that I think he's now having to deal with earlier mistakes. Obama, hoping to avoid the stumbles of the Clinton administration, took a "if you love something, set it free" approach and left the specifics up to congress. Anyone who's been watching the current Democratic leadership in both chambers for the past few years should've been able to predict that this was a bad plan. Pelosi and Reid (especially Reid) could get lost in a blind alley -- with a map. It was a really bad idea.

Polling on health care reform itself is a little unreliable. You can't really ask about specifics, since deals are still being hammered out and nothing is set in stone. There isn't actually a bill to talk about, so asking about specific aspects of "the plan" means asking about specifics of a hypothetical plan.

Still, the idea of reform in general seems extremely popular. Despite the fearmongering of the right on the issue, a new TIME poll finds that "enthusiasm for the prospect of reform remains high." 69% thinks it's either "very" or "somewhat" important that major health care reform be passed this year. Only 28% believe it's not important. "In a separate question," TIME reports, "more Americans said it would be better to pass 'major reform' to health care (55%) rather than 'minor adjustments' (43%)."

Support for a public option is 56%. 63% want universal coverage. 57% support raising taxes on the wealthy to help pay for the plan. 80% support "a bill that required insurance companies to offer coverage to anyone who applies, even those with pre-existing medical conditions." And all of those figures come despite the fact that most Americans think that reform wouldn't help them personally; 62% think it'll be more expensive, 65% believe it'll be more complicated, and 56% believe it'll limit your choice of doctors. So health care reform opponents are having some success in their messaging -- no one's proposing any of that -- but that success doesn't matter. The current system is so royally effed up that the success of the fearmongering is irrelevant. People want change.

And, like the MSNBC/WSJ poll, we find that the big losers are still in the opposition to Obama.

Obama also retains significantly more credibility with the public than with his Republican foes when it comes to tackling the problem. Asked who they trust to develop new health-care legislation, 47% of respondents said Obama, compared with 32% who said Republicans in Congress. At the same time, Obama received less approval for his handling of health care than for his handling of foreign affairs and the economy. Americans were split evenly, 46% to 46%, when asked if they approved or disapproved of Obama's handling of health care. By contrast, 58% of the same respondents said they approved his foreign affairs management, while 51% approved of his job on the economy.

None of which is to say that the decline in Obama's poll numbers isn't significant. It's just that they've gone from "Oh my God, we just elected the first black president! Yay!" to "You know, I think this guy's a pretty good president." And it's clear that the people are with him on health care reform, even if they're not all that happy with the way he's handling it.

If Obama wants to get health care reform back on track, he's got to step in and take control here. He needs to lump the Blue Dogs in with the Republicans, by making them both opponents of real reform. And, make no mistake, they are. If the Blue Dogs and the Republicans have their way, we'll have health insurance reform, not health care reform. Very little will change and even less of that change will be for the better.

I think it's pretty clear that we'll come out of this with something and, no matter what we wind up with, the Obama White House will declare victory. But there's still a way to get real reform and there's no good reason why we shouldn't pursue it.


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1 comment:

Xigent said...

Delighted, as always, Wisco, when you point out the silver, or pewter (sometimes), lining behind the MSM headlines.

But I've studied and followed the course of attempted health care reform in the U.S. since before WW I, when it was called "compulsory health insurance" (not a misnomer now, ironically, under what we know of the Obama plan).

All the right wing and the corporations have to do is create doubt in the minds of Americans by playing to their prejudices about "socialism," "confiscatory" taxation, and other nonsensical hyperbole. That's much easier to do now than even during the Clinton reform attempt because the MSM are almost entirely corporate-owned or -beholden, if not proto-fascist (e.g., FauxNews).

Conversely, it's much more difficult to maintain optimism based on reason and the long-term view while the barrage of propaganda continues, day in, day out. Obama, as you suggest, has let the control of the show slip away from him to the herd of cats in Congress. With something like 70% of Americans in favor of reform, that's a blunder of some heft.

And then there's the fact that no one knows exactly what the plan that Obama favors is — a tactic not devoid of political savvy — or to what extent the compromises with the insurance companies and other lobbies have all but stripped out cost control and true, equitable universality.

In case you missed it, Trudy Lieberman and Marcia Angell, both long-time proponents of a single-payer or Medicare-for-all approach, made these points exceedingly well on Moyers, which is well worth watching closely.

Angell in particular was so ardent — and remains so — in her passionate but lucid support of single-payer while editor of the New England Journal of Medicine that she was forced to step down. She is now saying that Obama needs to start over and actually propose something himself that he believes in, like single-payer.

The truth, I fear, is that we may be trying to solve the wrong problem: federal-level reform may simply be structurally impossible in the U.S. of today. As was done in Canada by Saskatchewan, reform may ultimately have to take the form of a groundswell at the state level first.

The feds, without a solid consensus of their own, are often more comfortable following than leading.

I'll be reading your blog more often after the recess as the dark clouds gather once again on the horizon. I expect to be looking for signs of a miracle.