What a change a week makes!  Since the Massachusetts election on January 19, pundits this past week have been having a field day trying to explain why prospects for passing the House and Senate Democrats’ bills are coming perilously close to failure. There are no one or two single reasons, but several:

• Bad luck The administration was dealt a bad hand from the outset. Financial deregulation, thanks to Republican Senator Phil Gramm and buddies back in the 1990s, and the “starve the beast” strategy adopted since the Reagan administration (running up huge deficits when in power and turning them over to Democrats who are blamed for not reducing them and thwarted from spending money on their own priorities). What if they hadn’t inherited a near depression and didn’t have to help expand on the Bush administration’s bail-outs of the financial and other industries?  What if they could have passed a better and larger stimulus bill (as many called for) that would have put us on recovery sooner? What if Ted Kennedy didn’t die early in the effort to attain the political goal of his life? What if Martha Coakley ran even a so-so campaign, instead of a feeble one?
• Millions and millions of dollars spent by stakeholders to keep the status quo. “Just like in any political campaign, if you’ve had millions of dollars thrown against you, it creates a negative impression that tends to be very harmful, and that’s what happened to the healthcare bill,” former Senate Majority Leader Tom Daschle said. “Millions and millions of dollars have been directed in a negative campaign to distort and to mislead the American people, and that’s going to have an effect.”
• Wishful thinking by Senator Max Baucus Even though it was obvious back in July that the Republicans were not interested in passing any health reform bill, Senator Max Baucus, chair of the important Senate Finance Committee that needed to weigh in on any legislation presented to the Senate, kept pushing to get Senator Snow to support the committee’s bill even though her vote was not needed to get it out of committee. The result was an unfortunate delay through the recess month of August and September that helped the opposition. The Committee finally produced its bill in mid-October.
• Obama’s strategy to let the Congress design the bill based on the Administration’s principles alone This strategy pushed health care reform legislation further than ever in over 50 years of trying but it also had Congress trying to guess what the White House wanted in the details. Congress, the branch of government under our Constitution that is suppose to make the laws, has become accustomed to the executive branch of government being more of a leader in legislation development instead of only the implementer once Congress passes the laws. Even the public has come to expect more emphasis of importance on the presidency than on the equal branch of Congress. This emphasis is clear in election years when more voters come out to cast their ballot for a president than for Congress. 2010 is a congressional election year.

• A smear campaign driven largely by nothing other than blatant political opposition President Obama reached out to Republicans and John McCain in particular at the beginning of the year in the hope of bi-partisan cooperation. But Republican strategists early on issued warnings about the Democrats finally achieving a “victory” on such an issue that has defied Congress for decades. As we noted back in early May, Republican pollster Frank Luntz guided Republicans on sound-bites to use to disparage the Democrats’ proposals, based on his focus group research. And William Kristol repeated the same stop-it-at-all-costs counsel he gave Republicans back when the Clintons tried to get health care reform passed. What might be best for the country in general and the uninsured in particular was less important than the party’s own fate for allowing passage, even if seen as bipartisan.Republican Mitt Romney, known as the man who just happened to be governor of the Commonwealth of Massachusetts when the health reform program he endorsed was enacted there in 2006, even last week had to tell three whoppers to disparage the final House and Senate bills and protect his disassociation from a very similar approach. When asked on January 11 if his Massachusetts program was really all that different from the approach being proposed by Democrats, the man “from Michigan” said with a straight face that the Democrats’ approach was a “one-size fit-all plan,” “raises taxes on people,” and that you shouldn’t put a mandate on businesses (see Slate, January 20, click here). The Democrats’ plan is hardly one-size-fits-all (though one could argue, what’s wrong with that anyway?), it does not raise taxes on the vast majority of people, and the Massachusetts plan itself mandates that all employers with 11 or more employees provide coverage or pay for some of it. Likewise candidate Brown backed up Romney and disingenuously claimed that Massachusetts citizens would end up paying for both their state program and additional costs to cover those in other states.The full-press partisanship, couple with the Senate’s 60-vote filibuster rule, which the Republicans have now exploited as the new normal, meant the will of a modest majority can no longer prevail.

• Broadcast media that were irresponsible in at least three ways:
  

1. While all news networks have certain biases, Fox News has perfected the art and easily brainwashes viewers who do not bother to check other sources. Their “fair and balanced” doublespeak was clearly foreseen by George Orwell in his novel 1984. On one day in 2009, a reporter cataloged 16 negative stories in a row about the Democrats’ health care reform bills. According to media watch web site, Media Matters (click here) “In our poll, 72% of self-identified FOX News viewers believe the health-care plan will give coverage to illegal immigrants, 79% of them say it will lead to a government takeover, 69% think that it will use taxpayer dollars to pay for abortions, and 75% believe that it will allow the government to make decisions about when to stop providing care for the elderly.”  And Fox News played a central role in organizing and promoting the Tea Party rallies in Washington, including passing along the highly exaggerated attendance estimates. Read the following article and you will know that Fox News has been out to get the administration from the outset on all fronts (click here). Fox News, essentially an arm of the Republican Party, has been trying to kill health care reform, just as they are trying to kill climate change legislation and other initiatives of the Democrats.The Wall Street Journal

   (owned by Rupert Murdoch’s News Corp, the same big-business favoring, anti-regulation organization that owns Fox News) also provided a consistent, almost daily feed of negative editorials and guest columns from such “experts” as Karl Rove on the faults of the Democrats’ bills. One would have thought the drafted health bills had nothing positive to offer - that universal lifetime coverage, affordability subsidies, better prescription drugs for seniors, insurance company protections, and competition-enhancing exchanges were just minor provisions to lure people to accept a big government take-over, raise taxes, tell doctors how to practice medicine, or encourage the elderly to cooperate with those death panels. One need not even mention all the lies and fearsome “Nazi” speculations fomented by the likes of Rush Limbaugh and Glen Beck.

2. Surveys and our own meetings with citizens around the county last year showed overwhelming ignorance and false impressions of the bills. But the fault is not just with Fox News but also with CNN and the other major networks for failing to cover the actual issues at hand and instead focusing on the political contact sport and intrigues. In part, the many issues contained under the umbrella of health care reform do not easily lend themselves to TV talking heads or radio. Newspapers and web sites sponsored by organizations like the Commonwealth Fund, Kaiser Family Foundation, and Robert Wood Johnson Foundation are more able to lay out analyses and comparisons among alternative provisions.  Still, PBS’s Frontline programs, “Sick Around the World” and “Sick Around America,” and several editions of Bill Moyer’s Journal provided very informative and in-depth analyses of health care reform issues. Unfortunately, these sources are generally ignored by those who prefer the black-and-white clichés from Fox News, have more important Twitter and Facebook feeds to attend to, or get headaches from reading multiple paragraphs of nonfiction.
3. News show hosts and interviewers on all networks did not follow up on erroneous and ridiculous claims by guest politicians, because they were either too reticent to make their guests sweat or else themselves had only a superficial understanding of the issues. Politicians were constantly mixing annual health care costs of the current program and 10-year total costs of the proposed bills, leaving the impression that the latter would dramatically increase costs. Likewise, they’d leave out key details, like the fact that the gross costs of the enhancements would be offset by savings and tax increases to produce a net savings. Or they’d overlook the fact that the Congressional Budget Office’s projections were very conservative regarding possible savings and had way overestimated costs for the last three major changes to Medicare. Or they would not be challenged for their solutions when accusing the Democrats’ bills of not cutting costs, while also saying they themselves would protect Medicare (by far the biggest health care cost for the federal government) from any “cuts.”

• Messy and ultimately embarrassing special deals to secure support of key stakeholders and key votes in Congress First it was agreements with the AHIP (America’s Health Insurance Plans) organization and then PHARMA (representing the major pharmaceutical companies) to gain some savings and avoid stirring a cranky Harry and Louise up out of the crypt. Then, as the bills worked their way through Congress, it became apparent that the Democrats “big tent” super majority wasn’t all that big or super. The public option, which studies showed would have generated significant savings, increasingly was pruned back from a large tree to a small bush. Finally, lest it grow back at all, the four ponies of the apocalypse, Senators Lieberman, Nelson, Landreiu, and Lincoln chopped it down altogether.To secure enough votes in the House, Bart Stupak and friends demanded higher priority for the unborn than the uninsured, forcing pro-choice Democrats in the House and Senate to threaten not to vote for the bills. In the Senate, Ben Nelson worked on a special deal with Majority Leader Harry Reid for Nelson’s Nebraska Medicaid program, which then caused huge embarrassment for Democrats. Finally, in trying to minimize the impact of the so-called “Cadillac” employer-paid health plan tax, union groups forced a seemingly unfair deal to defer the tax on their collectively bargained plans.These “deals” are all part of the ugly legislative process (often despairingly called sausage-making) that this time was much more transparent than past legislation, when we learn of the deals after the fact, as was the case with Medicare Drug deals in December 2003. Since Obama ran on changing Washington, this was viewed as business-as-usual and angered a lot of people both Democrats and Republicans.

• Proposed bills that had to preserve a very complicated patchwork of current health care approaches in order to allow people the choice to “keep your current plan if you like it.”
  The result was an inevitably messy mix of provisions laid on top of Medicare, Medicaid, large employers, small employers, hospitals, community health services, states, pharmaceutical and medical equipment companies, insurance companies, and individuals in order to achieve universal coverage, insurance reforms, affordability, and cost savings. Not surprisingly, the bills were very long, left the potential for many gaps and unintended consequences, and were difficult to explain and justify to the many affected parties. An ideologically “pure” solution, like either the liberals’ single payer approach on the one hand, or the conservatives’ elimination of employer-coverage and replacement of Medicare and Medicaid with tax credits and individual policies offered through exchanges, on the other hand, would have been more coherent and easier to explain.

• A natural human bias against change Psychologists have long known that humans have a built in resistance to change and rather hang on to what they know than face the unknown or make a change. For this reason, for example, employers are enrolling employees into their 401(k) savings plans by default. Employees have the choice of opting out, but most stay in. When not enrolling was the starting point, most don’t bother to enroll or don’t think they can afford to (see the following Time Magazine article on the “science of change” click here).

Tags: Democrats Health Care Bill, Difficult week for Dems, Life Support

This entry was posted on Tuesday, January 26th, 2010 at 1:49 pm and is filed under Health Care. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.