Think it Through

from Bjorn J via Creative Commons

These days, the tail that wags the dog in Congress is colored blue.

The so-called Blue Dog Democrats are not a majority of the House of Representatives. They are not even a majority of the Democrats. But they are tugging so hard on the reins of the majority that they are determining the direction of heath care reform.

Think of the 52 Democrats in the House of Representatives who call themselves Blue Dogs as Darwinian creatures of politics – descendants of a pest called the boll weevil that infested Congress in the 1980’s.

Russonello’s political dictionary defines a “Blue Dog” as: “a congressional animal that barks incessantly about saving the taxpayers money while quietly carrying water for policies that increase the federal deficit and the national debt.”

The most important thing to Blue Dogs – about half of them come from Southern states – is presenting themselves to their local news media and their constituents as fiscal conservatives in order to send the message that they are a different kind of Democrat – code for not too liberal.

The Blue Dogs feed on a special brand of “fiscal conservatism,” which claims to spend less of taxpayers’ money but in reality merely shifts what the government’s money is spent on and who pays. Their ancestors, the boll weevils, worked against any spending in the 1980s that was not a weapons system.

They had a large impact on government and our country:

By the end of Ronald Reagan’s second term in office in 1988, spending on domestic needs such as health care; child nutrition; economic programs to help create jobs, build housing and educate our children; medical and scientific research; and everything else except entitlements and defense, dropped from 20.1% to 14.8% of the federal budget. Congress, with the boll weevils leading the way, found the money to increase military spending from $158 billion in 1981 to $291 billion in 1988, and spending on the military rose from 23.3% to 27.3% as a proportion of the federal budget. These fiscal conservatives were responsible for the budget deficit increasing from $79 billion to $155 billion during the Reagan years (1981 to 1988).

Taxes on the wealthiest Americans dropped to their lowest rate in decades (from a top marginal rate of 69.125% to 28%). The interest on the federal debt reached $12.65 billion every month.

Today, the Blue Dogs have health care reform by the neck. They intone ominously about their fears of a high price tag on President Obama’s plan for comprehensive health care. Then they oppose provisions that will save money for health care consumers and for the federal government. Specifically, they oppose a strong public option because it would be too difficult for private insurance companies to compete against – in other words it would provide quality care at less cost. They are also willing to draw a line in the sand to block health care reform if it includes new taxes on businesses or millionaires.

They dubbed President Obama’s stimulus package as “too costly,” but gave President Bush an open check book to wage war in Iraq. Their reasoning seems to be that many of them came from traditionally Republican districts, so they need to act like Republicans.

If the President loses meaningful health care reform because of the Blue Dogs, he has his chief of staff to blame. Many of the current Blue Dogs were recruited by Rahm Emanuel when he served as chairman of the House Democratic Congressional Campaign Committee. He believes they are the key to the Democrats holding the majority in the House because only the pro-insurance company, pro-millionaire type of Democrat can get elected in these districts.

This type of thinking is part of the reason why people tell us in focus groups that it doesn’t matter who wins elections, because “they are all the same in Washington.” Voters legitimately ask: why should we work for the Democrats to win a majority in Congress if they are not willing to make real changes from what the Republicans offered?

Nothing will test this assumption more powerfully than the outcome of health care reform.

If you read the news headlines on health care recently, you might get the impression that most people are more worried that President Obama will succeed in getting health care reform enacted than that he will fail.

The day after President Obama’s news conference last week, the Washington Post’s page one headline blared: “Obama seeks to calm fears on health care.” The New York Times interviewed people in one of the most Republican counties in the nation and concluded in a front page lede: “President Obama sought to convince an increasingly skeptical American public that proposed changes to the health care system would benefit them and strengthen the economy.”

Fears?

The headlines run contrary to the constant demand for health care reform that many of us have been hearing from people across the country for many years. In nearly every national poll over the last ten years , health care has been a top-tier concern. If you actually talk to people out in the country, health care concerns are on the top of their minds. Most Americans tell pollsters they are satisfied with the quality and accessibility of their own health care, but this does not mean they feel safe that things will stay that way. Scratch the surface of their satisfaction and you uncover fear that nothing is secure when it comes to health care: you hear stories of friends or relatives who have become destitute or have gone untreated for illnesses because they have lost health coverage somehow.

It is this insecurity that I believe is behind most polls showing clear majorities supporting President Obama’s efforts to change the way health care is delivered in the country. Our firm, Belden Russonello & Stewart, conducted a national survey last week to gauge if Americans really are worried about health care in the future.

The BRS national random digit dial survey of 800 adults, from July 20 to 24, found that:

• 72% of adults are worried that if someone in their family becomes seriously ill their health insurance might not cover enough of their medical bills. Nearly half the country — 47 % — is very worried about inadequate health coverage.
• 65% worry that if they lose or change jobs they might lose their health insurance and not be able to afford new health insurance. Again, close to one out of every two Americans — 46% — is very worried about losing health care.
• 60% say they worry that if someone in their family becomes seriously ill their health insurance might drop their coverage. 41% worry very much.
• 56% worry that if they lose or change jobs they might not be able to get new health insurance because of a pre-existing condition. Nearly four in ten –38% — worry about this very much.

When you consider that the June 2009 national survey by the AP/GfK reported 35% of Americans worry being victims of terrorism, you can easily conclude more Americans now fear their health insurance company than they do Osama Bin Laden.

The BRS poll last week also found that overall 62% of Americans favor President Obama’s efforts to create comprehensive changes in the health care system. About four in ten — 45% — feel strongly in favor. One in three (33%) Americans opposes what the president is trying to do.

Support for the plan reaches far beyond liberals and Democrats, as 65% of independents and 66% of political moderates favor what Obama is trying to do. A substantial 44% of each of these groups strongly supports his efforts.

One statistic from the BRS poll provides even more evidence that anxiety about the future rather than immediate concerns is driving support for comprehensive health care reform: younger Americans more firmly embrace comprehensive reform than their elders. Over two-thirds (67%) of Americans under 45 years old support Obama’s health care reform efforts, compared to 56% of those over 45. It is not just that Obama is more popular with young people. When you account for political affiliation and ideology, age is still an important consideration in support for reform.

This is why when I read headlines that say Americans fear health care reform, I am thinking, which Americans? Maybe reform is risky for some insurance company CEOs, some hospital big shots, and the Chamber of Commerce. For the rest of us, it is a matter of eliminating the risk of health care that may be out of reach in the future.

So far, President Obama has chosen not to use fear as a weapon to pass health care reform. As refreshing as this it is, Obama would benefit from at least reminding Americans of the insecurity they feel about the future of health care.

Update: full questionnaire here

The recent surveys on health care reform have been reporting large-scale support for reforming our health care system but no consensus on the specifics.

• The latest New York Times/CBS poll (June ‘09) reports 85% of the American public wants either “fundamental changes” (51%) or to “completely rebuild” our health care system.
• A June survey by the Pew Research Center found 71% favoring either fundamental changes (30%) or to completely rebuild (41%) the health care system in America.
• A June survey by the Kaiser Family Foundation reports that 68% of Americans favor “creating a public heath care option similar to Medicare to compete with private health insurance plans.”

The dissonance between this broad support for reform and the reservations about the specifics of reform, shown in some polls, lead some analysts to voice skepticism that health care legislation will pass this year. Others point to polls showing that the public is generally satisfied with the quality and cost of their own health care right now, so where is the impetus for reform? Indeed, the latest Pew numbers show that majorities of Americans do not have a “major problem” with “paying for the cost of routine medical care” (65%), “paying for the cost of health insurance” (56%), or the “quality of medical care in your community.” (73%).

If you only consider the numbers showing satisfaction with the current scene, you will not understand why seven to eight in ten Americans want Congress to pass health care reform. Talk to ordinary Americans, however, and the answer is clear – it is the insecurity Americans feel about health care and their future.

When pollsters have asked about motivations, the results are revealing. The Washington Post/ABC News poll in June asked a question that begins to explain why people are calling for reform, even if they say things are ok at the moment: the Post/ABC survey found 85% of Americans are concerned about “you and your family’s health care costs in the future.” 59% said very concerned and 25% were somewhat concerned.

Along these lines, it might also be a good idea to find out how many Americans worry about:

• If someone in my family becomes very ill, our insurance will drop us from coverage.
• If someone in my family gets cancer or some other serious illness, our insurance will not cover all the costs. Could this put me at risk of bankruptcy?
• If I lose my job, I will lose my health coverage and I will not be able to afford to buy new health insurance and pay all my other bills.
• If I lose my job or if I change jobs, I will not be able to get health insurance because of a pre-existing condition.

A broad inquiry into the strongest currents behind health care reform needs to measure the insecurity that we all hear expressed every day in our lives. To what degree are Americans scared to get sick, scared to leave a job, or worried about a family member because of the way health care is administered?

The latest polls showing that President Obama is more popular than some of his policies are a sure sign that meaningful health care reform with a public option should be a slam dunk for Obama.

The intangibles of leadership, not the specifics of policies, usually determine whether or not the country will accept large scale change like health care reform.

If Franklin Roosevelt had lived through his fourth term in office, the country would have heard him call for national health insurance as part of a Second Bill of Rights he was preparing. After FDR’s death, President Harry Truman took the first step by calling on Congress to provide universal health care coverage. But in 1945, Truman was not popular, and the American Medical Association and others crushed Truman’s plan.

Twenty years later, President Lyndon Johnson had just won a landslide election and he enjoyed a national consensus behind his leadership. He move quickly in January of 1965 to ask Congress to send him a Medicare bill. He faced the same bitter opposition as Truman, as the AMA fought back hard with lobbyists and money. The AMA even offered an alternative it named Bettercare, a voluntary program run by the private insurance companies. None of this mattered in the face of LBJ’s popularity. Just 204 days after LBJ asked for a Medicare bill, he signed it into law on July 30, 1965, in Independence, Missouri with former President Truman at his side.

President Obama’s personality and style of leadership is polar opposite that of LBJ. Yet, Obama has the same level of trust at a time of hope and anticipation that he will accomplish great things for the country.

Obama’s consistently high job approval ratings — 65% in the latest ABC/Washington Post poll — reflect the public’s general trust in his leadership. This high level of trust is much more important than the fact that somewhat fewer Americans like his specific policies.  For example:

• 61% approve of the way Obama is handling foreign affairs
• 57% approve of his handling of the threat of terrorism
• 56% approve of his handling of the economy
• 53% approve of how he is handling health care

President Clinton’s health care reform did not unravel due to the details of his plan as much as the public doubts about his leadership and voters’ disgust at Congressional behavior. The infamous “Harry and Louise” ads did not focus on the particulars of the president’s plan as much as they argued that something as important as your personal health could not be entrusted to the government at a time when Clinton had stumbled during his first year in office and Congressmen were bouncing checks and playing the float at the House Bank.

Although the history of health care reform covers decades of defeats, the level of trust the public has for Obama should make health care reform achievable.

Yet, there are some things he can do to lose:

• He can lose if he relies on men and women of good faith to come together to do what is right for the country. For the insurance, hospital, medical and trial attorney lobbies, health care reform is about money, and they will oppose every dollar they are asked to sacrifice for the common good.

• He can lose if he depends on selling the details.  Flow charts did more to hurt than help the Clinton plan’s presentation to the public. The devil is not in the details, it is in his determination. If the issue is reduced to one of who do you trust: the President or the insurance industry, who do you think will win?

• He can lose if he talks more about how he will pay for the plan rather than how we will benefit. Obama’s best line so far on health care has been “we cannot afford not to do it.” He must describe for us the pay-off, not the process of how to get there.

Like LBJ, Obama has the opportunity to either convert or roll over the naysayers and enact a program that will benefit hundreds of millions of Americans for years to come.

Health care reform is his to lose.

Like the Bill Murray character in the movie What About Bob, who is so immobilized by fear that he cannot move forward, the U.S. Senate took a “baby step” yesterday toward becoming a functioning institution which actually represents the hopes and needs of the rest of the country. The Senate passed a law providing health insurance to about 11 million low-income children who have not had access to affordable health care.

Last year the bill, known as SCHIP, died after two Bush vetoes and Republican opposition. This year, more Democrats in the Senate and House were able to expand SCHIP, but not before some Republicans tried to defeat it by raising the specter of immigrants using services. The Republicans objected to giving health care coverage to immigrant children whose parents are legal residents of the United States, who live and work in our communities and pay taxes.

One of the most contentious changes in SCHIP, and an improvement over the bill Bush vetoed, is the elimination of the current requirement that children of immigrants who are here legally wait five years before being included. Five years may seem like a flash to a U.S. Senator – just barely enough time to raise the $15 million+ needed for the next reelection campaign.

But five years is a lifetime to a child. That is exactly the phrase average Americans told BRS researchers in focus groups we conducted across the country for the National Immigration Law Center. When given the chance to think it through, the voters we heard from believe children should not suffer for a situation they did not cause.

Armed with the righteousness of their cause and that simple phrase – five years is a lifetime to a child– SCHIP coalition advocates won their case on Capitol Hill and persuaded them to include legal immigrant children. The president will sign this bill and the Senate will have done some good. Baby steps.