The biggest news to emerge from the weekend and spill over into Monday's blogosphere is that the White House looks to be flexible when it comes to the public plan option. For some time, this aspect of reform has been a lightning rod for attacks from the right against "big government" and "socialized medicine." In fact, I even suggested recently that it might be a shrewd political move to make the public plan even more optional, by letting each of the states decide whether or not to participate.
Well, it seems that President Obama may be prepared to drop the matter entirely. As Jonathan Cohn writes, Obama would prefer the public plan be included, but he's not so attached to it that he's willing to throw the health reform baby out with the bath water. The Wall Street Journal anticipates that the co-ops Kent Conrad is so fond of, will step in to replace the public option.
Robert Reich sees this as a big mistake, while Merrill Goozner remains far more optimistic. What I want to know, though, is where President Obama is going with this. Once one concession is made over a controversial provision, won't others be close behind? Are we going to end up with an eviscerated health reform bill? Or, are we seeing politics at its finest -- the art of the deal between the president and key members of Congress?
Ezra Klein points out using a word cloud (my favorite!) that Obama's not talking about costs or health care reform, but is talking about health insurance reform. He bases this on an analysis of Obama's most recent remarks in Montana. I wanted to take things one step further, and decided to look at the content of Obama's health reform town hall meetings to see if there were any telling trends. Here's what I found.....(Note: The images are too large for me to upload to the HuffPost. To view them, please visit my blog.)
First, take a look at a couple of word clouds. The first comes from the president's first town hall meeting held in Wisconsin on June 11. The second represents the president's last town hall meeting held in Montana on August 14. Notice any differences?
Wisconsin Town Hall
Montana Town Hall
Well, what you should see is exactly what Ezra was pointing out: Obama's moved from health care reform to health insurance reform. While word clouds are pretty to look at, however, sometimes they can be hard to interpret. The following graphs show some not-too-subtle changes to Obama's rhetoric.
Here, we see that while the usage of public and private tend generally to trend with one another -- which is probably due largely to the overall tone of Obama's remarks -- the focus has gradually, but noticeably shifted from talking about the public to emphasizing the private. What does this mean? Well, without more context it's hard to say, but it probably indicates some reluctance to continue feeding misguided fears about the public plan and government's role in health care.
Another area that generates a lot of opposition is cost. People I talk to about health reform--especially those who are opposed to it -- want to know: "How much is this going to cost?" and "How much am I going to have pay for this?" While rising costs are a major concern and a primary motivation for health reform, the above graph suggests that costs are an unfavorable topic. Why? Because, as evidenced by the two questions I just posed, when people hear "costs" their first instinct is to defensively reach for their wallet, rather than to think "Hey, this might save me some money." Again, it makes it very easy for opponents of reform to insinuate -- or boldly assert -- that big government is going to raise your taxes and that's not a criticism that Obama wants to invite.
Finally, we see very clearly that health care reform is being discussed less and less, while insurance reform is taking center stage. There's not much I can explain that the graph doesn't make abundantly clear on its own.
Putting it all together, you can begin to get a sense of the White House health reform strategy going forward. To use a sports metaphor, the whistle has blown signaling the end of the first half of health reform, and all the players are huddled in the locker room that is August recess. In this context, Obama's town hall remarks are the coach's pep talk. In September, the second half begins, and here's what I think you can expect:
Democrats are going to shy away entirely from the public option. Health care co-ops will be shopped around, but their success will depend on how well they are communicated to the public. Rising health care costs will fade into the background, which is just as well considering that the savings from preventive medicine and medical homes are not a certainty. Insurance companies will increasingly become the target of critics of the status quo. In short, I think if we're lucky we'll see Democratic-style reform presented using language more traditionally employed by conservatives, which will win not only moderate bi-partisan support in Congress, but also -- and more importantly -- more widespread support from the public. Will the bill we get be perfect? No. But the game's not over yet.
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I'm not sure if I completely agree with that. Yes, like I said in my comment below, and have written about extensively on my blog (http://www.healthpolicyanalysis.com) the public option is nice. I wouldn't say it's the ideal, necessarily, because you'd need to consider things like single-payer in that mix, but from where we are now, an alternative that would provide coverage to the uninsured and make the insurance companies honest is a pretty big step in the right direction.
As a progressive, I would continue to support my party even without the public option as long as something meaningful does get pushed through. Here's the thing: You're absolutely right about what happens when turn-out is low, but what happens when turn-out is high because the right is furious about the public option (which has pretty darned low public support)? This is precisely the kind of political calculus Dems--especially the Blue Dogs--are doing right now.
As a health services researcher, I can spout the reasons to implement meaningful health reform until I'm blue in the face, but at the end of the day, appeals to empirical evidence do little to influence what we must remember is largely political posturing.
Rock on, let’s see where it takes us. The journey is all the reward and all of the punishment.
Alright, I will not be lazy, here is the Durbin comment:
http://www.huffingtonpost.com/2009/04/29/dick-durbin-banks-frankly_n_193010.html
http://ww2.jhu.edu/hurj/issue7/research-brar.html
As I said, rock on...rock on...
The thing is, procedurally, there aren't enough votes for cloture unless the left courts the moderate Dems. A public option isn't favorable to them, so offering to let it go in return for their support of a bill is a move being considered. What I'm really afraid we'll see if they're not careful is some seriously heated party infighting, and that's a sure-fire way to blow majority control.
Let's keep hoping for the ideal, but anything that's a step in that direction is better than sitting still.