05/15/2010 05:12 am ET Updated May 25, 2011

Fixing the Health Care Message Problem: What's in the Bill for You, This Year

Many armchair pundits have taken whacks at the President and his communications team for having "lost control of the message behind his drive for health care."

This critique is based on the faulty logic that the President can control everything.

It ignores the fundamental obstacle to strong messaging that a "big tent" party like the Democratic Party will always face during massive reform efforts: a party can't coordinate messaging while disagreeing with itself.

The President can be on-message day-in and day-out (and, I'd contend, he was).

But if the rest of his party is busy jousting over the details -- during the strange process known by high school social studies teachers as "legislating" -- the media coverage will be about the uncertain outcome of the conflicts, which will swamp any messaging effort.

Only upon a final agreement can coordinated messaging begin. And since so many Democratic congresspeople keep their cards close the vest to maximize bargaining leverage until the very last minute, Democrats don't seem to get to a final agreement until the moment the bill passes.

This leads to a political paradox.

With coordinated messaging an impossibility during the legislative process, voters are likely to be unsure how any pending legislation will affect them. Confusion about what change might in practice weakens poll numbers. Which makes it harder for Democrats to reach consensus. Which delays passage. Which prevents coordinated messaging that would reassure voters to begin with.

But Democratic leaders are ramping a post-passage coordinated messaging strategy.

And it's particularly important, because conservatives are already pushing the false talking point that the bill would increase taxes now but won't produce benefits until later.

While it's true that the major reforms won't be implemented until 2014, it's not true that everyone pays higher taxes now.

Only singles earning at least $200,000 and families earning at least $250,000 will pay a slightly higher Medicare tax.

Meanwhile, there are $40 billion in small business tax CUTS that kick in right away.

More importantly, as far as messaging is concerned, it's also not true that there are no immediate benefits.

In January, The New Republic's Jonathan Cohn sketched out a strategy for congresspeople to tout those immediate benefits. And it appears the Democratic leadership is heeding his call.

The Democratic Congressional Campaign Committee succinctly listed 10 immediate benefits for supporters of the legislation to promote.

  • Offer tax credits to small businesses to purchase coverage
  • Prohibit pre-existing condition exclusions for children in all new plans
  • Provide immediate access to insurance for uninsured Americans who are uninsured because of a pre-existing condition through a temporary high-risk pool
  • Prohibit dropping people from coverage when they get sick in all individual plans
  • End lifetime limits and restrictive annual limits on benefits in all plans
  • Require premium rebates to enrollees from insurers with high administrative expenditures and require public disclosure of the percent of premiums applied to overhead costs
  • Ensure consumers have access to an effective internal and external appeals process to appeal new insurance plan decisions
  • Require plans to cover an enrollee's dependent children until age 26
  • Require new plans to cover preventative services and immunizations without cost-sharing
  • Relief on the Donut Hole

And White House adviser David Axelrod, doing the Sunday show circuit yesterday, showed how to make the highlights of the list sing. Here"s how Axelrod responded to Meet The Press guest host Tom Brokaw:

MR. BROKAW: As a man who's run a lot of campaigns, can't you understand the anxiety of a lot of Democrats, in the House especially, who have to vote on the Senate bill, even though reconciliation comes next to try to fix parts of it, when they know that when they go back in the fall it's that vote on the Senate bill, 2,700 pages, the "Cornhusker Amendment," the "Louisiana Purchase," all the Christmas tree ornaments that are in there that they'll be hearing about when they run for re-election?

MR. AXELROD: Tom, the only way they're going to hear that [is] if this bill does not move forward. I've said many times that they've got to vote -- that Republicans and the insurance industry and others can run against them already.

What they don't have is the accomplishment.

If this bill passes this year, children with pre-existing conditions will now be covered.

There'll be an end to lifetime caps and annual caps on what the insurance companies will cover, so if you get sick you won't go broke, if you get sick they can't throw you off your insurance.

The doughnut hole will be filled in so senior citizens will save hundreds of dollars on their prescription drugs, [and] the life of Medicare will be extended...

And earlier, Cohn described how congresspeople can take those messages to their districts:

Visit a senior citizen home and talk about how their drug bills are coming down. Go to a community college, and chat with kids staying on their parents insurance. Shovel dirt at the construction site for new community clinics. Kiss babies while talking up the waived restrictions for OB/GYN care. Give speeches at job fairs for health care workers.

The unfortunate reality is that few voters, even well-informed news junkie voters, can tell you how the health care bill will directly affect them. If we had a competent news media, that might different a story. Without that, the party in power needs to push past their disagreements, take the actions they were elected to do, and then give a consistent explanation about what they have done.

As frustrating as the wait for it has been, it appears that messaging effort is underway.

Originally posted at