Chris Matthews asks: “What happened to the Obama message machine.” And Dee Dee Myers and Tony Blankley dutiful provide various off the mark answers about fear and insecurity. But, also, it’s clear to all three that Obama’s message on health care doesn’t have the same clarity as his message during the campaign, and they attribute that to his vagueness in the absence of a specific proposal for reform that he is advocating. In short, the failure of “the Obama messaging machine” is not due to a deterioration in the messaging machine, but to an absence of specific content that people can understand and organize around, and that Obama can deliver and repeat again and again. That content must be something that people can easily understand and that is resistant to the Republican lying machine.
Unfortunately, the public option idea being pushed by the President and many of his progressives supporters doesn’t have the needed clarity. One problem is that it requires a health insurance exchange whose features are vital to the success of any plan, but whose characteristics are currently unknown in the absence of a concrete bill that the President is advocating. Another problem is that lack of clarity besets the “public option” notion itself. What is a “public option”? it’s a policy offered by a non-profit Government-owned insurance corporation, in competition with policies offered by private insurance companies. But that’s vague because that corporation could have authority to sign up everyone for insurance, or could be authorized to sign up only a very small proportion of the population. It could be authorized to use the Medicare network of providers or not. It could be authorized to pay the prices for services that Medicare pays, or something else. It could be authorized to bargain for drugs from companies in other nations or not. In short, there are many types of public options, depending on the features given to, or withheld from, the public corporation established to run it. And the likelihood that the public option will work depends very much on these features. So, when Obama says we should have a “public option to keep the insurance companies honest,” what does he mean? That is just not clear, and people cannot evaluate whether he is supporting something that will do the job of "keeping them honest," or whether he will just be exposing people to forever escalating insurance costs.
Yesterday, the President sent an e-mail to millions outlining eight consumer protections he was looking for in the health care reform legislation. The eighth protection was: “Guaranteed insurance renewal so long as premiums are paid.” Clearly, this is great as long as the premiums are affordable. But what guarantees their affordability? That wasn’t clear in Obama’s e-mail, even though it expressed the need to do something about rising costs and premiums. Now, we know that Obama wants to control premiums through a “public option,” but again that term is ambiguous and it is clear that certain “public options” may have a chance of doing that, whereas other “public options” are just window dressing, that don’t have a chance in hell of holding costs and premiums down. So, Obama’s message so far isn’t clear enough to persuade people that his health reform bill would work. They know the present system doesn’t work. But who wants to go from the frying pan into the fire? Why should we trust that the President’s best intentions will come out of the bill that gets through the Congress?
Look at the Obama record so far. We have a bank bailout that used huge sums to bailout the big banks, but did very little to restart lending for main street, and that has produced the recurring outrage of excessive compensation awarded to the employees of companies on the public dole. We have a credit card reform act that doesn’t take effect for 9 months, in which time period consumers are getting socked with doubled and tripled interest rates, and all manner of fees, by the very banks they bailed out. We have a stimulus package that may have slowed the economic decline somewhat, but was far too small to prevent state-level job cutbacks across the country, or to produce the many millions of new jobs needed to turn the economy around. We have an energy bill going through Congress that looks like a coal company giveaway, and that will be very damaging to the environment, and we have a health care reform legislation-writing process that, it is plain, is thoroughly penetrated by insurance industry lobbyists who have given millions of dollars in campaign contributions to committee Chairmen and members who are writing that legislation.
President Obama is not very new anymore. We have all seen him operate, and he has so far not produced legislation that is “change we can believe in." But, rather, legislation that seems to reinforce the trend away from democracy and towards plutocracy. So, how can folks trust him to deliver this kind of change with health care reform?
The answer is that he has to commit to and deliver a message with content that cannot be gamed, or otherwise “fuzzed up” by lobby-penetrated congressional committees, and that clearly indicates that health care reform legislation will fix the health insurance problem that has killed, bankrupted, and broken up the families of so many Americans since the 1970s. That message has to guarantee reforms that people can trust, because there is concrete evidence that similar reforms have worked at other times and places, and in other contexts that they may even be familiar with. President Obama has to reset his health care reform message so that it delivers that kind of content, not content that conjures up vague and indistinct images of what health care reform will be like. And, unfortunately, for the President and his initial choice of strategy for health care reform that message can’t be built around the vague and highly manipulable idea of “the public option.” Instead, the only alternative that will fill the bill I’ve just outlined is “Medicare for All,” a single payer plan that will take the insurance companies out of the business of funding and profiting from basic health care for Americans.
“Medicare for All” is a very clear message. Everyone will, for good or ill, understand it. The insurance companies will fight it tooth and nail. They will tell all kinds of lies about it. The Administration and its allies, however, will be able to reply with all kinds of experiences that people already have. They can talk about Medicare and the experience American seniors have had with it. They can talk about an 86% approval rate for it. They can give all kinds of anecdotes. They can recruit various Tricare military recipients to talk about their experiences and the nature of military family coverage under Tricare. They can also talk about the experiences of other countries that use single payer systems. They can have the President and the Secretary of State do Town Halls in these countries to get the experience of ordinary people with their national single payer plans.
Of course, the opposition will scream “socialized medicine,” but the Administration can reply that “Medicare for All” is not “socialized medicine,” but only “socialized insurance.” And when the opposition says that socialized insurance is bad for America and that we should rely on the free market, the Administration has to reply without hesitation or doubt, that “socialized insurance” is necessary because there is no free market in health insurance, for the reasons Paul Krugman has recently given, and that even if there had ever been a possibility of a free market in health care, the insurance companies themselves destroyed this possibility by consolidating to such a degree, that there are now only 7 major health insurance companies in the United States, and that in much of our country a single insurance company dominates local markets, and has been able to increase premiums without fear of a free competitive market penalizing it for doing so.
The Administration then needs to go on to point out that in concentrated, monopolistic markets like the health care market, private, profit-making companies are free to engage in all manner of unfriendly consumer practices and to extract unconscionable profits, since consumers have no alternatives, which is exactly what the health insurance companies have done for many years now. And that therefore companies operating in such markets and realizing excessive profits in them, forfeit the right to claim that their businesses should not be restricted or regulated on grounds that they provide the benefits of competition in a free market, simply because there is no free market on which to base such claims.
Now, I know that the Administration will find it very difficult to advocate “Medicare for All” because they’d have to admit error in their health care strategy so far, and Administrations don’t like to do that unless reality absolutely forces them to. But, this Administration can be different from the bankrupt Administrations of the past. It can forget about such nonsense, admit its errors, and explain its actions by saying that the President originally favored a public option rather than “Medicare for All,” because he was looking for legislation that Republicans and the health industry itself might be willing to support. He wasn’t out to get the insurance companies, or to exclude the Republican Party from credit for this great and historic health care reform. Instead he was looking to pass legislation that was “live and let live” and that would produce a great improvement for the American people by introducing a very strong public option that would work to hold down increasing premiums and costs. The Administration can go on to say that after months of trying to get such a bill, the opposition of the Republicans and the health industry to a decent “live and let live” compromise has been unflagging, rigid, and impossible to deal with, and that they have shown that they will accept nothing but a bill that represents a trillion dollar giveaway to the insurance companies, enabling them to extract unprecedented profits from the previously uninsured. He should then go on to say that this is not reform, and that since the insurance companies and their bought legislators in both parties are not interested in a reasonable compromise, there is no reason for him to try to work out such a compromise at the cost of lack of clarity in the health care reform, or loss of trust on the part of the public, which constantly sees the unconscionable, and unseemly, gyrations in some circles in Congress to create a ‘reform” bill that will deliver even more profits to health insurers than they have so far been able to extract.
So, from here on in, the President should say, he will no longer fruitlessly seek a strong public option compromise with Republicans and the industry. But, instead, he will propose and support, without compromise, the Bill that makes the most sense for all of the American people: a Bill that will get the health insurance companies off the backs of the American people forever, and provide for “Medicare for All.”