Thursday, March 29, 2012

Health Care Framing

With the Supreme Court's oral arguments out of the way and a decision on the Affordable Care Act not expected until June, the battle now begins in earnest over how to frame health care reform. Pema Levy over at Talking Points Memo has a good rundown on how things are expected to play out. Basically, Republicans feel they will benefit electorally if the law is upheld, while Democrats feel that they stand to gain at the ballot box if the Supreme Court strikes down some or all of the ACA. Strategists on the left and right are focused on how the ruling will galvanize their respective bases and see the decision as a key point in the upcoming elections.

Putting aside the real world implications of overturning the law (hint: millions of people will lose their health insurance), one thing that strikes me as important as we start to think about this is how little the political dynamics have changed since 2010. Back then, the law had just passed and no benefits had kicked in. Tea Partiers swarmed congressional town hall meetings, and opposition to the bill hovered around 54%.

Interestingly, this level of opposition has remained largely unchanged in the two years since, even though key parts of the law, such as the provision affording individuals under 26 years of age to remain on their parents' health insurance plans, have been implemented.

Why is this so? There are a number of reasons people still oppose the health care law, but I think a lot of it has to do with the ineffectiveness of the Democratic messaging on the issue. From President Obama on down, Democrats have not put forward the strongest case for why people should support health care reform, which as it is currently designed should appeal to moderates and independents.

Just consider the word "mandate." For most people, the salient feature of "Obamacare" is the fact that the government is going to start forcing people to buy private health insurance. This is true, of course, but Democratic leaders, and progressives as a whole, have done strikingly little to explain what this means. In reality, the mandate is a policy that is meant to prevent people from "free riding" off the system. Since everyone is going to get some form of medical care, we need to make sure that everyone pays at least something.

This is a conservative position (that got its start in the Heritage Foundation, of all places) and has been most famously implemented in Mitt Romney's very own Massachusetts - with very positive results! Indeed, Romney himself has done a better job explaining how the system works than most Democrats.

So how can Democrats better market health care reform, and the mandate in particular? Well, I'd suggest taking a page out of the conservative playbook and arguing that the mandate is needed to make sure everyone contributes their fair share. No free riders. Repeat. No free riders. Individual responsibility, everyone pays, nobody is allowed to cheat. Repeat. You get the point.

As a Californian, I can assure you that this stuff gets traction. I can't tell you how many of my moderate friends make the argument that the California budget is broken because illegal immigrants game the system and receive benefits without paying their fair share. That this argument is incorrect is beside the point. It is a political winner, and hopefully progressives will use the uncertainty over the Supreme Court's forthcoming ruling to rethink how they market health care reform to the public.

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