Matt Miller says the framing of health care reform is crucial:
Lessons for Obama from Ted Kennedy’s noble flops, by Matt Miller, Commentary, Financial Times: ...Senator Kennedy has rightly been hailed as a passionate voice for the voiceless and a master of the legislative process. But any assessment of his legacy is incomplete if it fails to ask why American liberalism’s modern icon proved so ineffective in persuading his country to share his vision.
This is not a matter of abstract interest. President Barack Obama stands little chance of succeeding in the coming healthcare endgame without understanding why, for all his passion, Kennedy could not make the sale. ... There is no single answer. But one reason was the sense among voters that liberals tended to worry more about the poor than about the struggling middle class. This same sentiment now threatens Mr Obama’s health reform.
“We have to do better at making this issue a moral imperative,” Tom Daschle, former Senate majority leader (and Obama confidante) told the New York Times Magazine last month. “This in many respects is the civil rights battle of the early part of this century.” But middle-class voters do not see healthcare as a “civil rights issue” – a cause in which they should enlist to bring justice to others. With soaring premiums and shrinking and precarious coverage, the 85 per cent of Americans who have health insurance see reform as a matter of economic security for their families.
Unfortunately, the American left has for years defined the issue predominantly as a matter of ending the scandal of the uninsured. ... The Democratic argument has failed to emphasize how health reform can deepen the economic security (and improve the health status) of the middle class. Yes, one part of that argument is to ensure that no American in the 21st century goes without coverage. But the liberal instinct – to focus first on the neediest in ways that lead squeezed middle-income voters to conclude liberals want to take their hard-earned money and spend it on someone else – helps explain why Kennedy-style politics never prevailed.
Democrats need to frame their goals as inclusive measures to promote security and opportunity in a global economy – improving the life chances of society’s most luckless but also bolstering the security and prospects of America’s vast middle class. This is also the only way to persuade average Americans to pay for such policies...
I've also argued that the debate needs to be framed in terms of how it will help the typical household (while maintaining the goal of expanding coverage), so while I might have stated it differently, I think the argument that the benefits to middle class voters need to be emphasized is essentially correct. The moral argument for extending care to those who currently cannot afford it is important, and I wish it was enough by itself to motivate changes, but I suspect too many people will wonder why the government wants them to help pay for someone else's health care when they can't afford to the coverage they need for their own families. Unless and until reformers can answer that question satisfactorily, reform will be difficult to bring about.
[A quick, far from comprehensive comment on the Baucus health care plan: The plan s far from perfect, and it doesn't do a lot for typical households, but it does provide a cap on out of pocket expenses thereby eliminating the risk that a serious medical condition will create severe financial hardship. Protecting people from catastrophic outcomes is an important and worthy goal, and that does provide additional security to typical households, but I'm not sure the additional security the plan provides is enough by itself to make the sale on health care reform to the voters who matter. Most people will be required to have health insurance and people on this plan will still face high deductibles and high co-payments for regular care.]