In the Democratic presidential debate held in South Carolina on January 21st, Senator Barack Obama was put on the defensive over his health care reform package. Both Senator Hillary Clinton and former Senator John Edwards blasted Senator Obama for putting forward a proposal that fails to cover all Americans. Universal coverage, they claimed, is the Holy Grail of health care reform, at least in the Democratic Party.
And they’re right. Polls consistently show health care is one of the highest priority issues Democratic voters consider when selecting a candidate. Being perceived as the candidate who doesn’t care about universal coverage is not a recipe for success in Democratic primaries. By allowing Senators Clinton and Edwards to frame the debate as their universal coverage packages versus Senator Obama’s plan “that leaves 15 million Americans uninsured,” the Illinois Senator is at a severe disadvantage.
What’s surprising is that Senator Obama is on record as favoring universal coverage. Last year I wrote on my health care reform blog a post concerning a speech Senator Obama made to Families USA. In his talk, Senator Obama lamented the politics-as-usual approach to health care reform all too common in the nation’s capitol. “While plans are offered in every campaign season with ‘much fanfare and promise,’ they collapse under the weight of Washington politics, leaving citizens to struggle with the skyrocketing costs.”
Senator Obama told his audience that his goal would be to find a way to make universal coverage a reality, but warned it would probably take him four years to do it. As I wrote then, “By being agnostic about the means, a president could actually achieve the desired end. On the other hand, a president could take a ‘my way or the highway’ approach like the Clinton Administration did in the 1990s. The result from that effort: nothing much.”
Here it is, a full 12 months later. Senator Obama’s health care reform plan focuses on controlling costs. It does not require every American to purchase coverage, but instead tries to make the cost of coverage affordable for more Americans. There’s nothing wrong with that as a goal, especially if you’re plan is defined as part of a journey, not the ultimate destination.
There’s also nothing wrong with tying a mandate to buy coverage with a mandate for carriers to sell coverage to all applicants. Recent polls in California, where a health care reform package including these twin mandates is being considered by the State Senate, shows a majority of Democratic and Independent voters supporting this approach. Perhaps surprisingly, nearly four-in-ten Republicans back these requirements. This is also the road to universal coverage proposed by Senators Clinton and Edwards.
The California reform debate suggests a way for Senator Obama to reframe the debate. Liberal and union opponents of the mandate to require individuals to buy insurance condemn the provision for forcing consumers to purchase something that may be beyond their means. Supporters argue there are safeguards and hardship exemptions that will prevent this.
Senator Obama needs to seize on the legitimate concern voters have that government safeguards don’t always work. He should say something along the lines of, “Senators Clinton and Edwards want to force you to buy health insurance and to trust them that it will be affordable. That’s putting the cart before the horse; trust before the proof. I’m saying ‘let’s prove we can make coverage affordable,’ then we’ll see if mandates are required. They’re forcing you to buy before you see the price tag. I’m going to show you the price tag first. Then we’ll continue to the march to universal coverage.”
This is consistent with his past statements. The key is to focus on his long term vision (which, I assume, includes universal coverage) while positioning his opponents as typical politicians who promise everything and ask voters to trust them to deliver. It’s a more complicated, nuanced message than the others have, but it’s better than simply accepting the charge that his health care reform plan is out of step with Democratic voters.