President Obama didn't wear a bike helmet on vacation, but maybe he should when he returns to work next week. He'll need it to protect himself from the hail of incoming advice about how he should handle the health-care-reform fight. He's being told to be less liberal, change his message, stay on course, get more emotional, and (by everyone) to get more hands-on.
The president will get more involved, aides promise. He will get more specific about what he wants and build a coalition in Congress around those ideas. Then, he'll have to convince the public and hope that specificity will improve his connection with the American people. Until now, despite his constant effort to sell health care reform, the public-opinion numbers have been moving against him. In a just-released CBS poll, 40 percent approve of his handling of the health care issue, down seven points from a month ago. A plurality of Americans (47 percent) disapprove.
How did things get so low? If the president is going to make a new and successful pitch, knowing where he went wrong might help him keep from making the same mistake in the future.
A lot of smart analysts are saying that one of Obama's big mistakes—perhaps his biggest mistake—is that he talked too much about lowering health care costs as a way to shrink the budget deficit. (Slate's own Mickey Kaus has been arguing this for months.) Because the president was fixated on accounting, goes this argument, he didn't address the issue of security—people's worries that they'd lose coverage or their job or face financial ruin because of the broken system.
Is this right? Obama's budget director talked about the deficit, naturally (it's his job), and Obama has said regularly that the key to reducing the deficit is controlling health care costs, but looking back over the president's speeches, meetings, town halls and forums on health care, you discover there was something else he always talked about first and more extensively when it came to health care costs: personal security. Here is a typical comment from a town hall in Green Bay, Wis., in early June:
Every day in this country, more and more Americans are forced to worry about not just getting well, but whether they can afford to get well. Millions more wonder if they can afford the routine care necessary to stay well. Even for those who have health insurance, rising premiums are straining family budgets to the breaking point—premiums that have doubled over the last nine years, and have grown at a rate three times faster than wages. Let me repeat that: Health care premiums have gone up three times faster than wages have gone up. So desperately needed procedures and treatments are put off because the price is too high. And all it takes is a single illness to wipe out a lifetime of savings.
The president has talked about those without insurance, but his extended tales of woe—about either a woman with breast cancer in Wisconsin or a couple in Colorado whose son has hemophilia—have focused on those who already had coverage. Here E.J. Dionne reports that Democratic strategists say Obama should talk about bankruptcies caused by the high cost of health care. But that's a regular part of his pitch. He made it at his first big White House event in March:
The cost of health care now causes a bankruptcy in America every 30 seconds. By the end of the year, it could cause 1.5 million Americans to lose their homes. Even for folks who are weathering this economic storm, and have health care right now, all it takes is one stroke of bad luck—an accident or an illness, a divorce, a lost job—to become one of the nearly 46 million uninsured or the millions who have health care, but really can't afford what they've got.
To emphasize the point about economic security, the president regularly tells the story of his mother, who struggled to pay her health care bills as she was dying. When he's worried that he's gotten off-course, he's circled back to his main point: "Ultimately, the debate about reducing costs—and the larger debate about health care reform itself—is not just about numbers; it's not just about forms or systems; it's about our own lives and the lives of our loved ones."
Maybe the president's problem is not that he didn't link health care reform to personal security but that he did make the case and he's just not getting through. This is a bigger problem because it suggests even an improved message or greater presidential involvement or backing specific proposals will be only so effective. There's evidence for this in the most recent CBS/New York Times poll. Even after countless interviews, town halls, and speeches, 60 percent say they don't think the president has a clear plan (whether it's to reduce the deficit or provide health care security). Despite his repeated efforts to pitch reform on a personal level, 77 percent say reform would either hurt them or have no effect on their lives.
The message may not be getting through for a number of reasons. By letting Congress take the lead and fashion a bill, his remarks have been drowned out by the spectacle of the legislative sausage-making. He didn't emphasize until a recent course correction the other elements of reform that appealed to people's sense of security: the way they'd be allowed to keep coverage when they changed jobs and given access to coverage despite pre-existing conditions. The summer town hall/"death panel" sideshow has, with the aid of 24-hour cable news, warped the debate. Obama's political arm sent an e-mail Monday to supporters blaming the media for not fighting claims about death panels. The media might bear some responsibility, but the public was skeptical before death panels became a cable fascination.
These issues can be overcome once a final bill emerges from Congress and the president can defend a single piece of legislation. (So far, he's been forced to sell a product that hasn't arrived yet.) But other problems may not be so easily fixed. Obama's power of persuasion may just have definite limits. At a time when people have been through economic trauma and a lot of change (or, at least, the fear of change), he's offering them a new big serving of change. In an unpredictable world, how can he keep promises about such a vast new set of policies?
The good news for the president is that 82 percent of the country still thinks the health care system needs to be either fundamentally changed or rebuilt entirely. And they still favor many of the elements he supports—from a public option (60 percent support) to requiring insurance companies to cover those with pre-existing conditions (79 percent).
Obama and his aides are going to have to decide how persuasive the president can be, and where they draw that line will determine the next stage of the health care story. Does he continue working to educate people to build a political consensus, or does he take whatever deal is available now and focus his energy on selling that deal to the public? White House aides and allies suggest he'll take the latter route. In that case, his problem may not be the general public but his liberal base. If a final deal does not include a public option, many of Obama's supporters will be furious. He'll have to "finesse the issue," as one senior aide put it, by arguing that a partial deal is better than no deal at all and that reform now can be expanded in the future. For that debate, he might need a football helmet.