Which are you more afraid of: the president or the insurance industry? This is the key question of Thursday's White House health care summit. There may be moments when it will seem like both sides are debating tax credits. But it's really this question they'll be debating. You can switch to the women's curling semifinal without fear; Washington's leaders will be fighting over the same territory when you switch back. In fact, whether health care reform passes or not, this debate will go on for the rest of this election year.
If you are afraid of President Obama and congressional Democrats, then you will see this final push for health care reform as a scheme to bankrupt the country and ruin your current health care and as proof of a government-knows-best approach that will slowly erode personal freedoms. If you are afraid of the insurance industry, you'll see the Republican obstructionism in the face of rising premiums and inflation as an unconscionable abandonment of those who can't afford coverage now and those middle-class families who soon won't be able to.
The half-day event is supposed to be a discussion. But the pregame posturing suggests it's more likely to resemble a genuine exchange of ideas about as closely as, say, a presidential debate.
The president offered his case in his Sunday radio address. "The other week, men and women across California opened up their mailboxes to find a letter from Anthem Blue Cross. The news inside was jaw-dropping. Anthem was alerting almost a million of its customers that it would be raising premiums by an average of 25 percent, with about a quarter of folks likely to see their rates go up by anywhere from 35 to 39 percent." He argued that, unchecked, insurance companies would raise premiums that would cripple middle-class families and small businesses.
Monday, Obama presented a plan that included measures intended to keep insurance companies from raising rates too high. Republicans responded by denouncing it almost immediately. Their main argument didn't come from the Heritage Foundation or Hoover Institution, but from public opinion polls. Minority Leader John Boehner said the president's plan was based on "a partisan bill the American people have already rejected." In the Senate, Mitch McConnell accused the administration of "completely ignoring what Americans across the country have been saying." John Cornyn said the plan was based on one that had already been "overwhelmingly rejected by the American people."
Politicians claim to ignore the polls. Yet they know citing public opinion is powerful in these kinds of debates: It shows that the politician making the charge is in touch with the wisdom of the voters. And it further suggests that his opponent is not only out of touch, but is also actively ignoring the good people of his home district. A politician trying to refute this line of attack must do so carefully or risk looking like he thinks the noble voters are stupid.
Sometimes public opinion is in line with policy arguments. Sometimes it is a substitute for them. Last week, during the one-year anniversary of the stimulus bill, Republicans cited as proof the program had failed to create jobs a CBS poll showing only 6 percent of the American people said it had worked. (This kind of thing must make them start drinking early at the Bureau of Labor Statistics.)
To refute these charges, Obama will offer his own kind of populist stance. He'll have to ignore the arguments about what the polls show—that kind of debate only leads to a numbing discussion of polling minutia that means nothing to regular people. Instead he'll focus on another set of figures—and that's where the insurance companies come in. The premium-increase figures may be a big enough number to shock viewers into wondering why Republicans claim to speak for the people but cite opinion polls rather than joining with the president to drive down premium costs.
If Republicans point out that Obama's insurance horror stories apply to only 7 percent of the insurance market, the president and Democrats will use that to position their opponents as defenders of the insurance industry. It's a part of a longer-term strategy in which Obama and his allies will offer regulation to protect people from any corporate entity deemed dangerous. "Anything that forces Republicans to defend insurance companies, Wall Street, drug companies, etc., is a win for us," said one strategist involved in the 2010 races. It's a twist on Obama's oft-stated goal of bringing about change. With this strategy, he is not an agent of positive change, but a guardian against unwanted change.
Obama has two audiences Thursday. He needs to convince the public that reform is necessary and that Republicans don't have a plan. He also needs to convince House and Senate Democrats that they can win this argument in the public square. The central argument White House officials and their allies make to nervous Democrats is that the public has reacted negatively to the political process but not the underlying measures. Once a bill is passed, the public will react favorably to the substance of the new law. (By holding the summit, Obama hopes to replace Congress as the public face of reform. It's not the first time he's tried.)
Rather than making the debate a referendum on the messy congressional process, which aides the party out of power, Democrats want to make the debate about whether Republicans choose to stand with middle-class voters or with insurance companies. In recent weeks, Democrats have benefited by debate over the stimulus bill, as much of the GOP opposition has appeared political rather than principled. They hope to make the same case with health care.
In a time when analogies to the Clinton years seem to abound, some Democrats hope that on Thursday the president creates a tipping-point moment in which GOP obstructionism is so evident, it rivals the 1995 GOP government shutdown that wound up favoring Bill Clinton. (That's a stretch. No one is losing services in a way they can immediately recognize, as they did during the Gingrich shutdown. And there is no equivalent of Gingrich to get grumpy about being seated too far back on Air Force One.)
This will be a tough balancing act for Obama. He will have to be political without seeming to be if he wants to create the kind of comparison that puts Republicans on the defensive. He'll have to retain a bipartisan posture to show that he is not the liberal zealot of the GOP caricature. Yet he'll also have to draw bright partisan lines by pressing Republicans on their plans. This is a president, remember, who called for politicians to work together in his State of the Union address just days after campaigning against future Sen. Scott Brown by arguing that Brown was a captive of the insurance companies and banks.
Obama might seek the counsel of his White House ushers, who are highly skilled at managing White House functions. When they want to nudge guests toward the exit, doors start to shut and little velvet ropes start to appear. For guests who don't get the hint, the ushers smile pleasantly and nod. And then, if they must, they put a comforting hand on you to guide you to your destination. So the president must do Thursday: Be kind and hospitable to his guests while at the same time putting them into a corner.
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