Health Care Reform Redux

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Now that the House has left for summer recess, with the Senate leaving in a week, it’s a perfect time to look back and see what may have gone wrong in the Democrats’ plan to pass a major health care reform package before this week had passed. Most people tend to focus on the policy and the intrigue of ‘the fight’, but I think the failure to pass this bill is more a tactical one rather than mistaken policy or lack of potential votes.

Polling on the issue has been fairly  consistent. A majority do want health care reform this year, but while a majority is willing to pay more in taxes for better coverage, they care more about lowering costs than expanding coverage. A large majority support a public option that competes with private insurance, but an even larger majority are actually satisfied with their current coverage. This creates a situation where people are wary that government coverage may lead to rationing and will lose the relatively free choice they currently enjoy in their health care options now.

Much of the debate has circled around how to try and pay for this health care reform, so it doesn’t lead to more debt. I suggested one way to help pay for some of it, but I am not aware of the idea of taxing the consumption of unhealthy things as a source of funding being discussed as an option (although polling shows the public supports the idea). The idea of taxing the wealthy is still popular and will probably be included in the final bill to pay for part of it. A big wrench was tossed in the gears when the CBO announced that the cost savings touted by Democratic leaders really didn’t exist.

Perhaps as much attention has been given to a coalition of conservative and moderate (or centrist if you prefer) democrats who hold the swing votes to push this piece of legislation over the hump into passage. They’ve been leveraging this situation to push for modifications that lowered costs and squeezed more savings from the system itself before adding taxes on the wealthy or taxing more high cost benefits. The latter idea has hit a brick wall, since some labor unions have extremely good benefit packages that they have negotiated for over the years that would fall into the category of taxable benefits in some of the proposals.

The tipping point for this legislation stands here, at the junction between the more liberal Democratic Party leadership, the so called Blue Dog Democrats and the independent and moderate Republican constituents they need to get reelected. If I had to point out one thing that has had the most detrimental effect on the march towards passage, it would be the misplaced attempted strong-arm tactics against these Democratic swing votes.

When confronted with a powerful enemy, do not fight them head on but try to find their weakest spot to initiate their collapse. This is the weak overcoming the strong.

-Sun Tzu, from The Thirty-Six Strategems

An illustrative example of this fell into our lap yesterday, with moderate Democrat Ben Nelson, of Nebraska (where I live), lambasting ads leveled at him by Howard Dean’s Democracy for America (DFA). I was pretty surprised at how poorly executed the ads are, but the same tired attacks are being leveled at Nelson, that are being leveled against other swing votes across the country, are what make the ads so ridiculous.

We begin with the perennial attack you can level at any politician regarding who donates to their campaigns. Pretending that you know that he’s doing what he’s doing because of who his donors are, rather than the distinct possibility that he’s doing it because many of his constituents (including myself) asking him to slow down passage of the bill, look for more cost savings and make sure we don’t rush this, is plain idiocy. Nobody can read his mind, and I’ve yet to see any evidence that the guy is any more corrupt than any other politician. I would be pushing for many of the same modifications if I was in the senate, and I (unfortunately) don’t get millions of dollars given to me each year by anyone.

Then there is the time pressure argument, that we need to pass this legislation now. I can’t disagree with this sentiment more. If anything we should slow down further still, with more and more coming out as to mistaken estimates of cost savings and details of proposals being made more clear. There is no artificial timetable you can set on something like this, it needs to take however long it takes to be reviewed in great detail.

Regardless of what you believe, this sort of push only works when you have a majority of the public with you. It would work if he was in a weak position, but he’s not. This is Sun Tzu 101 stuff here… you don’t mount a full frontal attack on an enemy in a fortified position unless you have vastly superior forces. Like it or not, the Blue Dogs have the high ground right now.

The groups that are pushing for this with these tactics need to look in the mirror to lay blame when they look back and wonder why they weren’t able to get some of the things they wanted when this finally moves to passage. A public plan pegged on Medicare, with that panel slowing the rate of cost growth, would have saved us an amazing amount of money over the years, and I think the Blue Dogs and Moderates would have been convinced to support that with more work on cost savings and less political pressure. The pressure from liberal groups force them to fight back very publicly, so they don’t look like they are towing the liberal line to the independent and moderate republican supporters they need to get reelected.

Sun Tzu would have advised these groups to use the same tactic that PHARMA used once they saw that a health care bill of some kind was going to pass whether they wanted it to or not. The choice was to go in early, get a seat at the table and get a better deal by offering concessions from the start, or fight a losing battle later on and get stuck with a much worse deal. These groups demonizing Blue Dogs and moderates are doing precisely opposite what they should have done. They should have realized the situation early and negotiated a way for them to show their constituents that they fought for cost savings, like the Medicare panel, which instead took months of fighting to accomplish.

Sun Tzu would have told these groups that they should ‘remove the firewood from under the pot’. Instead of fighting the Blue Dogs head on, they could have weakened their resistance by working with them from the start, rather than turning a soft ally into a potential enemy with these tactics.