The Wrong Tree

Blue Dogs and Other Moderate Democrats Are Barking Up One Regarding a “Public Option”

In the past two weeks, Democratic leaders in both the House and Senate have issued their respective versions of a healthcare reform bill. Surprisingly, both bills ended up including a “public option.” In the House, this consists of a new government-regulated insurance “exchange,” where private companies would sell policies in competition with the government. The Senate bill contains a much weaker public option, with states allowed to exempt themselves if desired.

I say “surprisingly” because two competing camps have been squeezing the bills’ authors from opposite directions for a long time on this issue. Democratic liberals are adamant that an aggressive public option is essential to achieving universal coverage and controlling costs. Democrats that are more conservative insist voting for any public option would cost them re-election, with constituents punishing them over profligate government spending and promoting socialized medicine.

In the House, the main objectors are Southern Blue Dog Democrats. In the Senate, it is a group of twenty or so moderates.

Until recently, conventional wisdom assumed the concerns of moderates would hold sway. The argument ran that liberals were desperate to pass some form – any form – of healthcare reform whereas moderates would be only too happy to walk away from anything that struck them as politically toxic.

Informal vote counting suggests that, particularly in the Senate, healthcare reform proponents still lack the necessary votes to pass any bill with a public option. Does this mean Democrats are doomed to drop it before the two chambers bring their respective bills to a floor vote, let alone then attempt reconciling them in joint committee?

I do not think it necessarily does. However, the argument Democratic leaders need to apply to recalcitrant moderates is not cajoling over Party loyalty or impassioned moral pleas. The factor motivating moderates on this topic is fear. The key is to create doubt in their minds about what they ought to fear most.

The prevailing notion is that any House Blue Dog or Senate moderate will be crucified by Republican opponents over their “yes” vote on healthcare reform in 2010 or thereafter.

For House Blue Dogs in particular, the assumption that a public option is a deal-breaker may be a non sequitur. The main objection by Blue Dogs serving on the House committees writing healthcare legislation back in the summer was that bills contained insufficient reforms to control healthcare system costs. They also wanted a broader exemption for small businesses that did not have to pay penalties for failing to offer healthcare coverage to employees and fixing what they see as inequities in the current system for reimbursing rural doctors and hospitals.

In September, Democratic Representative Stephanie Sandlin of South Dakota, the leader of the Blue Dogs, said she still believed that a majority of the group would ultimately support healthcare reform “if it was reasonable and represented a consensus Democratic view.” When Speaker Pelosi released her bill, Blue Dog did not damn the public option but rather withheld support waiting to see if the Congressional Budget Office rated it as budget neutral or better.

It is true that President Obama campaigned on the promise of healthcare reform but then so did his Republican rival. So did his challengers in the Democratic primary. So did virtually every Democratic candidate in 2008. After the election, voters understood healthcare reform was not only a top priority for the Obama Administration but for the new Democratic majority session of Congress as well.

At the same time, Congressional Republicans decided to make opposition to any form of healthcare reform favored by Obama and liberal Democrats as the cornerstone of their ideological stance as well as their platform for 2010. Many Democrats hoped that Obama’s popularity would overcome voter objections. Although the Administration has effectively countered some of the harshest criticisms levied by Republicans, the President has been unable to shift public opinion on this topic.

This makes sense to me and I believe Democratic reliance on Obama to carry the day is not only overestimated but also essentially misplaced.

Much has been made of a recent Washington Post poll that shows public support for a government-funded entity offering health insurance at fifty-seven percent. Another Post poll, this time in combination with ABC News, places support as high as sixty-two percent. However, these same surveys show that if a public option caused employers to drop their current offerings and/or forced private insurance companies out of business, support for a government-funded entity plunges to thirty-seven percent.

The most recent Rasmussen poll shows that only forty-five percent of those surveyed support the current healthcare reform bills as written – or, more precisely, as best understood – and forty-nine percent would rather see no healthcare reform passed this year than the current bills become law. In spite of this, the same survey found fifty-four percent said the current healthcare system needs some major changes and sixty-one percent think it is important for Congress to pass some reforms.

Similarly, a new USA Today/Gallup poll finds that despite concerns about its high costs and the implications for the country, fifty-six percent favor passage of a healthcare reform bill.

Rasmussen looks at all these conflicting results and concludes, “Voters do not have firm opinions” on the public option or healthcare reform in general. I think it suggests that voters are every bit as much of two minds on this topic as are Democratic lawmakers. They support the idea in the abstract but easily give in to hesitation over specific proposals for reasons ranging from legitimate concerns to wild rumors to deliberate fear mongering.

Moderate Democrats are correct to believe that Republican opponents and some voters may hold a “yes” vote that turns healthcare reform into law against them. However, they are naïve in the extreme if they think a “no” vote that prevents healthcare reform’s passage will cause this issue to go away by next November. They are outright delusional if they think Republicans will not attempt to use healthcare reform as weapon against them next year.

It seems to me that voters are less likely to hold Democratic incumbents responsible for passage of legislation they favored in the abstract but retain concerns about in the concrete, especially when they will not yet have felt the impact of healthcare reform’s passage in 2010. The alternative for Democratic incumbents will be to face Republican charges that their Party first created bad legislation and then failed to solve any significant problems. This is exactly the condemnation that Democrats used to win against Republican in moderate to conservative districts in recent elections.

It is also notable that while trust for either Party remains at all-time lows among voters, most incumbents are traditionally exempted from these general suspicions by their own constituents. Voters nervous over healthcare reform and government takeovers are much more likely to be reassured by the fact that their local Representative or Senator – “one of us” – believed in it enough to vote for it than by the fact the President Obama wanted/supported it.

By voting for healthcare reform, Democratic incumbents make the race about them and their actions. Voting against it makes the election into a referendum over the Democratic Party and its ideological direction. I suspect Republicans will find the later much easier to demonize.

I suppose the correct metaphor for almost any Democratic lawmaker regarding healthcare reform is to say they find themselves between a rock and a hard place. However, House Blue Dogs and Senate moderates who find themselves so squeezed may want to consider the problem began for these particular dogs when they began barking up the wrong tree. Embracing the public option carries its share of risks but also holds potential rewards. Rejecting it is simply an admission that their Party of choice does not know how to govern – there is nothing to be gained in that for any Democrat.