The White House is pushing hard the meme that Americans’ disapproval for health care reform is purely based on their disgust with the process. While the process has been stomach-turning to watch, people also do actually hate many of the proposed policies within the bill. The White House seems incapable of acknowledging that the Senate bill they designed is something the American people do not want. They are blaming the messaging, but not the product. This is unfortunate because the only hope of making the bill more popular, and therefore creating the political space needed to pass reform, is to change the proposals to make the legislation more in line with what the American people want. No amount of creative messaging, no strong PR push alone can make the bill popular.
It is true that the bill contains some very popular provisions, but it also contains some incredibly unpopular provisions. Probably the two least popular provisions are the excise tax and individual mandate. The fact that both are extremely unpopular should come as no surprise to Obama. He won his campaign successfully running against both ideas. Why his team thought they should fight hard to include both ideas in the bill or why they thought adding two provision that Obama ran against would not kill popular support for reform is beyond me.
People also dislike the bill because they feel that many of the popular provisions promised by Obama were stolen from them. People really want a public option, a Medicare buy-in, and drug re-importation. Having these popular provisions removed from the bill by “process” while the unpopular ones stayed is what made the process unpopular. People were not upset simply because the process took a long time or was partisan. People are angry because the process was used by unprincipled senators to make the policies in the bill worse for regular Americans and more friendly to corporations.
Making the Bill Popular with Policy Changes
The Democrats do have the option to use reconciliation to try to make the bill more popular by making policy changes. The Democrats can completely drop the excise tax, which is a political death sentence, right now, and replace it with a more popular tax on the rich. There are many possible fixes to the individual mandate. The provisions could be dropped for now or replaced with an alternative like a back premium payment system, which should have a near identical effect. Having a public option makes the individual mandate much more palatable. Adding a public option and/or a Medicare buy-in would probably turn out to be very popular.
The Alternative: More Process and More of the Same Same
The alternative is to go through even more process, reconciliation, to pass the same very unpopular Senate bill with only minor changes. If you believe it is simply process that turned people off to health care, this will only make the bill more politically toxic. Spreading the meme that Americans were turned off by the process, and not the product, should make every Democrat extremely reluctant to move forward with health care reform.
On the other hand, if you believe, like I do, that people disliked the process because it resulted in unpopular policy changes, using reconciliation to add the public option and take out the excise tax should make reform more popular. If reconciliation could make reform more popular by making popular policy changes Democrats would have a reason to embrace it. I understand the White House is reluctant to acknowledge that they designed an inherently unpopular bill, but I don’t see how health care reform moves forward until they do and take steps to make the bill better with popular policy changes.