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February 06, 2007

But Fight For The Principles

A lot of interesting talk about whether candidates should release detailed policy proposals today. Putting aside professional desires -- what will I wonk at if not candidate white papers? -- I come down on the side of specificity, at least on the big, controversial, politically dangerous elements.

Put it this way: Every Democratic candidate elected promises to bring universal health care to the people. The party's ranks don't lack for generalities on the issue. But universal health care is a beast to get passed. Even more so if you've not built consensus for it in advance. A plan emanating out of Congress will be more, not less, vulnerable to industry evisceration, as its proponents will have less time to explain it before its detractors knock it down. In short, that's what happened with Hillarycare. Clinton, remember, did not bring out a terrifically detailed plan during the election. Instead, he convened, under Hillary's leadership, a sprawling web of advisors and experts and operatives to construct a comprehensive piece of legislation. I agree, of course, that Congress should've been more involved. But the end result was the same: Out came a bill that its proponents proved unable to positively explain before its enemies absolutely demonized it. They never had a chance. 1993 wasn't a year when Clinton could dominate the airwaves, and a health care bill, particularly one as big and comprehensive as theirs, must be repeatedly and effectively explained. They lacked the time and they lacked the visibility to do so.

Now take another template: What if a candidate ran largely on health care? Or on a tax reform plan? Let's use community rating. That's a specific policy portion of any good health care plan, and it's exactly the sort of thing that draws interest group fire. So one of the fights our hypothetical nominee picks, during the election, while she has media coverage, is community rating. "Insurance companies," she says, "cannot continue punishing the sick and the unlucky." And she starts the fight. She goes to war. She picks the battlefield. And let's say she wins the election. In that case, the mandate is there. Congress can work out the details, but that's going in the bill.

To some degree, the word "details" here is misleading. The important thing, which Mark actually preserves in his post, are the mechanisms, the non-negotiable elements, what I called the bottom-lines. Community rating. Purchasing alliances. Medicare enrollment. FDA reform. Things like that. They, not their specifics, are exactly what the industry will fight. And they are the fights progressives have to win. Whether you want to define the exact range of tax subsidies or the precise standards for acceptable plans is somewhat beside the point.

What you must do during an election is win the argument over the principles, the outline. With that battle won, you actually can turn it over to Congress and get a decent result. Without that mandate though, without proving the waters are safe, the legislature's natural risk aversion will kick in and Senator Max Baucus will craft you a perfectly useless set of tax subsidies. So stay vague, if you must, but pick the elemental battles. Not the ones specific to your plan, but those common to any plan you will accept. There's no better time to advocate for them, after all, then during an election, when your earned media is at its peak, your paid media is maxed out, and the landscape is too crowded for special interests to drown out your voice. But if you take the easy way out and just ask for universal insurance, well, you may get something that's technically universal, but you're not going to get anything this crowd of discussants will like. Unless you convince the electorate of the need for community rating and public insurance options and guaranteed issue and all the rest, you're not going to get Congress to sacrifice industry donations for any of them.

Crossposted to Tapped

February 6, 2007 in Health Care | Permalink

Comments

Edwards has upped the ante on health care.

What you say is true, Ezra. Each candidate has to weigh the advantage of building political capital for his more controversial programs against the risk of not getting into office at all. Being more specific on a controversial subject usually costs you more votes than it gains.

I don't think there was much chance of Hillary coming out with a plan as specific as Edwards', having a special liability in that area. Now she, and probably the others too, will have increased pressure to meet or beat Edwards' plan. Edwards, having come out first, now controls the ground. His plan includes the most sensible ideas, so other sensible proposals will be liable to accusations of copying Edwards, though Hillary may be able to claim some priority on some points--points that were unfortunately slapped down once already. So, even though it's risky (Harry and Louise may come out early), it does give him some advantages for now. In the general election it may be a liability, though, for Edwards or anyone who matches him.

Or the voters could actually like the specificity despite the criticisms and unfair attacks. How likely is that?

Posted by: Sanpete | Feb 6, 2007 10:49:54 PM

Your are right on spot Ezra for saying at minimum you must stake out the principles that are your bottom line (as you have done in an earlier but recent post), so that you can claim a mandate if you win.

Fuzzy words and fuzzy concepts are tuned out, as they should be after after the many electoral cycles when fuzzy things confused the voters (Joe Lieberman's approach to Iraq comes to mind when he was running as an independent against Lamont - and said he wanted the troops home quickly).

You may win being fuzzy, but the reality of enacting policies will cut you down later, since nothing concrete was ventured and therefor noting concrete was earned.

But on issues where the problems are confusing, and the answers are likely to be complex, even the princples thing may not be enough. Questions of how much it will cost, where will the money come from, and how am I as a voter affected (in my particular status category) will bring you down without more detail. Fear and doubt outweighs hope.

Edward's position paper comes close, but still leaves gaping holes - like what amount of taxes would be required at various levels of adjusted gross income.

So, a real concrete proposal, clearly labeled as one negotiable approach, and available on the net is probably needed for a issue that hits so close to home for almost all citizens, like health insurance.

But you can't campaign on the details, only the principles at best, or you will be bogged down. The details have to be referred to only as an exempler that is a place to start consensus building - and defended as just that and no more. "Here's one approach that can work, that I support, and that I see a place to start crafting legislation, working with others".

I also don't think anything can be won in the way of voter support (pre and post election) but a dry program proposal. They is going to require some good old fashioned populist campaigning to attack early and often the vested interests that raise their flag of opposition. Offense, not defense (weak or strong) is crucial. Hillary's proposal lost momentum because they couldn't explain the program in an elevator pitch and they were not willing to take on the entrenched forces (that they wanted as allies, but screwed her early and often). This is what makes progressives seem like wimps. She got rolled.

Posted by: JimPortlandOR | Feb 7, 2007 2:13:36 AM

There are to me two stances here that are worth exploring:

1) The Candidate: For the Candidate, this discussion is a tactical one about election. If publishing detailed health care plans makes people less likely to think "you'd be good to have a beer with" then, in the end, it's not a winner for the Candidate. Likewise, if sticking your neck out on details leaves you open to devastating attacks, then it's not the winner.

2) The Movement: For the Movement, every articulation of policy is an action related to an "Overton Window."

a) Frankly, if there's one good thing about HilaryCare, it's that it made the current mood and discussion on healthcare possible. Before that, the CW was, you don't make grand health plans. True, it didn't pass, but HRC still has a chance to get elected. Some of the sting was drawn.

b) The more detailed plans produced that produce support for all the principles Ezra mentions, the more those principles are mainstreamed. Every time a "contenduh" has a plan with "community rating" (for example) in it, "community rating" takes a step closer to being in whatever Congress pig-breakfasts together on health care next time around.

For the Movement, every policy document produced that gets serious promotion pushes the Overton Window a lot further than an awful lot of other work can. Even if the candidate loses, it can still influence the "national conversation" particularly if the Dems hold Congress anyway...

Half the neo-liberal reforms were started not by GWB, but by Newt's Congress. Clinton just couldn't fight them all off.

Of course, the ideal thing is to strike a balance. Win the election and consolidate the principles...

Posted by: Meh | Feb 7, 2007 8:01:11 AM

Slightly OT--but can you give (or link to) an argument as to why community rating should not include age as an acceptable rating factor?

Posted by: SamChevre | Feb 7, 2007 9:56:02 AM

What if a candidate ran largely on health care?

You mean like Dean did? If that were to happen, the result would be the same thing that happened to Dean: the media will ignore policy stuff and concentrate on horserace and inside baseball stories.

Did you hear anything in the media this week about Edwards' policy proposals? Nope. All you heard about was the blogger controversy. And that's the way it's going to be for the next (checks calender) 21 months.

Posted by: Newport 9 | Feb 9, 2007 1:16:47 AM

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Posted by: judy | Sep 26, 2007 10:54:15 PM

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