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November 30, 2007

Ezra's Commenters Are Smarter Than I: Politics of Man Dates

by Nicholas Beaudrot of Electoral Math

Reader 'Christmas' on the optics of enforcing an individual mandate:

"And I've said this before over at Matt Yglesias's place, but it's pretty obvious to me that the top Democrats - along with pundits like Ezra Klein - have really learned the wrong lesson from '94. Clinton's plan didn't just fail because it would've changed people's coverage; it failed because it was very complex and hard to explain, and was easily portrayed as dangerously impenetrable and convoluted."

Setting aside Christmas' preference for single-payer (and a pony!), I'm not so sure. People understand how an individual mandate would work. And on the campaign trail, Democrats make tremendous efforts to have health care policies that map to straightforward sound bites ("anyone who likes their current health insurance can keep it", "every American should have the same health care that Congress gets", "we should mandate health insurance, the way we do today with car insurance, but help people who have trouble affording it", etc.).

The trouble comes when you start getting into the details; but of course, that would happen with any massive health care reform. On the one hand, we can just sweep the nitty-gritty details under the rug. On the other, we can use the competition of the primary election as a chance to come up with enforcement mechanisms that the public will find palatable, which will help smooth the way for passing the bill when the time comes. This all looks like real eat-your-vegetables stuff now, but in the long run it will be helpful.

I hope.

November 30, 2007 | Permalink

Comments

Barney Frank has a mandate

Posted by: El viajero | Nov 30, 2007 2:33:23 PM

On the other, we can use the competition of the primary election as a chance to come up with enforcement mechanisms that the public will find palatable, which will help smooth the way for passing the bill when the time comes.

IF we get the White House. I suspect too much talk of IRS enforcers doesn't help our chances. I think Hillary Clinton's position on details -- she'll leave that to negotiations with Congress -- is perfectly reasonable, justifiable, and politically astute.

Posted by: Jasper | Nov 30, 2007 2:34:51 PM

People understand how an individual mandate would work.

This is the problem. People understand "mandates" as "punishing people for not buying health care." It's utterly bizarre to me that this looks like better optics to you than trying to sell single-payer - which, as I've said before, seems to be deemed impossible to sell only because no major candidate has tried to sell it. And here's the real kicker: we've already got a working version of single-payer health care that lots and lots of people like in the United States - that is, Medicare. What we don't have is a working version of individual mandate health care.

Posted by: Christmas | Nov 30, 2007 2:37:39 PM

The solution is simple-- don't get bogged down in the minute. Keep the themes of why you are doing the plan at the emotional level, not the intellectual. Once you get into the intellectual, in this case, you are playing into the rightwingers hand. Why? Because Americans feel this viscerally, and the details do not much matter, except to wonks who want to argue with every nutter who has an opinion about some tiny aspect of the overall goal. I know is against your nature, but it's really the key.

Posted by: akaison | Nov 30, 2007 2:37:42 PM

The solution is simple-- don't get bogged down in the minute.

Easier said than done. Any plan that gets proposed is going to be attacked, and then defended, on the details. If you think that a general election campaign - much less an actual legislative fight - over national health insurance can take place without exhaustive rehashes, debates, and misconstruals of what's actually in your health care plan, you're awfully naive (and were apparently sleeping through the mid-nineties). The simpler any given plan is to explain, the easier it is - which has been one of my biggest problems with the patchwork nature of the plans we're seeing here. Throw in mandates and threats of wage garnishment and you're going to scare lots of people off.

Posted by: Christmas | Nov 30, 2007 2:44:52 PM

anyone who likes their current health insurance can keep it

Ahhh--no--no one is proposing that to my knowledge. Community rating means everyone who has underwritten health insurance today pays more--often, several times more--for their coverage.

If you want easy to explain and sell, have "very-limited single-payer." Here's the list of procedures/drugs/etc that the government will cover; any doctor who'll see you, the government will reimburse for these things. Base it on cost-benefit,a dn start with "the government spends exactly what it does today on health care and insurance." If it works, it's easy to expand.

Posted by: SamChevre | Nov 30, 2007 2:51:29 PM

"which will help smooth the way for passing the bill when the time comes."

Exactamundo. Put out there and defend the hard parts before the election, not after.

Winning an election on details X and Y make getting a plan with details X and Y passed into law significantly easier.

Stand up for what you believe, and get a different kind of "mandate" for that from the American electorate.

Posted by: Petey | Nov 30, 2007 2:54:53 PM

Jasper wrote:
I think Hillary Clinton's position on details -- she'll leave that to negotiations with Congress -- is perfectly reasonable, justifiable, and politically astute.
It would have been indeed - right up until recently when two thiongs happenned.

#1: Edwards spelled it out. Like it or not, she is going to have to explain why her mechanism is different from his plan or accept being lumped in with his.
#2: She decided to go after Obama hard for not having mandates in his plan. By doing so, she is forcing him to point out the problems with mandates - and he is going to do so in terms that are going to hurt politically.

Posted by: SKI | Nov 30, 2007 2:59:11 PM

I'm with Christmas. People don't much like having swords hanging over their heads -- sign up, on your own initiative, or we'll get you! -- especially when we don't feel like access to health insurance is actually much in our control.

Better to say:
-- Every American is automatically signed up. Your card will be in the mail.

You have no idea how SIMPLE it is to get health care in Canada. You walk in, show a card, and they treat you.

Posted by: rm | Nov 30, 2007 3:13:43 PM

The vast majority of voters are already insured, whether they're happy or not with that insurance. That's most of the voting public who are guaranteed not to be scared by the thought that the government will force them to buy insurance.

Posted by: Steve | Nov 30, 2007 3:15:47 PM

No , I wasn't sleeping through the 90s or this decade, but apparently like the top Democrats you misunderstand what happened. It was a war over in whom do you trust, not in whom has the best policy minute.

Posted by: akaison | Nov 30, 2007 3:19:35 PM

concretely if the democrats really wanted to win - simple emotional phrases and narratives that are repeatable should be the first step befoer any policy is ever stated.

Posted by: akaison | Nov 30, 2007 3:20:43 PM

It's utterly bizarre to me that this looks like better optics to you than trying to sell single-payer - which, as I've said before, seems to be deemed impossible to sell only because no major candidate has tried to sell it.

No, single payer seems to be impossible to sell because millions of Americans -- perhaps up to 80% of those with private insurance -- don't want to be enrolled in a government-run health insurance plan like Medicare. I happen to think they're misguided, but that's another story.

Posted by: Jasper | Nov 30, 2007 3:32:39 PM

What akaison said, a million times:

simple emotional phrases and narratives that are repeatable should be the first step before any policy is ever stated

simple emotional phrases and narratives that are repeatable should be the first step before any policy is ever stated

simple emotional phrases and narratives that are repeatable should be the first step before any policy is ever stated

In the general, we have seen over and over that voters will vote for the simple, emotional appeal to eat shit over the complex, nuanced, wonkish discussion of ice cream. How much better to craft a simple, emotional appeal to eat ice cream. Yet Democrats don't do it. Arg. A million times arg.

The meta message is

-- WE WILL SOLVE THE PROBLEM --

and it has to sound SIMPLE.

Posted by: rm | Nov 30, 2007 3:42:57 PM

"and it has to sound SIMPLE."

Many don't understand how to reduce the complex to the simple. I'm a lawyer transitioning into media. I can tell you that the former is about going into the minute of each detail and defining every term and parsing every phrase until nothing is left but the ambiguities that you intend, and the later is about finding the elegant emotional solution that has the same impact without you having to go into the detail. The best example I can give is how many details in a scene from shot to shot can be inconsistent, and yet if you hook the audience with the emotions, they don't notice it. In my first short film, I had a scene where I go from an table with food in the middle of shot to the next shot of the same scene without the foot on the table to the next where it magically appears again. It's been in a couple of festivals. No one has ever noticed. Why? Because of the impact of how we human's really process information. It's not a computer collecting data. It's like an animal with millions of years of evolution for reducing information and our environment to small enough packets of understandable information. What do you want the voters to understand and feel about your plan? that's where you start. I understood wht i wanted my audience to feel, and they ignored the rest.

Posted by: akaison | Nov 30, 2007 3:53:02 PM

by the way , the food covering the table is in the foreground. the discovery that the audience would completely ignore this as my editor argued was a big surprise to my liberal lawyer brain.

Posted by: akaison | Nov 30, 2007 3:55:45 PM

I think akaison's right that there has to be an emotional appeal... but the devil still lurks in the details. If the details are not easily understood, then you've still got a problem (and it may be, as akaison calls it, a matter of trust, but I think there's more to it than that). I think a lot of Democrats are convinced that what's gone wrong for Democrats, when conservatives attack, is that we don't know how to fight back, and I'm not sure that's the right lesson, or the only one. And I don't think a soundbite, or a carefully crafted emotionally appealing storyline, or a "never mind the details, it will all be fine, trust us" approach will be the answer that fixes that problem.

And one other thing to consider, still, is that with health care, we still haven't explained the problem well, which is why many solutions - including mandates - come to people in a vacuum without clear understanding of why they're needed. I suppose that's the question of "framing" as some like to call it, though I think it's simply defining the problem correctly and then explaining how the solution fits the problem. As long as Republicans can fight health care proposals with a "there's no problem, that's why we don't need any of this" answer, we're a little stuck; and that problem is not about how you make mandates sound appealing (and really, I think that's possible, if we make a mandate less about punitive action than about a positive "we all need to participate for this to succeed" approach). We need to remember that many voters, as well as many non-participating Americans, haven't gotten all the information that people who, say, read Ezra regularly get. People's experience and understanding of the health care system is largely anecdotal, and for healthy people with insurance, those anecdotes usually tell them that things are pretty much okay for them, and maybe bad for others. That doesn't help make mandates, or a lot of other elements of universal coverage, look better. Getting out more facts, helping people to see the larger picture of healthcare in this country... these things would go a long way to selling the solutions we propose. And absent it, I think things are very vulnerable, and I'm not sure even the best constructed emotional appeal can fix it.

Posted by: weboy | Nov 30, 2007 4:04:06 PM

This is the problem. People understand "mandates" as "punishing people for not buying health care." It's utterly bizarre to me that this looks like better optics to you than trying to sell single-payer - which, as I've said before, seems to be deemed impossible to sell only because no major candidate has tried to sell it. And here's the real kicker: we've already got a working version of single-payer health care that lots and lots of people like in the United States - that is, Medicare. What we don't have is a working version of individual mandate health care.

Not only that, but it is morally wrong to throw someone in jail or fine them because they can't afford something. What ticks me off about the individual mandate thing is that it is exactly how a Republican (e.g., John Chafee, Mitt Romney, Arnold Schwarzenegger) would solve the health care crisis-- by making sure that the burden will be born by those who least able to afford to bear it.

And the other thing about it is that it isn't like insurance companies provide any important function in the provision of medical care. They are nothing more than cream-skimming middlemen.

It isn't a matter of "wanting a pony", it is that the only way to ensure that the costs get cut and the money goes into medical care is to eliminate the middleman. And the only moral way to provide health care to the uninsured is to provide it to them, not punish them and turn them into criminals for not buying something they can't afford.

Posted by: Dilan Esper | Nov 30, 2007 4:04:07 PM

weboy- that may all be true, but we wouldn't know since it's never been tried. i am for innovation rather than caution.

Posted by: akaison | Nov 30, 2007 4:06:12 PM

I'm all for innovation too, akaison, but people fear change. It's how you address that fear that we're really talking about - and I think you have to fight fear with facts. Is all I'm sayin'...

Posted by: weboy | Nov 30, 2007 4:11:41 PM

you don't fight fear with facts. you fight fear with desire.

Posted by: akaison | Nov 30, 2007 4:22:34 PM

Keep the themes of why you are doing the plan at the emotional level, not the intellectual.

The usual librul playbook. When you can't dazzle 'em with your brilliance....

Posted by: El viajero | Nov 30, 2007 4:30:57 PM

"When you can't dazzle 'em with your brilliance...."

At least there is some brilliance to dazzle them with. the right's fetish for the market as God is about as brilliant as the street preacher saying we are all going to hell because the bible says so.

Posted by: akaison | Nov 30, 2007 4:39:03 PM

Christmas,

This is the problem. People understand "mandates" as "punishing people for not buying health care." It's utterly bizarre to me that this looks like better optics to you than trying to sell single-payer - which, as I've said before, seems to be deemed impossible to sell only because no major candidate has tried to sell it.

Hard to believe anyone on the left is still pushing this nonsense about single-payer. It's dead. It's an ex-parrot. It has ceased to be. The reason no major candidate has tried to sell it is because they don't want it and they know the American people won't support it. Single-payer was rejected by popular vote by a 2-to-1 margin in Oregon and California, two of the bluest states in the country, and yet you still believe it has some realistic chance in the country as a whole. You're living in a fantasy world.

And here's the real kicker: we've already got a working version of single-payer health care that lots and lots of people like in the United States - that is, Medicare.

Yes, we have a hugely bloated, wasteful and inefficient single-payer system for the elderly that will be bankrupt in about a decade, and is already failing. Many elderly people have to buy private insurance or spend hundreds of dollars a month out of pocket to buy prescription drugs not covered by Medicare. And the only reason Medicare was politically feasible in the first place is because it covers only a subpopulation that is at special risk of health problems (the elderly) and that has no other reasonable means of obtaining health insurance (unlike Americans of working age, the vast majority of whom receive health insurance through their employer, or have an income from working that they can use to purchase health insurance themselves).

Posted by: JasonR | Nov 30, 2007 4:48:22 PM

as if on cue paranoid Jason shows up

Posted by: akaison | Nov 30, 2007 4:52:08 PM

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