This, I am coming to believe, should be our message right now regarding health care reform:
Democrats want to impose a new tax.
Republicans want that new tax to be even higher.
I don't know if it's catchy enough, but it has the virtue of being true.
Does it make sense to campaign on the idea that we're raising people's taxes?
I think it does. "Health insurance insecurity" -- caused by rescission, lack of portability, pre-existing condition clauses, rate hikes, and employers dropping insurance benefits -- is a huge problem that requires a political solution.
Part of that solution is a universal mandate to expand the insurance pool. That is: a tax.
Given that there will be this new tax, the question is: how do we keep it, as much as possible, from harming people?
That is, how do we keep this new tax as low as possible?
That's where we win this argument.
I have argued before we make a mistake when we try to sell people on the public option for its own sake. It sounds like another "big government" program. Instead, the public option should be presented as a solution -- perhaps even, in some respects, a reluctant solution -- to a problem that the public thinks MUST be solved.
Presentation of our position on health care should proceed largely along the lines of Obama's speech, but with slightly different emphasis:
1. We need to make the case that there is a need for change.
Those of us who have been reading nyceve's diaries for years now many lose sight of how much of this information the public does not know. My only criticism of Obama's speech in this respect is that the "horror show" it presented was a bit limited, a bit perfunctory. Obama was "touching the bases" well enough, but the question is whether the true horror of our status quo came through. People need to be -- and can be -- horrified enough by where we have been, where we are, and where we are headed to be willing to do that most "unAmerican" of all things: support a new tax.
The status quo is horrible. We can convince people of this. But if we undersell what we're doing in response to it, we allow the Republicans to beat us. We want the public to be horrified by the solution as well as by the problem. So let's call the solution what it is:
2. Solving this problem requires a universal mandate that people by insurance or face a steep penalty; in other words, it requires a new tax.
"A new tax." Have you heard people describe the universal mandate that way? Isn't it strange that Republicans haven't? Well, no -- they don't do this because they like the universal mandate: it gives money to their donors.
People ARE NOT GOING TO LIKE the idea that we're imposing a new tax. It's practically a spinal reflect, more than 30 years after California passed Prop 13. They're not going to like it -- but, if convinced of the urgency of the problem, they may accept it.
The fact that we are imposing a new tax, particularly on the young who would prefer to play the odds and go without insurance, creates a new political opportunity, though. This is where we win.
3. Here is how we Democrats want to keep this new tax as small as possible.
I don't think that I'll have to work hard to convince you that this is good PR and good politics. So instead I want to convince you of something more fundamental than that: this statement is true. This is exactly what we are doing.
We know that imposing a universal mandate without a public option is a terrible move for the Democratic Party. Why? Because it's imposing a new tax on predominantly young voters, Obama's base, that they will hate. As Paul Krugman described it:
What worries me is not so much that the backlash would stop reform from passing, as that it would store up trouble for the not-too-distant future. Imagine that reform passes, but that premiums shoot up (or even keep rising at the rates of the past decade.) Then you could all too easily have many people blaming Obama et al for forcing them into this increasingly unaffordable system.
We don't want to do that. But if we have to do it by imposing a universal mandate -- and most wings of both major parties, with the major exception of single-payer promoting Democrats, agree that we do -- at least we want to make it the least burdensome tax possible.
THAT is why we favor the public option! It will help keep costs low for everyone.
Now, Obama has said that he's open to alternatives to the public option, and yesterday I provided another tax-limiting plan that is even more insidious because it's even more clear:
Contract the service out to private insurers, but only reimburse them for the actual narrow cost of the service.
In other words, we adopt a reimbursement scheme that looks a lot like Medicare. Medicare keeps cost low by negotiating arrangements with providers. This would be different in that health insurers would have to participate -- or else, and I'd write this directly into the legislation, people will be allowed to buy directly into Medicare.
As I said yesterday, look at what this does to the debate. Now the question is now "should we have a public option?", but "should people be forced to pay profits, as well as cash for actual value, to medical insurers?"
WE are then the party of KEEPING TAXES LOW.
THEY -- and the Blue Dogs and ConservaDems who might as well in this respect be Republicans -- are the party of RAISING TAXES HIGHER SO THAT THE EXTRA MONEY CAN BE GIVEN TO HEALTH INSURERS.
I don't know about you, but as we head into the endgame of the health insurance reform drive, that is EXACTLY the political battle that I would like to fight!
So let's go there. The first step is to say this:
The Universal Mandate is a new tax on consumers to solve a serious problem.
So what are we going to do to keep that tax as small as possible?