Quieting the health circus

The ’70s Scottish folk/rock group Stealers Wheel had a huge hit that has since been covered by half a dozen rock, folk and country artists. “Stuck in the Middle with You” could be the White House theme song as the battle over healthcare reform devolves into rigid partisan posturing on both ends of the political spectrum. “Clowns to the left of me, jokers to the right/ Here I am, stuck in the middle with you,” songwriter Joe Egan sang in the band’s only big hit.

The White House is in much the same position. August belonged to the “jokers,” with their town hall outbursts and charges of “death panels,” coverage for illegal immigrants and socialized medicine. The liberal wing of the Democratic Party has been just as strident on the public option. The fighting between the two, fed by the 24-hour yammering of cable television hosts — both clowns and jokers — has left many Americans confused and uncertain about just what healthcare reform will do to them. The White House has, wisely but belatedly, begun trying to explain what it will do for them. In the weeks ahead the distinction between to and for may determine the outcome of healthcare reform in 2009.

The president needs the middle — especially the middle class — to win. Democrats need middle-class voters to hold control of Congress, and so do Republicans who want to wrest that power away. The big-picture view argues that even the left wing of the Democratic Party will eventually concede that no liberal will lose his or her seat if there is not a public option in the final healthcare reform bill — but a lot of vulnerable Blue Dogs will lose their seats if there is a public option and they vote for it. They’ll do the math, then compromise.

Republicans, on the other hand, gain most from a middle anxious about getting stuck with the bill for healthcare reform. Fear and greed are the drivers of opinion that will return Republicans to power — fear over what middle-class families might lose in coverage and an unwillingness to pay for reform that seems only to help others.

With the Senate Finance Committee bill headed for markup next week, the flames of fear will also be fanned by any number of special constituencies. Whether the final price tag is $900 billion, $1 trillion or some other number, it is going to cost someone a lot of money. Medical device makers have launched a massive lobbying effort to make the case that consumers “will get walloped upside the head” with increased costs from a proposed $4 billion in fees on their products. Health insurers, already committed to killing the public option, are stressing over $6 billion in fees and a 35 percent tax on so-called Cadillac plans that, combined, could cost the industry as much as $400 billion. Clinical labs will fight $750 million in annual fees. Business groups argue all these costs will get passed on to their members and, eventually, to customers. As the debate centers on who will pay for whatever is in the final bill, lobbyists will be swarming over Capitol Hill and well over a hundred million dollars will be spent on advertising geared toward making the middle class nervous about the costs of reform.

To prevail, the White House and proponents of reform must shift the focus to what reforms will do for the middle class. The president seems to have gotten that message. In his speech to the AFL-CIO’s annual convention this week, he hammered home his point that reforming health insurance was fundamental to revitalizing the middle class. “We are going to grow our middle class with policies that benefit you, the American worker,” he said to thunderous applause.

Reining in insurance companies, guaranteeing security and stability in coverage and driving down costs are the messages the middle class wants to hear. If that includes some demonizing of health insurers and other industries that have grown fat and happy in the healthcare market — so be it. The middle class is looking for someone to be on their side right now. Candidate Obama convinced them he was; now President Obama needs to make the case that they’re better off sticking with him than with the “clowns” or “jokers.” Inspirational as POTUS can be, he needs help from his supporters with that message. Progressives should worry less about insisting on a public option and spend more time and money telling the middle class what health insurance reform will do for them.

Goddard is a founding partner of political consultants Goddard Claussen.
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