Time Running Out for Health Care

When Republican rallies began to get out of hand during the presidential race last year, responsible voices spoke up, including John McCain, whose running mate was egging on the fringe right. The grievances then centered on Barack Obama "palling around with terrorists" and wanting to tax poor Joe the Plumber. Now the conservative faithful are claiming that our president will heartlessly euthanize your grandmother, tax you up the kazoo, and take away your choice of doctor. And this time there are no responsible Republican voices calling for a halt to the mob tactics disrupting Democratic town meetings around the country.

There's plenty of evidence that the seemingly spontaneous eruptions are orchestrated by conservative interest groups in Washington, in the same way that the antitax tea parties were made to seem like a grassroots uprising earlier this year. The public relations and lobbying firms that specialize in generating the kind of public outcry we're seeing have a name for it; they call it AstroTurf. And it works, attracting media coverage disproportionate to the minority of a minority it represents and fooling Americans into thinking there's a full-scale revolt underway.

The right sees an opportunity during the August recess to take a hammer and really pound home their message. All manner of poison could be unleashed with media loudmouths like Glenn Beck and Rush Limbaugh encouraging race and class resentment. The few traditional Republicans left who want to build a more diverse party stay silent because the fanatically passionate are the GOP's foot soldiers; without them, the party would lose its base.

President Reagan used to tell a joke about a fellow who consulted a psychiatrist about his brother, who thought he was a chicken. Asked how long this had been a problem, and it turned out to be years, the psychiatrist wondered why he hadn't sought help sooner. "Because we need the eggs," the fellow said. It was Reagan's way of underscoring how a particular pattern of behavior, however irrational, might serve a larger purpose.

The Republicans need the eggs, and whining about the brutish tactics of right-wing "chickens" won't get the Democrats the support they need for health-care reform. Democrats need to get out there and organize and build a case for the broad overhaul of the health system that Obama is trying to put in place. If Democrats let this moment slip away when they have significant majorities in Congress, they will pay a price in next year's congressional elections. A loss of 20 to 30 seats in the House wouldn't risk the Democratic majority, but it would make life a lot less pleasant for the Obama administration.

Much of the current impasse is a problem of Obama's own making. By leaving the writing of the legislation to Congress and his own wishes deliberately vague, he lost the clarity of message that would have helped sell voters on the need to overhaul a sixth of the economy. This is classic Obama. He doesn't show his hand and leaves people guessing as to what he'll really fight for, if anything. It's a strategy designed to allow him to take credit for whatever passes. He doesn't want a debate about how much he surrendered along the way. By keeping his counsel about critical aspects of reform and playing so much of an inside game, he gave up the bully pulpit, his most powerful tool, squandering the advantage he once held in public opinion.

He did a superb job co-opting most of the big dogs that killed health-insurance reform in 1993, keeping doctors and hospitals in the loop and negotiating an $80 billion deal with the drug companies to narrow the hole where Medicare patients lose coverage. But what he lost along the way is the hearts and minds of people who already have insurance and are scared about what they'll lose if coverage is extended to some 45 million Americans without insurance. In one of the raucous town meetings that popped up on YouTube, the lawmaker asks how many in the audience are without insurance, and not a single hand went up. The outraged voters we're seeing are getting whipped up by conservative media telling them they'll get a bigger tax bill and a smaller insurance package if Obama's ideas take hold.

Twenty years ago, Congress repealed the Catastrophic Health Care Act of 1988 for Medicare recipients after seniors stormed the car of House Ways and Means Chairman Dan Rostenkowski to protest an increase in their premiums. The expanded coverage would have included prescription drugs and was by most accounts a good deal for seniors. But they didn't buy it. Unless Obama and his surrogates find the language to reassure the majority of Americans with health insurance that they will be better off under his reform plan, the Astroturf opposition we see playing out now on our TV screens could morph into the real thing.

© 2009