Terrible messaging on health care

I'm following this pretty closely, and I couldn't tell you what the actual health care plan is. I mean, I understand they're going to try to optimize care to save money and improve outcomes. And I guess maybe everyone is going to be required to have health insurance? Maybe insurance companies won't be able to deny coverage for existing conditions? They're talking about some flavor of a government-run health insurance plan?

I understand this is a $1 trillion dollar bill overhauling an industry that's 15% of our economy. It's going to be complicated. But if you're going to sell it, you have to be able to boil that complexity down into something simple and easy to grasp. Obama did a great job of this during the campaign. On the most fundamental level, he associated his campaign with two words, "Hope" and "Change." If I had to pick a word for health care reform? "Complicated."

I would have chosen "Security." Tens of millions of Americans have no health insurance. If they get sick, they'll get shoddy care through an emergency room, and they'll be wrecked financially. Many others have poor coverage. 50% of all bankruptcies in the US are related to medical expenses. 68% of those are people who had health insurance.

The first talking point about health care should be that this plan provides a safety net. If you get sick, it won't ruin your life.

Instead, Obama and the Democrats have touted many different aspects of the plan at different times. This really just shores up people's apprehension. I think Obama is making the same mistake on health care that he made on the stimulus bill: he's letting Congress write it. That ensures that the bill will be filled with individual senators' pet projects, and that it will be held hostage to the whims of committee chairmen like Max Baucus. It also means that there are now about 5 different competing plans, which will somehow be mushed together, sausage-like, in a closed-door committee.

In turn, this gives moderate Democrats a chance to cross the aisle. Obama could have come down with a single plan, firm in its major initiatives, and blurry in the details. Individual Congressmen would have a single choice: get on board or get out of the way. Those on the fence could be offered small changes in the details. Right now, though, there is still hot debate over the most important part of the plan, the government-run public option. This lets the Blue Dog caucus make an ultimatum, "Take that out or we won't vote for the plan." Which in turn forces Obama into a corner, either neutering the plan and losing the support of the liberals, or forcing it through on a very slim majority.

Something will pass. It would be too embarrassing for Obama to fail to get any kind of reform through. I think what's most likely is a plan with a public option. Republicans will uniformly oppose the bill. It's quite unlikely that all the Senate Dems will support it. Nelson, Baucus, Pryor, Lincoln, and Conrad have all been publicly skeptical. Byrd and Kennedy are ill and may not be able to vote. It will need to be forced through via reconciliation. In the House, many of the Blue Dogs will defect, but Pelosi will add enough pork to the bill to slime it through.

A plan without a public option is also possible, but would probably be even harder to pass. Several liberal Senators and a block of 50 House members have said they would oppose such a plan. That plan would not have much in the way of grassroots support. Its main supporters would be Obama, wanting to save face, and the various industry lobbyists who have riddled it with loopholes.

I'm not sure how Obama can run such a great campaign and then forget everything he knows about selling an idea once he gets to the Oval Office. It's not too late to turn this around. He needs to get a single plan together, tell people what it does, and start pushing.