Echoes of Social Security Reform in the Health Care Debate

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A couple of months ago over lunch in San Francisco Speaker Pelosi was ruminating over how the Dems won control of the House. The problem after the 2004 election was that President Bush’s approval ratings were too high: 58% in January of 2005 and more than 60% of seniors liked his ideas on Social Security. But Pelosi saw an opportunity with Social Security reform – labeling the private accounts tantamount to a privatization of Social Security and waging a war, with the help of vocal outside groups, to take them off the table. By September 70% of seniors were with the Dems and Bush’s plan was in ruins. Pelosi had resisted calls within her own party to put out an alternative plan – risking the label of the Party of No and arguing that Social Security is their plan – in order to later, when the time was right and Bush’s poll numbers were in the tank, reveal the Six for 06 agenda. “I used to say to him, ‘You’re going to 60 cities in 60 days, I want you to go to 120 cities in 120 days and I’ll buy the ticket,’” Pelosi told me. “You are giving us a golden opportunity.”

This week Senate Republicans came out swinging against the proposed public plan offered in most Dem health care reform proposals as an alternative to private insurance. They have labeled such a move tantamount to socializing the health care system. “The idea of a government-run health care plan is a big problem for us. And it’s a big problem because it leads inevitably to a Washington takeover of health care,” Lamar Alexander, the No. 3 Republican senator, told reporters on Tuesday. “Those are two words we hear a lot today, ‘Washington takeover.’ In the case of health care, it’s like putting an elephant in a room with some mice and say, ‘OK, fellows, compete.’ After a while, the elephant has taken over the room, and your only choice is the elephant.”

Today the American Medical Association became the first powerful outside group to come out against a public plan. “The A.M.A. does not believe that creating a public health insurance option for non-disabled individuals under age 65 is the best way to expand health insurance coverage and lower costs. The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans,” the group said in a statement.

The G.O.P. push, in coordination with outside groups, against the public plan has the same feel to it as Pelosi’s early push against Bush’s private accounts. But this time around there are some key differences, most notably, Pelosi argued, is the character of the president. Bush “was a poor messenger across the board. That’s not going to happen to Barack Obama. He’s not an ideologue. And when you’re an ideologue you insist on things a certain way and then you pay the price,” she said. Another difference is the state of the economy. Yes, Social Security is a large and looming problem, but there was no immediate impetus for reform in 2005. Health care costs are a massive burden on millions of Americans and millions of American businesses. The G.O.P. would have a much harder time not offering an alternative plan or arguing the status quo would be better.

That said, Republicans are taking advantage of widespread concern about government spending too much money. And for all that Obama’s not an ideologue, Dems on both ends of Pennsylvania Ave. are not considering taking the public plan off the table – they won the election after all. But, as Pelosi proved with Bush, all it takes in one effective pin prick in a president’s polls and you risk the whole house tumbling down.