The Democrats’ Communication Problem

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Democrats are still smarting from Scott Brown’s upset victory in Massachusetts last week. Health reform seemed inevitable and then, suddenly, it wasn’t. As Karen pointed out, Democratic lawmakers are still searching for a path forward that might include reconciliation. They may succeed, but certainly not because the American people got on board with their plans. No, if Democrats manage to squeak by comprehensive health care reform legislation, they will do it in the face of polls showing that the majority of the American people oppose their efforts. Most Republicans would no doubt argue that the public is rejecting the Democratic plan for reforming the U.S. health care system, but a report released yesterday shows the Democrats came up short in a far more fundamental sense. They failed to convince the public that the system is flawed enough that it needs fixing.

A new survey from the highly respected Robert Wood Johnson Foundation indicates that slightly more Americans are confident in their ability to access and afford health care than they were in May 2009. Despite all the town halls, the rallies organized by pro-reform progressive groups, the pro-reform television ad campaigns, the Congressional hearings featuring Americans injured by a flawed insurance apparatus, the public is simply not convinced that the health care system is broken enough that it needs to be changed dramatically. (And I might add, despite all the reporting that’s been done about how broken the U.S. health care system is.)

In conversations with pro-reform policy experts and Democratic political aides throughout 2009, I heard it said that one reason Bill Clinton’s 1994 health reform efforts failed was that things weren’t bad enough back then. But fifteen years later, I was told, enough people had had negative experiences with their insurance companies over denied claims. Enough people had seen their premiums skyrocket. Enough people had found themselves suddenly and terrifyingly uninsured. But this turned out not to be true. Most people in America are still happy with their health care coverage and their health care. And most believe they will continue to be happy, despite Democrats’ effort to convince the public that the system is buckling and will eventually cost Americans far more than they can afford. Nope, this message did not get through.

According to the latest RWJF survey, which is conducted monthly, Americans have about the same confidence not only in their current ability to access and afford health care as they did in May 2009, but also the same confidence in their future ability to access and afford health care. The methodology of how the surveyors calculate “confidence” is fairly complicated, and the sample size is small – about 500 adults – but here’s a snippet of the results:

* 76% of those surveyed in May 2009 who had health insurance insurance said they were “not worried at all” or “not too worried” that they would lose their coverage. 69% were not worried in December 2009.

* 56% of those surveyed in May 2009 said they were “not worried at all” or “not too worried” they would not be able to afford routine health care in the future. In December 2009, the figure was 58%.

* 76% of those surveyed in May 2009 said they were “not worried at all” or “not too worried” they would go bankrupt from medical bills. In December 2009, the figure was 74%.

* One set of responses in the survey that experienced at least a 10-point swing between May 2009 and December 2009 came from a question about public health insurance programs. 16% of those on public insurance programs were worried about cuts to the programs in May 2009. By December, that figure had risen to 26%.

So Democrats failed to communicate on all counts. They did little to convince those with health insurance that their coverage was fragile and likely to cost more soon. Meanwhile, Republicans successfully convinced Americans that reform would cut funding for public programs. A reality check: The existing employer-based health insurance system – where some 60% of Americans get their coverage – is objectively unsustainable. Costs for these plans increased 131% between 1999 and 2009; employee contributions went up 128%. Surveys indicate that in 2010, 40% of employers will shift more premium costs onto employees and 39% will increase deductibles, co-payments, co-insurance or out-of-pocket maximums. These are just a handful of the available statistics that expose the massive vulnerabilities in the U.S. health care system. In addition, Democratic health care reform would dramatically increase the size of the public insurance program Medicaid – to the tune of 15 million people. Money would be cut from the Medicare program, but would mostly come from the subsidized private Medicaid Advantage program. None of the Medicare benefits legally required by current law would be cut.

The Democratic health care reform plan is either worth passing or not. Where you stand depends on many factors, including how much you trust the Democrats and what you believe the role of government should be. But regardless, it’s hard to argue with the notion that the first step in selling dramatic change is selling the idea that change of some kind, any kind, is badly needed. On this, American voters were not convinced. At least not in 2009.