In its healthcare messaging, the White House has taken an issue more intimate and immediate than perhaps any other in a voter's life and transformed it into an abstract, technical argument about long-term actuarial projections. It's a peculiar kind of reverse political alchemy: transforming gold into lead.
Of course, there's a certain logic to the White House approach: despite widespread public support for reforming the healthcare system, a desire for more choices and pervasive insecurity about the stability of coverage, a majority of people think that their health insurance is just fine. The trick then is to promise two contradictory things: that healthcare reform will change the system while leaving your healthcare intact. In what at first appeared a deft bit of jujitsu, the White House settled on the long-run-cost argument as the way to pull this off.
But now we're seeing the problems with this approach. For one, converting a moral and political argument into a technical and accounting one ends up ceding veto power to the accountants at the Congressional Budget Office. In a Beltway version of Revenge of the Nerds, every time a Democratic bill comes out of committee it's sent to the CBO to be "scored"--that is, to evaluate how much it will cost and how much it will "bend the curve" on future costs. So far, the results have been mixed. CBO head Doug Elmendorf has been skeptical about the gains to be had from measures like health IT and wellness programs, and both the House and Senate bills have been scored as revenue neutral over the next ten years. In another context that would be great news, but since healthcare is being sold as a way to reduce the deficit, revenue neutral doesn't quite cut it.
The other problem is broader than just these pieces of legislation. Obama has inherited a shared political vocabulary in Washington (with phrases like "fiscal discipline," which he himself employs) that shapes the contours of the possible and semantically militates against progressive politics at every invocation. If "fiscal discipline" meant that politicians support tax increases on the wealthy or cuts to the military budget to pay for programs, it would be a useful concept. But what "fiscal discipline" means in Washington is cutting government. It means no taxing and no spending. It means "pain" and "sacrifice" and gutting the welfare state. When politicians say they're "fiscally conservative," what it actually means is they're conservative. Full stop.
Yes. I saw this coming back in January when I first wrote about this after watching Andrea Mitchell lay down the village gauntlet:
MSNBC commentator: ... The subtext of all of this [call to service] is "hey Americans, you're gonna have to do your part too. There may be some sacrifices involved for you too." Do you think he's going to use his political capital to make those arguments and will it go beyond rhetoric?
Andrea Mitchell: It does go beyond rhetoric. He needs to engage the American people in this joint venture. That's part of the call. That's part of what he needs to accomplish in his speech and in the days following the speech. He needs to make people feel that this is their venture as well and that people are going to need to be more patient and have to contribute and that there will have to be some sacrifice.
And certainly, if he is serious about what he told the Washington Post last week, that he wants to take on entitlement reform, there will be greater sacrifice required from a nation already suffering from economic crisis --- to ask people to take a look at their health care and their other entitlements and realize that for the long term health and vitality of the country we're going to have to give up something that we already enjoy.
It's possible that they want to position health care reform as "entitlement reform," but I do not think it will work. The forces that want to destroy the safety net are influential and well funded and they are selling entitlement "reform" in just the way that Andrea Mitchell describes --- as something the American people must give up in order to set the country on the right course. They will not sit still while someone tries to sell it as anything other than necessary cuts in benefits or complete elimination of the programs. That's the whole point.