11 August 2009

Heads I win, Tails you lose

TNR's Jon Cohn makes an excellent point regarding the messaging troubles that Obama and the Dems are having in selling health insurance reform:

Squeeze Play - The Treatment
[C]onservatives have been making two separate arguments--arguments that cut in completely opposite directions.

For some conservatives, the problem with health reform is that it’s too expensive. It will cost too much money up front--and cause us too spend way too much money in the future. The more earnest and reasonable version of this critique comes from the likes of David Brooks, the cruder and more dismissive version from columnists like Robert Samuelson. Common to both is the suggestion that reform, as currently envisioned, won’t do enough to change the way we get medical care and, as a result, won’t do enough to reduce the money we’re spending on it.

Still, it was fair to say that this early version of the House bill didn’t go as far as it could. So when the measure ran into trouble at a third House committee, the administration and some of its allies seized the moment to double-down on cost control. In particular, they won inclusion of a new, independent commission of physicians to guide Medicare payment policy.
Emphasis added.  And I should point out that it's not just anti-reform conservatives making this point -- KevinMD has opined that cost controls should come first and universal coverage later.  It's a good, fair point, and I share the concern that the proposed reforms won't save as much money as is needed to make American health care sustainable.

And the anti-reform crowd can't help but seize and run with the opportunistic retort:
Well, you can see where this is going. Two weeks later, the right has seized upon that very provision to make a radically different argument. Now a (mostly) different set of conservatives are arguing that health reform will put the government in charge of medical treatment and that, as a result, we’re on our way towards harsh rationing of care. The hysterical version of this argument--Sarah Palin’s delusional invocation of Nazi-like death panels--is the one making all the news now. But there is a less over-the-top version in the writings of libertarians like Megan McArdle.

There are a lot of reasons why I think this criticism, even the saner version, is wrong-headed. Among them is the fact that there's no precedent for this sort of behavior by politicians in this country--or in other countries like ours, where the public expects (and gets) a high level of health care services without rationing based on age, medical condition, and so on.
It's a classic catch-22, isn't it?  No matter what the Dems do, there are infinite ways to attack it:
  • The bill's too complex. (You want simple? Single payer.)
  • It's rushed. (Dems have been trying this every decade or so for 60 years, and there've been two years of policy groundwork going into this.)
  • Obama let congress get too into the details. (Clinton failed because he didn't engage Congress.)
On and on and on.  These attacks will need to be weathered; it's part of the process.  Hopefully, Obama and the Dems will listen somewhat to the former concerns about cost containment, while not taking too much damage in the PR arena from the latter.

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