Healthcare Has Long Been Campaigning in Slogan, But Governing in Policy Prose
Three times over the past quarter of a century, politicians from both parties have learned the hard way that sound-bite campaigning is far different than actual policymaking.
Especially, that is, when it comes to the complex and intensely personal issue of healthcare reform.
Bill and Hillary Clinton found that out in 1993. Early polls showed most Americans supported their proposed reforms. But that changed after the substance of their plan was fully dissected.
The lesson was reaffirmed in the early days of the Obama administration. Democratic candidates had campaigned on behalf of universal coverage. Polls showed that a solid majority of Americans wanted reform, and Democrats saw the issue as an opportunity to paint Republicans as defenders of a broken system.
A Kaiser Family Foundation survey, for example, found that 59 percent of Americans supported many of the policies that would become the Affordable Care Act.
Democrats let favorable polling numbers light their path. But, they ignored the hazards of where they were going.
They were guilty of topline-gazing — skimming only the surface of polling data. Lurking beneath topline numbers were unexplored layers of data that showed the depth of public distrust in government’s ability to competently deliver changes to the healthcare system.
And that was the reason many Americans doubted the benefits of ObamaCare right from the start.
Voters often react positively to certain words and phrases — such as “reform,” “universal care,” “affordability” and, most recently among Republicans, “repeal and replace.”
When that happens, politicians embrace these concepts and start believing they are substitutes for actual policy. But when they get into office, they quickly discover that they can’t pass slogans into law.
Republicans are learning that lesson now.
The GOP reaped electoral gains from their opposition to ObamaCare and the big government mindset it symbolized. But as efforts to repeal and replace ObamaCare became increasingly serious over the last three months, support for it unexpectedly rose — which caught Republican leaders off guard.
A survey taken a year ago by the Kaiser Family Foundation, which regularly monitors public opinion on health issues, found that only 38 percent of Americans supported ObamaCare.
Their latest study from early March found that support for ObamaCare had increased to 49 percent. Another poll taken in mid-March by Quinnipiac University revealed that only 17 percent of voters supported the first repeal-and-replace plan offered by GOP House leaders.
It also showed that 54 percent of voters had little or no confidence that Republicans would replace ObamaCare with something that was as good or better.
Politically explosive links connecting these poll numbers are self-evident.
Clearly, their handling of the healthcare issue in March took a toll on Republicans, who were viewed as unprepared and lacking compassion. That’s why they came roaring back last week with new legislation.
While the House bill they barely passed gave them a legislative victory — something they badly needed for party morale — it does not get them out of the political thicket. Far from it. Now the bill limps to the Senate, where long knives are waiting to hack its provisions.
To the extent that Democrats were basing their healthcare initiatives in 1993 and 2009 on topline polling, at least they had superficial voter majorities in their corner. But Republicans today don’t even have that. Even the topline numbers are bad for them.
According to a ABC News/Washington Post poll last month, only 37 percent of Americans want to “repeal and replace” ObamaCare. Most of the rest want to keep it and try to improve it. In addition, only 26 percent want individual states to have the option — a key feature of the House-passed bill — to decide whether healthcare insurers are required to cover people who have pre-existing medical conditions without charging extra for it.
There may be one way out of this healthcare reform thicket as the Senate now considers the issue.
It’s a path neither Democrats nor Republicans have tried in recent decades — and that’s to create a simple-as-possible plan and then fully explain it to the American people before they pass it.
The horse, you see, always belongs before the cart.
Ron Faucheux is Executive Vice President at Qorvis MSLGROUP & president of Clarus Research Group, a nonpartisan polling firm based in Washington, D.C., and publisher of LunchtimePolitics.com, a daily newsletter on polls. He’s the former editor of Campaigns & Elections magazine.