Opinion: Lead Health Care Reform With Conviction

(Jan. 25) -- The conventional wisdom inside the beltway is that the election of Scott Brown to the Senate signals that the electorate at large in the U.S. has taken a sharp turn to the right as a reaction to over-reaching by the majority. This, of course, is total nonsense, as is much of what passes for spin, political calculation and punditry in Washington.

A poll of Obama voters conducted by Research 2000 on election night in Massachusetts paints a very different picture. The poll found that 18 percent of people who voted for Brown also voted for Obama in the 2008 general election. Of these voters, 82 percent said they wanted a public option, and 57 percent said they thought the health care reform bill in Congress did not go far enough. The poll also found that among the Obama voters who stayed home, 86 percent said they wanted a public option, and by 6-to1 they said the bill in Congress did not go far enough.

The Massachusetts vote was a populist rebellion by voters on the left, in the middle and on the right, mobilizing against a Washington that they see as both unresponsive to and ignoring their needs.

The American electorate was promised change. So far they have not seen it. The Republicans have skillfully opposed everything, and then blamed the Democrats and the president for failing to deliver. The Republicans can't govern, but they sure are good at opposition. And we play the role of collaborative punching bags all too well. George W. Bush, with an assist from the Supreme Court, gained power because we simply weren't tough enough, and we are seeing it happen again.

Our country cannot afford another Republican government. The last one brought us to near economic collapse.

Rules for winning

1) Lead with conviction. Prescribe a course for the country and then do it. The American people respect strength and decisiveness in leadership. They desperately want change in the way business is done in Washington, where they see everyone except themselves represented at the table. Remember that there's a difference between making a compromise and compromising principles.

2) In the long run, how you get there matters less than how good the results are. A majority of Americans care less about using reconciliation than they do about stopping insurance company abuses. Allowing health care companies to charge two or three times as much to older people or women (as is in the current House and Senate bills) is not insurance reform and shouldn't be sold that way. Ultimately you can't fool the voters.

3) Timing matters. What political adviser would suggest to a client that they pass a bill that the client would have to defend for two election cycles with only modest changes seen by the vast majority of voters? Yet that is what both the current House and Senate bills do.

4) Use what people know and like. Expanding Medicare and Medicaid works, and people like these programs. Remember last August. People really did say, "Keep the government's hands off my Medicare." I asked 2,700 people at a town hall meeting in Virginia how many of them would give up their Medicare. Only five raised their hands.

5) Explain what we are doing often. Health care reform is complex, but it can be distilled to a few simple principles based on our values. One example is, "If you like what you have, you can keep it." We needed to stay with that. Another, "Put an end to insurance company rip-offs." Everyone gets that. Or, "You can choose between private insurance and a public insurance like Medicare." Americans like choices, and they hate to be told what to do, especially by the government.

We need to refocus our agenda, but we can't forget our promises on health care.

It may be too late for a public option or an individual mandate. If there is still the stomach for using reconciliation, use it to: 1) Expand Medicare to help those over 55 who are unable to get insurance because of disability or unemployment, or because it is a barrier to being employed. 2) Do the expansions to Medicaid, which were in both the House and Senate bills, and which would insure countless working people, especially young people just graduated into lower-wage jobs. 3) Pass a separate bill and dare the Republicans to filibuster insurance reforms such as extension of parental insurance policies to children under 28, eliminating pre-existing conditions as a barrier to insurance, and clamping down on insurance company abuse of claims denials.

The populist winds are strong, but they can shift direction quickly. The Republicans have that wind temporarily because Democrats have demoralized our own base, which gave President Barack Obama and our Congress their seats. But the Republicans cannot lead. So far they have only been able to say no, and to obstruct. That cannot make them winners, but it can make us losers. Unfortunately their pathetic strategy works when we fail to stand up to it and stand firmly on our values.

Be bold. That is what we promised. Bold leadership with less attention to politics in Washington and more attention to the desperation of ordinary Americans for real change is what will put Democrats back in the driver's seat where we belong, and which we earned in 2008.
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Howard Dean, MD, is former governor of Vermont and former Democratic Party chairman.