Three weeks I ago I wrote about Republican strategist Frank Luntz’ disingenuous advice on how Republicans should lie about health care reform. Last week, Democratic strategist Paul Begala gave Democrats a response that not only rebuts Luntz’s dishonest framing but gives wavering Democrats a helpful framework for a Democratic health reform proposal.
It’s worth looking at Begala’s 9-page memo (pdf), because he’s close to Rahm Emanuel (and so presumably would not stray too far from the White House view) and because Democrats were encouraged to use the memo’s talking points when discussing health reform with their constituents over the Memorial Day break.
Two things struck me in the memo. First, I’ve been searching for some confirmation that the Democratic leadership and the White House would hold firm on Obama’s campaign pledge to create a public health insurance option to compete with and provide a model for how the private insurance industry should function. Although 28 Senators have sponsored a resolution supporting a public "exchange" or public "insurance pool," these are not the same as a public plan option, even though some of the resolution’s supporters sometimes use the terms interchangeably.
Begala’s memo unequivocally and unambiguously advocates a public health insurance plan option, describes it’s role in giving consumers another choice over private plans. In his framing, the public option provides the minimum coverage model that competing private plans would have to satisfy. If this is the emerging Democratic proposal, it would be a step forward from where we’ve been.
The second point relates to Obama’s own rhetorical position, which Begala finesses even though, I will argue, it undermines his core message. I’ll discuss that in a follow up post.
A clear Democratic commitment to a meaningful public plan has been elusive: Sen. Baucus has been in charge of Senate efforts to date, but he’s been openly skeptical of a public option. He also wants to gain Sen. Grassley’s support. But Grassley clearly opposes any public plan, echoing the industry fear it would put meaningful competitive pressure on — and perhaps displace — private insurance/HMO plans. Of course, that’s what advocates hope. (Note that the Des Moines Register and a majority of Iowans support a public plan option.)
So I’m afraid the chances do not look good for even this half measure of reform, unless there’s a strong commitment from the White House and Democratic leadership. Both Obama and key Senators, of course, have taken any consideration of a single payer aproach off the table, despite it’s widespread support, literally removing advocates from the hearings for insisting they be heard. Bill Moyer’s Journal recently featured some of their many supporters.
To his credit, Begala provides a forceful rebuttal to Luntz and Republicans, while more honestly reframing the debate. The Dem’s position should be that they not only support much needed reforms, but they’ve identified the main problems with the current system that affect peoples’ lives and have thoughtful proposals to address them. In contrast, Begala argues, the Republicans support the status quo and would preserve everything that’s wrong with it.
As I argued here, Democrats should counter the misleading Republican arguments about "Washington bureaucrats controlling your health care" with the truth that it’s bureaucrats and fat-cat executives for big insurance corporations/HMOs who control those decisions today. It is they who deny coverage, deny claims, deny choice, cause delays and hardships, and decide which services/treatments/providers not to pay. From Begala’s point 3:
When Republicans repeat the Luntz talking point about delayed care, we should
say: Everyone has a health insurance nightmare story. It’s either happened to you
or someone you know. The insurance company won’t pay for something you need
or makes you jump through hoops to get it. We fix the health care system, and not
only will you be able to keep the insurance you have now if you like it, but it will be
better. We’ll have rules to stop them denying you care. And they’ll have to charge
you less because they’ll be competing with a new public health insurance option. So
if you get fed up, you’ve got somewhere to go.
Begala doesn’t shrink from nailing the insuance/HMO industry and its perverse incentive structure and practices for many of today’s health care horror stories. Almost every point reminds voters that the real culprits are the industry and their lobbyists who want to maintain the status quo.
On the key question whether there will be a genuine public health plan, Begala is either signalling that the Democratic leadership has accepted this critical feature or he’s advocating they should. It matters: Begala’s most powerful arguments — each responding to Luntz’ dishonest talking points — either collapse or become weak tea if the Dem’s proposal leaves out the ability to choose an affordable public plan in lieu of private insurance. Those who like the current private coverage are free to keep it; but genuine "choice" means having another, public option setting the standard for care and affordability. (How we pay for this is another topic for later; Begala does not address this.)
Begala’s memo touts the public health insurance plan explicitly in points 3, 7 and 9 and implicitly in point 4 and elsewhere. For example, on point 7, Begala counsels:
When Republicans repeat the Luntz talking point that our plan is “one size fits
all” we should say:
President Obama’s health care plan gives you MORE choice than you have now.
Right now, all most people have is the one or two plans offered through work — and
if you’re out on your own in the private market, chances are you’ve got even less
choice because health insurance is so expensive. When we create a new public
health insurance option, you’ll have one more choice. And you’ll know that choice
will be guaranteed to have the benefits you need, and you’ll be able to afford it. So if
you like what you have – great – you can choose to stay with it. But you’ll also have
an affordable alternative. And that’s something most people don’t have now.
That’s helpful framing. The next thing we need is a broad commitment to follow through. Reporters should be asking Robert Gibbs and Rahm Emanuel: do these talking points touting a public health insurance plan option represent a firm White House commitment to insist on including a public option in the reform bill? Because if there is no commitment, then what’s the difference between Democrats and Frank Luntz?
Update early Wed. a.m.: I made minor clarifying edits and added links to Sherrod Brown’s resolution and the Bill Moyer’s Journal.
Steve Benen, Health Care vs Health Scare (on industry ads following Luntz’ recommended scare tactics; more on Luntz here; and Luntz vs Begala here.
Larry Kudlow, fairly typical right wing reaction to a "public plan"