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How GOP can win healthcare message war

July 1, 2017

When Republicans in Washington, D.C. head home for the Fourth of July recess they’re going to have to sell a health care bill that’s very unpopular. At least, that’s what the conventional wisdom says.

Only 17 percent of Americans approve of the Senate bill, according to an NPR/PBS Newshour/Marist poll. Chris Cillizza at CNN argues, “The polling seems to send a very clear message: The public doesn’t want this bill.”

Democrats are convinced they have an opening. David Weigel at the Washington Post quotes Sen. Chris Van Hollen (D-Md.), chairman of the Democrats’ 2018 Senate campaign efforts, who told a “resistance” rally, “We’ve got to fight even harder over the Fourth of July and every day until we bury this atrocious bill.”

Still, Republicans can win if they go on offense and seize an opportunity that’s been staring them in the face for the past quarter century. Since the Democrats’ “Hillarycare” debacle of 1993 polling has consistently shown that while the public supports the concept of “universal” access to care they’re skeptical of “government-run” health care. If Republicans can convince voters that their ideas, which empower individuals rather than government, are the better way to achieve “universal” access to care they can win.

This is the key:

Instead of defending a bill, Republicans should offer a vision.

Polls since 1993 show the public is receptive to the Republican vision that empowers individuals while they’re skeptical of the Democrat vision that empowers government.

In 1994, Gallup revealed that while 69 percent of Americans supported universal health insurance, Americans were more afraid of government control than not having a guarantee of universal coverage. In the poll, 53 percent of respondents were more concerned about “government control” while 40 percent were more concerned about “no guarantee of universal coverage.”

In 2003, Gallup conducted the same poll. Their conclusion:

When reminded that the current system leaves some people with no insurance – and when also told that a new government-run health insurance system would cover everyone and be like the Medicare system – Americans said they preferred the government system, by a 62 percent to 32 percent margin.

But when offered a simple choice between the current system, based mostly on private health insurance, or a government-run system, Americans rejected the government system by a margin of 57 percent to 38 percent. These figures represent a 49-point swing in opinion – from a 30-point margin in favor, to a 19-point margin opposed.

Why such a massive swing?

The key appears to be conflicting feelings Americans have about a new universal health insurance system run by the government. They strongly favor the universal part, but balk at government participation.

In 2016, the Associated Press asked similar questions. Their conclusion: “A slim plurality of 39 percent supports replacing the private health insurance system with a single government-run, taxpayer-funded plan that would cover medical, dental, vision and long-term care, with 33 percent opposed.”

But when confronted with the policy details support melted:

Support for government-run declines when voters confront policy implications.

In 2016, a Kaiser Family Foundation poll offered a vital perspective. The notion of government-run health care could only be sustained by rhetorical sleight of hand. Kaiser found that 36 percent felt “very positively” about “Medicare for All” but only 15 percent felt that way about “single payer” or “socialized medicine.”

Beyond polling, the unpopularity – and ineffectiveness – of government-run health care has been apparent in election results (in 1994 after Hillarycare and in 2010, 2014 and 2016 after Obamacare) and real life consequences. Patients have had to endure losing doctors, losing plans, skyrocketing premiums and Soviet-style health insurance bread lines in Obamacare’s individual market where one has difficulty obtaining products a government-controlled market simple can’t adequately produce. And in the Medicaid program – which progressives seem to view as a utopia always worthy of expansion – patients experience the same outcomes as those with no health insurance at all.

Republicans can take three lessons from the past quarter century of health fights into the Fourth of July recess.

Unapologetically emphasize universality. Republicans are great at telling voters what they’re against (Obamacare) but not very good about describing what they’re for. Republicans should say, “We want everyone to have great care and the best way to deliver care to all is to put you, your family and your doctor in charge rather than the government. It’s about your health and your choices, not the government.” Republicans are hesitant to speak in these terms because they’re afraid of sounding too progressive or moderate. They shouldn’t be. Republicans are very comfortable talking about their desire for everyone to have a job or a higher wage without offering government-run programs to deliver those promises. The same should be true with health care.

Articulate policy within a vision or narrative that makes sense of policy. Offering a vision makes the task of defending a bill much easier. Republicans should speak with confidence because their policy ideas support the “universality” goal the public supports while the Democrats’ policy ideas undermine that goal.

Words matter but the actual substance and policy matters more. When it comes to health care, Republicans use words to amplify their ideas. Democrats use words to hide their ideas. The Democrats’ strategy is to find words to sell policies that don’t work and undermine the goal the public supports.

Health policy experts including Avik Roy, Yuval Levin, Doug Holtz-Eakin, Grace-Marie Turner, Doug Badger and others have done a good job explaining what the Senate bill actually does and why it helps people.

Criticize Obamacare and Congressional Budget Office (CBO) estimates after doing 1) and 2). With the Senate bill struggling in the polls it will be temping for Republicans to do what they’re comfortable doing and double-down on bashing Obamacare. Criticizing Obamacare is fine and necessary but making Obamacare less popular won’t make Republican solutions more popular.

It’s also fine and necessary to criticize CBO but that’s a rear guard action. As I detail here, CBO tends to overestimate government’s ability to control costs and deliver actual care while underestimating the market’s ability to do the same. CBO was wildly inaccurate in its estimates of Obamacare’s coverage and cost outcomes. It also failed to anticipate how the competitive, market forces built into the Medicare Part D prescription drug benefit would control costs.

As they prepare to head home, Republicans should also remember that the public’s metric of success isn’t whether Congress repeals or replaces Obamacare but whether the final product lowers costs and improves access, benefits and choices (the ABCs of success). Senate Majority Leader Mitch McConnell (R-Ky.) and his Republican colleagues should be congratulated for offering a discussion draft and working to make it stronger over the upcoming break. Senate Minority Leader Chuck Schumer (D-N.Y.), on the other hand, still refuses to offer the Democrats’ true alternative – Sen. Bernie Sanders’ (I-Vt.) health care plan. Perhaps that’s because the Left’s demagogic counterfeit compassion has been scored so poorly by history. And, no, partisanship and “resistance” rallies are not a plan.

Republicans should not feel intimidated and discouraged by the poll of the day when the trends of history are on their side. As humorist P.J. O’Rourke – who should be considered as CBO Director – once said, “If you think health care is expensive now, wait until you see what it costs when it’s free.”

http://bit.ly/2tAUaME

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