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Beyond coverage and cost, beyond market reforms and government oversight, the central issue in the health care debate with which President Obama and Democrats now must grapple is the nature of American democracy.
That health care will prove a political disaster for Democrats in November seems beyond question. They let it dominate the public agenda in Washington for more than a year at a time when Americans were far more concerned about the economy and jobs. They crafted a bill that most Americans don’t like, under a slimy process through which they bought congressional support by distributing favors to key members. In essence, as pollsters Pat Caddell and Doug Schoen recently argued, they’ve lost the debate with most Americans. And, while the increasingly likely enactment of a Democrat-drafted bill will delight the party’s liberal base that craves the expanded coverage and bigger government role in health care that it will bring, it will further alienate independent voters.
But that’s not the issue, or at least the most important one. We do not live in a pure democracy through which issues are decided by plebiscite. Nor, at least in our moments of abstract high-mindedness, do we seem to want to do so. Instead, we ask our leaders to do what’s right, not what’s popular; to lead, not follow; to deliberate rather than follow the ill-informed whims of an emotional electorate.
Thank goodness! For how else would FDR have educated the nation on the mounting threats from totalitarianism abroad at a time of deep isolationism at home before World War II? How else would President Truman have convinced Congress and the American people to assume global leadership at a time when Americans were more inclined to, as Averell Harriman put it, “go to the movies and drink Coke?” Why else would the first President Bush have violated his “no new taxes” pledge to tame a rising budget deficit, or the second President Bush have doubled-down on victory in Iraq by sending more troops at a time when most Americans were ready to declare defeat?
That brings us back to health care. That the status quo is unsustainable becomes obvious to anyone who takes even a cursory look at key trends. Fueled by rising costs, health care is growing exponentially as a share of the economy and the federal budget, making it increasingly hard for families to prosper and for the government to respond to emerging problems. Fueled by Medicare and Medicaid, health care is the main reason why the budget deficit will grow to unsustainable levels in the coming years, threatening an economic calamity if policymakers do not address it in time.
If, then, President Obama and congressional Democrats believe, as they say they do, that their bill will begin to slow health care costs while covering more families, that it will make necessary reforms in the insurance market while requiring that health plans provide basic levels of coverage, then they should look beyond the polls. Yes, Democrats face a tough November. But they face one whether they actually enact their legislation or, in the days ahead, fail to do so. They’ve lost the public debate. They can, however, still do what they believe is right for the nation.
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Lawrence J. Haas is former Communications Director to Vice President Gore and, before that, to the White House Office of Management and Budget. He's now a public affairs consultant who writes widely about foreign and domestic affairs, including fiscal policy.