Obama's Un-Sellable Hodgepodge Of Minor Health Care Changes

The big question right now is, how do you sell Obama's new health care proposal? His proposal is basically the Senate bill with some minor tweaks. Some of the changes should be popular--like a minor increase in affordability tax credits--and some changes--like an increase in the individual mandate penalty--should end up very unpopular. What I don't see is a strong public argument for using reconciliation--or any big move--that would manufacture more support for the unpopular Senate bill.

The biggest “improvement” that might be used to justify the reconciliation bill could be the new “Health Insurance Rate Authority” to prevent unreasonable premiums increases. The idea should be popular, but it seems unlikely to make it into the final bill. I would be curious to see how this compares in polls to, say, Medicare buy-in, which actually stands a chance of not violating the Byrd rule and, therefore, becoming law. I guess Democrats hope to blame Republicans for this new agency's failure, but as we have seen with the public option, promising a popular policy that Democrats don't plan to actually deliver can blow back hard.

Delaying the excise tax might gain some support, but the excise tax is so politically toxic that it is hard to imagine simply delaying its implementation would change public opinion. Dropping it completely seems to be the only way to deal with it politically. Increased affordability tax credits and fully closing the Medicare Part D donut hole are probably both popular. And increases in the employer mandate penalty could go either way.

On the other hand, increasing the individual mandate penalty should prove to be very unpopular, and an act of political suicide I simply can't understand. Efforts to cut more waste, fraud, and abuse out of Medicare and Medicaid should be popular, but the Republican party has successfully framed them as cuts to Medicare. I would not be surprised if Republicans make more “cuts to Medicare” very unpopular.

This proposal by the White House shows a misunderstanding of the mood of the country. It is now clear that Obama always wanted a bill very much like the current Senate bill, and simply can't see that it is a bad bill, unpopular with the American people for policy reasons. The White House keeps blaming messaging because they are too ego-driven to admit that they made a bad product. They are trying to keep the currently very unpopular Senate bill as unchanged as possible, which is a big mistake. This shows a tone deafness to the American people who've said that they don't like this bill as it now is. There needs to be big, new improvements to show people that the Democrats heard the complaints, and responded by making the bill more consumer friendly, and less a giveaway to the insurers.

I don't see how you sell this package of minor changes, some likely to be popular, and other unpopular. It is hard to explain, and there is no simple justification for the reconciliation measure. This package is basically putting a new bow on an unpopular Senate bill. It is a resale that I can't imagine working.

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