Healthcare for the Middle Class

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David Corn just got back from a breakfast meeting hosted by Nancy Pelosi, who outlined the Democratic messaging strategy on healthcare reform:

The “appeal” of this push, she said, will not be that 48 million people don’t have health care insurance. “What is important to the bigger population,” she explained, “is their own health care.”

….The bottom line: the battle cry will not be, “Health care for all!” Instead, it will be “Better health care for you — and also the rest of us.” Given how the Hillary Clinton-led crusade for health care reform flamed out terribly in the 1990s, this sort of tactical shift may be warranted. It may even be wise.

I’d go further than that.  Even as far back as 1993, Bill Clinton understood that fear of change among the already insured was the key issue in building public support for national healthcare.  Unfortunately, even though he got this, he still didn’t emphasize it enough, and that’s one of the reasons his plan failed.

Since then, however, this has become conventional wisdom.  Like it or not, universal healthcare will never get passed on the grounds that it will help the 48 million Americans who are currently uninsured.  It will only pass if the other 250 million Americans are assured over and over and over again that the new plan will be at least as good for them as what they have now.  The tactical shift Pelosi is talking about isn’t just wise, it’s absolutely indispensable.

More importantly, however, both David and Ezra Klein report that Pelosi’s real priority this year isn’t healthcare at all.  It’s energy policy — specifically, getting a cap-and-trade bill passed.  My sense from Obama’s non-SOTU last week was that this was his priority as well, so it wouldn’t surprise me at all if serious healthcare reform ended up getting pushed off until next year.

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