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POLICY: Health care at the Convention, or Jones the Policy Wonk explains how I’ve got my head up my ass it’s been used politically and why.

Here’s Jones the Policy Wonk in reply to my post on healthcare at the convention where I had written. . . . (and yes I am applauding!)

Maybe if the Democrats repeat their fuzzy message enough times, they’ll seize this issue. My question is, why did they decide this is the big issue? And why are they talking about the cost of health insurance which is somewhat alien to most people and not just focusing on the cost of drugs? I guess it just means that if they talk about it and the Republicans don’t, they own the issue.

The Wonk writes: If I’m interpreting your post correctly, you were asking why Dems are talking about healthcare and why, having decided to talk about it, are they all over the map with it?

You’ll be pleased to know I have an answer for you. Hold your applause until the end.

Short answer is that Democrats have a really clear and simple message on healthcare: "We’re paying attention, we know things are getting worse and remember, we’re the guys you’d rather have fixing this." So, although they’re not coherent from a policy standpoint, the speeches clearly express this political message.

Long answer is that convention speeches are not showcases for policy debate, especially for a challenger. For a challenger, the convention should be a carefully choreographed message event, designed to tell voters who the presidential candidate (and the party) is and why the voters should choose this candidate. Conventions are about winning the presidency and generating long enough coattails to win Congress.

((ASIDE: For a challenger, the convention is especially important because it’s one of the few opportunities he has to speak to the American people and have full control his message. Unlike a sitting president, a challenger can’t demand an hour of prime time for a speech. Most of his media coverage is "earned" media–stories in newspapers and sound bites on TV. The problem is, to get on TV, the challenger has to be "newsworthy." Newsworthyness (if this is, in fact, a word) is determined ex post facto–you get in the papers if, after hearing what you’ve said, the media decides it’s newsworthy. So, it’s a sound bite here, a picture there, and at no point is it a full presentation of the case the challenger is trying to make.   Conventional wisdom in the media is that conventions aren’t newsworthy, because, um, there’s no news (seriously, the logic is that circular)–if conventions didn’t exist in the past and someone had one today, nobody would cover it. This is because conventions are just candidates and party leaders bloviating on what they believe and what they would do if elected to office. I think it’s pretty clear that I disagree on the need for coverage–although it’s not exciting most of the time, it is important for both sides to be able to present their case directly to the American people in the manner of their choosing. Clearly, it’s not going to give the voters the whole story, but it is an important part of the decision-making process–when they can talk about anything in the world, what do they choose to talk about? How do they talk about it? What promises do they make?   Candidates, especially challengers, seldom have the opportunity to present their case directly to the people in a manner of their own choosing. It’s important to see what they say when they do have this change. Personally, I want to at some point see what they say when they know people are going to listen and no one is going to interrupt them. END ASIDE))

So, the reason the convention speakers are talking about healthcare so bizarrely is because though it’s an issue Democrats win on, it’s not an issue they can win with. In my humble opinion, that’s because American voters are still divided ideologically over the appropriate role of government in healthcare, and beyond that they are uncertain that even if this is a problem that government should solve, whether it’s a problem that government intervention can solve.

I’m digressing, but this ties into the comments that Abby made in the blog entry you linked. This threshold of whether this is government’s problem to solve still hasn’t been crossed with voters. I agree with you that the tipping point will probably come soon, as the economic problems brought about by out of control healthcare spending make ideological blindness an unaffordable luxury. But there does have to be an ideological shift or, at the very least, a realization that government=bad, private sector=good isn’t conventional wisdom but is in fact an ideology that serves special interests. There are a lot of reasons this hasn’t happened yet, not the least of which is that one major political party has thrown its full weight behind supporting this privatization ideology. But no small part of the problem is that people in favor of real healthcare reform haven’t gotten a 3 sentence argument together, and haven’t gotten it on the lips of every healthcare expert who favors healthcare reform. There’s a lot of muscle behind the current message, and the alternative has not been coherently articulated.

((FARTHER ASIDE: There’s reason to hope that this is changing. I think Abby is right again, that the key to this is to take a page from Lee Iacocca and point out the competitive burden placed on businesses. And on a personal level, we should talk more about the loss of freedom people suffer when they’re stuck in a job to keep their benefits, and how it crushes the spirit of American enterprise—people are scared of getting sick, so they won’t start a small business and follow their dreams. I think the business argument will go over well. For example, in NY State, 1199 floated a pay to play proposal. I was listening in on a conversation between a leading NY State senator (Republican) and 1199’s head lobbyist, and the Senator commented he was shocked that when he floated this proposal to business interests, they were willing to engage on the issue. Now, the bill still didn’t pass, but the fact that it wasn’t met with scorched earth tactics by business interests is a change whose importance cannot be overstated. Policy wonks need to start asking employers if they want to be in the business of providing healthcare or in the business of selling widgets. Because more and more, they’re in the business of running America’s healthcare system. Hmmm, maybe we can win big business by framing this as: "outsource your employee health costs to the feds!"END FARTHER ASIDE))

In the face of this political reality, Kerry has decided that he can’t win with healthcare, but he can score a few points with it. So his strategy on healthcare is not to go deep into it but to bring it up occasionally to remind voters what they already believe–that the situation is getting worse, that George Bush has no solutions to the healthcare crisis and that voters would rather have a Democrat working on this problem than a Republican.

So they’re bringing up health insurance because it’s a current healthcare problem–it’s tricking down to voters as an explanation their company gives for lower raises this year, as a stumbling block for union negotiations, as increased cost-shifting with higher co-pays, and for the recently unemployed as one of the biggest financial burdens they suddenly faced. They’re bringing up HMOs because it was the last healthcare crisis voters faced, and a crisis that Dems were on the right side of. They’re bringing up drug costs to remind seniors that they believe Bush sold out to pharma interests and pushed through a deceitful Medicare drug benefit.

But fundamentally, healthcare at this convention is an "and also"–as in: "John Kerry is a strong and decisive war hero, leading a party unified by true American values, who will unite the world behind a strong America. Oh, and also, he’s better on healthcare." This is why the speakers sound so bizarre to the wonks. It’s pure politics, and policy is way on the back burner.

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