Health care debate: democracy in action

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When we talk about health care reform, we’re talking about a process of government: it’s messy, it’s complicated, and the tone changes week to week. For Kathleen Hall Jamieson, Director of the Annenberg Public Policy Center at the University of Pennsylvania, this health care debate is a lesson in exactly the way government should work.

The current health care reform bill is one of the most ambitious attempts at changing policy the government has tackled for some time. And for many, it comes down to what role the government should play in health care.    

"The rhetoric is the way it is in part for those reasons," said Jamieson. "And that’s the reason that the Obama representatives are framing this as a public option, as opposed to a government-run program. And why opponents are calling it government takeover and socialized medicine. If you focus on the government role here, it becomes more difficult for the rhetoric to focus on the Obama objective — slow down the cost curve, be deficit-neutral in ten years and then ultimately expand coverage."  

The communication from the Obama administration has moved to focusing on the price tag of health care says Jamieson:

"If you look at the news coverage as your indicator of what’s getting through to the public, what you see is that the Obama administration and the press coverage are both focused now on cost control more so than increasing coverage; and on how you pay for it rather than what you would receive if this happened — what would be good about this for you.

"And the focus on cost control … for the Obama administration makes strategic sense if by doing so he communicates — and builds advocates to communicate — that the individual with insurance is going to be benefited by this plan, and not be asked to pay for it in some form at some level and provide insurance for others."

By focusing on cost control, the debate has bypassed the more difficult issues, and said Jamieson, "We’ve also leapfrogged over some of the parts of the debate that could be so complex that a reasonable person isn’t going to understand them. When you start talking about insurance exchanges and independent Medicare advisory councils, you’re now in a realm where the language is new, unfamiliar and as a result extremely confusing."

As for which group is doing the best job in the debate, Jamieson thinks it’s the Congressional Budget Office, "Because we have an environment in which, when each side offers an argument, there’s still a place where one can go to find evidence that neither side strongly attempts to discredit.

"The Congressional Budget Office, focusing on cost, said first that the Obama plan wasn’t going to be decreasing the deficit — or even deficit-neutral — it might in fact add to it. Then secondly, that the second mechanism the Obama administration talked about — the independent Medicare advisory council — wasn’t really going to produce particularly great savings in the short-term, that agency [Congressional Budget Office] stood up, entered the debate and both sides acknowledged that it offered real evidence, and it advanced the debate forward."

Jamieson says this is an example of democracy in action, where government is being held accountable and legislators respond by changing policy implications, "That’s the way you’d like the system to work. In most debates about legislation, about global policy proposals, one side offers one set of facts, the other offers the other; the press doesn’t know exactly where to go and begins to try to find experts, and nobody goes to common ground. CBO [Congressional Budget Office] has provided common ground." 

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