New Hampshire Votes: Thoughts on the Democratic Primary

Well, let’s see. I already handed the Comeback Crown to Senator John McCain in the previous post on the Republican New Hampshire primary vote. It seems unfair to deny Senator Hillary Clinton the same honor considering the polls and pundits showed her losing big to Senator Barack Obama there. Yet she defied the surveys and eked a victory, surprising, it seems, even herself.

A week ago, winning New Hampshire by just two percentage points — less than 7,500 votes — would have been proclaimed a disaster by most analysts. Now it’s a major victory and a tremendous shock. Of course, the shock is to those who wrote her off just five days ago.

Which shows how significantly, and inappropriately, Senator Obama’s victory in Iowa last Saturday changed the expectations of the Democratic nomination fight. Prior to those caucuses, Senator Clinton’s campaign focused on the depth of her experience and on the inevitability of her nomination. Then she finished third, losing out to Senator Obama and, barely, to former Senator John Edwards. Both Senators Obama and Edwards had campaigned as change agents. Senator Clinton’s message had failed to resonate and the inevitability of her success was seriously in doubt.

So in New Hampshire, she modified her message slightly, promoting herself as the candidate whose experience made her most capable of achieving change. The message seemed to reinforce the opinion of those who had supported her before the Iowa and may have been strengthened by New Hampshire voters’ penchant for thumbing their noses at expectations. According to the CNN exit poll, thirty four percent of the voters said they had made up their minds at least a month ago and Senator Clinton garnered 48 percent of their votes while Senator Obama received 31 percent.

What this says to me is that the Iowa bump for Senator Obama was in the eyes of the pundits, not among voters.

The New Hampshire results does seem to have accomplished three things. First, it put to rest talk of inevitability concerning any candidate.  Second, it confirmed the old cliche that the only poll that matters is the one on election day. Voter surveys as recent as yesterday projected a decisive win for Senator Obama. But it’s who shows up at the polls that matter, and the Clinton campaign got their voters out. I also think the polls may have worked against Senator Obama as New Hampshire voters seem to dislike being told what to do.

Third, the New Hampshire results have all but reduced the primary trail to a two person race, sending Senator Edwards on a downward spiral from which he is unlikely to recover while limiting Governor Bill Richardson to showcasing his Vice Presidential credentials and seeking favorite-son status from New Mexico.

Senator Edwards’ post-Iowa strategy was to convince voters — and the media — that the campaign was about change and Senator Clinton was incapable of delivering it. He then believed his more aggressive and partisan approach to transforming America would win out over the more conciliatory style of the Senator from Illinois.

It didn’t turn out that way. Senator Edwards received only 17 percent in the New Hampshire primary, less than half of what Senator Obama earned. Perhaps even more disastrous, polls show Senator Edwards to be even further behind Senators Clinton and Obama in the upcoming South Carolina primary, the only state he won in his unsuccessful presidential bid in 2004. As a southerner, if Senator Edwards can’t win there, it will be tough for him convince anyone he can win anywhere.

Senator Edward’s downfall stems, at least in my opinion, from his extremely partisan stance. He positioned himself as a fighter, but too much so. For example, after castigating insurance executives as greedy and accusing them of valuing profits over human life, Senator Edwards proclaimed, “And people say to me that as president of the United States, they want me to sit at a table and negotiate with these people? Never. It will never happen.’”

Now, contrast this with Senator Obama’s approach. In his concession speech tonight he promised supporters he would tell insurance and drug companies that “while they get a seat at the table, they don’t get to buy every chair. Not this time. Not now.” (This can be viwed about five minutes into the clip).  Senator Obama’s rejection of Senator Edward’s contention-as-usual politics was explicit, describing his supporters as a new majority “who are tired of the division and distraction that has clouded Whasington, who know we can disagree without being disagreeable.” (About four minutes into his speech).

Senator Edward promises a new agenda, but the same ugly, tired politics of division. Senator Obama promises changes in policy and in politics. Senator Obama finished a close second. Senator Edwards finished a distant third and, while he retains enough support and money to to continue to slog ahead, at least until February 5th when the bulk of delegates will be selected, he’s likely to be increasingly marginalized over the next four weeks.

Meanwhile, attention on the Democratic side turns to the Nevada Caucuses and the South Carolina primary (Michigan will hold a primary on January 15th, but neither Senators Obama’s or Edwards’ name is on the ballot). Senator Clinton and Obama will be seeking momentum prior to Super Duper Tuesday when California and 21 other states caucus or vote. Which means by February 6th one of the two may have emerged as unbeatable.

Which one? The odds are, marginally, favoring Senator Clinton. According to the CNN exit poll, she out-polled Senator Obama among Democratic voters 45 percent to 33 percent. It was independent voters participating in the Democratic primary that kept the Illinois Senator close with 41 percent of them supporting Senator Obama and 30 percent voting for Senator Clinton (in New Hampshire, independents can choose to cast either a Democratic or Republican ballot) .

However, not all states allow non-Democrats to vote in their primaries. Of those that do, independents comprise less of the electorate than in New Hampshire where they represent about 45 percent of all voters.

Before proclaiming Senator Clinton as the inevitable winner, however, keep in mind that in California voters registered as Decline to State  — about 19 percent of the electorate — can cast a Democratic ballot (but not a Republican one). Senator Obama’s broader appeal should serve him well here. And on February 5th, California is the biggest prize of all.

New Hampshire Votes: Thoughts on the Republican Primary

If Pete Townsend wrote a rock opera about the 2008 New Hampshire primary, no doubt there would be a moment when former President Bill Clinton would sing of Senator John McCain,

“I thought I was
The New Hampshire comeback king.
But I just handed my comeback crown to hi - im.”

Written off just months ago, New Hampshire voters revived and revved up the Arizona Senator’s campaign with what appears to be shaping up as a strong victory over former Governor Mitt Romney. Meanwhile, Iowa winner former Governor Mike Huckabee, bereft of a strong evangelical presence, finished a distant third. (According to a CNN exit poll, evangelicals made up about 60 percent of Iowa Republican caucus goers, but only about 21 percent of New Hamphsire voters).

My guess is that the GOP — or at least the GOP leadership — will start rallying around Senator McCain. He now stands, ironically given his personality and history, as the most undamaged “traditional” Republican in the race. Conservative, but with an independent streak, his position on social issues could appeal to the GOP’s church going constituency while his pragmatism could appeal to Wall Street going Republicans.

Governor Romney on the other hand, doesn’t seem to be appealing to enough of any constituency resulting in a campaign that has little momentum at all — at least not of the forward variety. To be fair, however, exit polls indicate the Governor got the majority of Republicans casting ballots, but Senator McCain made up more than the difference by earning the support of independent voters (in New Hampshire, independents can choose which primary to participate in on election day, and more than 40 percent of New Hampshire voters belong to neither major party). Huckabee is clearly energizing the social conservative wing of the Republican party, but he has yet to gain much support from the business side of the party. The result, he ran a distant third in New Hampshire.

The wild card is former Mayor Rudy Giuliani. It’s hard to envision Republicans nominating a pro-choice, anti-gun, New Yorker, but anything is possible. Mayor Giuliani strategy is either brilliant or fatally flawed. His plan seems to be to avoid the early nominating contests in states like Iowa, New Hampshire and the upcoming South Carolina, let the other candidates engage in an exhausting elimination battle, resulting in one, damaged candidate stumbling into the states where the Mayor is making his stand, like Florida. The danger, however, is that by missing the early events, the Mayor could make himself irrelevant, ceding time to a candidate to become the decisive frontrunner who will barrell into the next wave of primaries sails full and war chest replenished.

Michigan, which holds its primary next Tuesday, January 15th, will be critical. Governor Romney (whose father was governor of the state), Governor Huckabee and Senator McCain have all polled well there at one time or another. The state could propel any of the three front-runners to an all but unassailable position or further muddy the waters.

The next test for the GOP will come just four days later when Nevadans caucus and South Carolina Republicans head for the polls (the Democratic primary in South Carolina is a week later). Will Michigan resurrect Governor Romney? Is resurrection even possible for his campaign? Will South Carolina revive Governor Huckabee? Will he need reviving after Michigan? Can Senator McCain unite the party in less than two weeks? Or will they all stumble into Florida on January 29th where Mayor Giuliani awaits?

Wish I knew, but I can’t wait to find out.

Close Votes in Reader Presidential Survey Results

The polls are open in New Hampshire, but they’ve closed on the first Alan Katz Health Care Reform Blog Unscientific Presidential Survey (the AKHCRBUPS, for short). And while we won’t know who won in the Granite state for awhile, we can now report on the winners, and losers, among this blog’s readers.

Republicans: Respondents gave a plurality of their first place votes to former-Mayor Rudy Giuliani takes the top spot followed closely by Senator John McCain who, in turn, was just ahead of former Governor Mike Huckabee. Former front-runner and former Governor Mitt Romney finished a distant fourth.

The survey asked participants to list their second and third choice. Weighting the results (first place = 3, second place =2 and third place =1), however, doesn’t change the order of the finish, although Governor Romney does move closer to the pack as does former Senator Fred Thomas. 

The comments provided by respondents showed some Republicans displeased with their choices this election cycle. As one Republican put it, “It just might be the first time I won’t go to the polls during the primary season.”

Republicans were asked whether they “would be willing to support a Democratic candidate in the general election” and, if so, which one. A majority said no. But of those who said yes, Senator Barack Obama was their top choice, followed by former Senator John Edwards.

Democrats: Senator Hillary Clinton would be the Comeback Kid of 2008 if New Hampshire follows the AKHCRBUPS results. She tied Senator Obama for the top spot as the first choice among Democrats. Yep, tied. (They were right, every vote does count!) Senator Edwards was a distant third.

When second and third choice votes are taken into account, Senator Obama squeaks out a win over Senator Clinton. Senator Edwards and Governor Bill Richardson makes strong moves, however, with Senator Edwards coming in just ahead of the Governor. Governor Richardson seems to impress more people than are voting for him. One supporter of Senator Clinton said, “I think Richardson is being overlooked. His … national experience would be a BIG help should he be elected.” Is this the start of a Clinton/Richardson boomlet? (Probably not, but I though it was interesting.)

Good news for the GOP: When asked if, and who, Democrats would support among the Republicans, the majority said yes. Of these, Senator McCain edges out Mayor Giuliani followed, at a distance, by Representative Ron Paul.

Independents: Those who identified with neither major party got to select their preferences among all the GOP and Democratic candidates. Senator Obama was the clear winner here.

The Issues: When asked what “the two most important issues you will consider in determining which candidate to support for president,” survey participants cited the Economy as their most important issue, followed by Health Care Reform and Terrorism/National Security and then Tax Policy. Iraq was on the list, but not as high as in national polls, not suurprising given the subject matter of this blog. When second choices taken into account, the standings don’t change, but the Economy moves even further ahead while Iraq gets closer to the pack. Yet, the comments would indicate that all of these issues matter. As one respondent put it, “So which one do you pick? Holy cow!! Most all of them are crucial.”

My thanks to all of you who participated n this survey. We’ll do at least one more as the vote in California approaches.  These polls may not be scientific, but they’re fun!

Another Health Care Reform Disconnect (collect them all)

Dealing with health care reform does strange things to people, especially to politicians. Regardless of party. For example, it’s not uncommon to hear Democrats bemoan President George W. Bush’s veto of the State Children’s Health Insurance Plan (SCHIP) expansion and criticize California lawmakers for cutting back on health services to balance the current (now severely out-of-balance) state budget, while at the same time proclaiming that the way to improve health care is to turn it all over to the government to handle. That this is the same government that vetoes SCHIP and cuts health services doesn’t seem to faze them. Maybe I’m missing something, but isn’t this a serious disconnect between reality and theory? 

The GOP can disconnect principles from proposals, too. There are Republicans who frequently call for letting the states chart their own course on issue after issue, but who also propose doing away with a state’s ability to regulate the health insurance carriers and HMOs selling to its citizens.

I was chastised by a reader for an earlier post that discussed GOP lawmakers taking themselves out of California’s health care reform debate by refusing to consider any tax increases under any circumstances. “Since you are not a Republican, do not waste your time trying to think like one,” wrote Tom Johnston. A fair point and a kindly phrased suggestion, concerning those he could have made.

So I know I’m on thin ice here, but …. If it’s inappropriate for the federal government to tread on a state’s rights, isn’t it just as wrong for it to empower other states to intrude on those rights? If New Hampshire has one regulatory scheme, should health plans be able to sidestep it by filing in Wyoming? Won’t this jurisdiction shopping process simply lead to carriers filing in the state with the most industry friendly regulation? If regulations in a state are too severe, shouldn’t the voters of that state demand changes, not have it thrust upon them by voters somewhere else?

Yet, according to a Kaiser Family Foundation web site tracking the health plans of presidential candidates, this is exactly what health care reform proposals put forward by former-Mayor Rudy Giuliani, Congressman Duncan Hunter and Senator John McCain would do. Of course, they don’t put it this way. Instead it’s couched as “Permit individuals to purchase insurance across state lines.” Or “Promote competition and individual choice of insurance by allowing insurance to be sold across state lines.” Sounds better, but it’s the same result.

Eliminating unnecessary regulation is one way to reduce the overall cost of health insurance. But promoting states’ rights on one hand while eliminating their ability to regulate health insurance plans sold within their borders makes as much sense as condemning how poorly the government deals with health care on one hand while giving it complete control over the entire health care system on the other.

As I said, dealing with health care reform does strange things to people.

Iowa Speaks!

The voters of Iowa have spoken. What they have to say may not mean much to you, but they certainly mattered to the candidates who spent months and millions trying to persuade voters not only to support them, but to brave the cold and stand around for hours in dozens of town hall like caucus meetings.

For Senator Barack Obama and former Governor Mike Huckabee it was a good day. Coming in first, by definition, is a good thing.

The key message for Democrats is that their constituency wants change. For Senator John Edwards it had to be frustrating to position yourself as the fighter for change and then to watch Senator Obama claim the change crown. But that’s what happened according to the CNN entrance survey of participants in the Democratic caucuses, 51 percent of those who stated the quality they were most looking for in a candidate was the ability to bring about change voted for Senator Obama. My guess is that Senator Edward’s extreme rhetoric worked against him and for Senator Obama.

Many voters are tired of the attack politics that is business as usual in Washington. It’s one of the reasons Congress is held in even lower esteem than President George W. Bush. House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid promised to change the tenor of the debate in Washington. They failed.

I believe most Americans want leaders who will build solutions, not tear down opponents. Seeking the mantle of Change Agent in Chief while promising to make Washington even more partisan and vicious, as Senator Edwards did, is counterproductive — at best. All he did was emphasize how much of a change the more open and inclusive style of Senator Obama would be. No wonder Senator Edwards earned only 20 percent of the vote from those whose top concern was bringing about change.

Senator Hillary Clinton had a rough night, too. Now she has to pivot from a campaign based on the inevitability of her nomination to demonstrating that she has the experience to implement the change that Senator Obama promises. Not an easy sell, but her campaign is very capable. It’s far too early to count her out.

By the way, expect both Senators Clinton and Edwards to claim second place. According to CNN, when the dust settles, Senator Edwards will have gotten a few more votes, but Senator Clinton will get 15 delegates to his 14 — compared to Senator Obama’s 16.

When asked by CNN for their top issue, health care was cited by 27 percent of those attending the Democratic caucuses, behind the war in Iraq and the economy (each mentioned by 35 percent of the voters).  Of those citing health care as their top issue, 34 percent said they were voting for Senator Obama, 30 percent for Senator Clinton and 27 percent for Senator Edwards. These numbers are so close it’s unlikely to have made much difference in the outcome. These results also reflect the narrow differences in the health care reform plans offered by the three front runners.

The CNN survey of Republican caucus goers indicate a different dynamic was at work there. First, the candidate leading in national polls, former New York mayor Rudy Giuliani didn’t campaign in Iowa. This left the field to former Governors Mitt Romney and Mike Huckabee with former Senator Fred Thompson and Senator John McCain fighting it out for a relatively distant third place finish (and it looks like Senator Thompson won the consolation prize by a hair).

The candidates views on God seemed to be the big issue for those showing up at the GOP caucuses. According to the CNN’s entrance poll,  77 percent of those attending the Republican caucus stated that the religious belief of the candidates mattered a great deal (36 percent) or somewhat (31 percent) in their decision. Only 15 percent of Republican caucus participants said the candidate’s religion didn’t matter at all. Of those who said it mattered a great deal, 56 percent said they’d be supporting Governor Huckabee. Only 11 percent said they’d be supporting Governor Romney — the same percentage that professed support for Senators McCain and Thompson.

When it came to specific issues, the top issue for 33 percent of the Republicans was illegal immigration, followed by the economy (26 percent), terrorism (21 percent) and the war in Iraq (17 percent). Health care reform didn’t make the list. A plurality of the voters citing each of these four issues as the most important to them said they’d be supporting Governor Huckabee.

What to make of the Iowa results?

1. The expectation for Governor Huckabee and Senator Obama going into New Hampshire’s January 8th primary have gone up considerably. And it’s always a bad thing when a candidate fails to meet expectations.
2. Coming in first in Iowa will give their war chests a nearly immediate infusion of cash (actually, credit card and Paypal donations). The Internet enables candidates to harvest contributions at speeds unfathomable in prior elections. More money will make it a bit easier for them to meet expectations. But as Governor Huckabee demonstrated to Govenor Romney, money doesn’t always translate into votes.
3. Iowa will become yesterday’s news as soon as the New Hampshire polls close. Whatever happens there will serve as the context for the next news cycle.
4. Perhaps most meaningful to regular readers of this blog, and as predicted here earlier, health care reform is unlikely to be a decisive factor in the primaries.

Roughly 340,000 residents of Iowa have now shaped the 2008 presidential election (that’s roughly the size of the city of Santa Ana). Now you can, too, by participating in the Alan Katz Health Care Reform Blog Unscientific Presidential Survey #1. I hope you’ll take a couple of minutes and participate. 

The Alan Katz Health Care Reform Blog Unscientific Presidential Survey #1

Iowa has voted. And yes, the turnout there was very large — for Iowa. But hey, we’re the readers of this blog. And we have opinions about the presidential candidates, too. America needs to know who the readers of this blog support!

OK, actually, America could care less, but hey, with all the 24 hour news channels, they’re going to need something to write about. And the candidate’s blogs — they’re starving for something to write about. A strong finish here could make their front page. Or their back page.

So here’s the Alan Katz Health Care Reform Blog Unscientific Presidential Survey. It’s fast, it’s easy, it might even be fun. You’ll be able to indicate your second and even third choice. You can also identify the issues that matter to you most.

This poll closes the evening of January 7th: the eve of the New Hampshire primary. I’ll try to post results sometime on the 8th, but no promises. And you may have noticed the headline indicates this is Survey #1. There will be at least one more of these opportunities to shape destiny before Super Duper Tuesday, February 5th. That’s when California plus a slew of other states have their primaries (a slew being “23″). It’s also when most of the candidates will collapse with exhaustion. By doing more than one we can report on trends, just like the real surveys do.

It’s too late to save the Biden and Dodd campaigns, but your vote could keep your candidate in the race through New Hampshire and beyond. Sure, it’s unlikely, but anything is possible in this election.

This survey is unscientific, but that’s no reason to skew it up completely. Please, vote early, but vote only once. Stuffing the ballot box will make it even less meaningful than it already is.

So, what you waiting for? It’s a two minute survey. Get to it.

Health Care Reform and Iowa

With Iowans going to caucus today it’s tempting to write about how this marks the beginning of journey toward national health care reform. Unfortunately, that’s not the case. The impact of Iowa on the health care reform debate will be minimal. To be sure, there will be exit polls parsing the issues that matter to voters (health care will be high on the list). In reality, however, the positions of the candidates within each party are too similar to be sway many voters one way or the other.

On the Democratic side, the health care reform plans outlined by Senators Barack Obama and Hillary Clinton, former-Senator John Edwards, and Governor Bill Richardson are fairly similar. They all seek to reduce the uninsured through expansion of public programs. They all have cost containment provisions. The only differences are that Senator Clinton and Senator Edwards would require all consumers to obtain coverage. Senator Obama focuses more on affordability issues and Governor Richardson’s proposal avoids the creation of new bureaucracies.

On the Republican side Senator John McCain, former-Governors Mitt Romney and Mike Huckabee, and former-Mayor Rudolph Giuliani all seek to increase the number of Americans with medical coverage through tax incentives and fewer restraints on the private sector. Even Governor Romney has backed away from the heavy government role he championed in Massachusetts.

Once the general election is engaged the differences between Democrats and Republicans on health care will move front and center. That’s then. For now, even though voters are concerned about the issue, it won’t greatly impact the results coming out of Iowa.

There will be one interesting dynamic to watch, however. In Iowa, independents can choose to attend the caucus of either party. If exit polls show unaffiliated voters made their choice of caucus because of a candidate’s stand on health care reform it would provide important insight on which party’s approach is resonating with swing voters. 

That today’s caucuses in Iowa are unlikely to provide much insight into voters thinking about health care reform doesn’t make them any less interesting. They kick off the most unusual presidential election in generations. For the first time since 1928 no sitting president or vice president is on the ballot. Then there’s the sheer number of possible “firsts” we may witness. Senator Clinton could be the first woman president? Senator Obama could be the first African American to hold the office? Governor Romney is seeking to be the first Morman elected president and Mayor Giuliani wants to be the first Italian chief executive. The list goes on, but you get the idea.

And think of the possible match-ups in November. The nominees could both be New Yorkers (Senator Clinton and Mayor Giuliani). Far more interesting would be having the Republican most willing to work with Democrats (Senator McCain) facing off against the Democratic most willing to work with Republicans (Senator Obama). Then there would be the most ironic match-up: Governor Romney versus Senator Edwards — two wealthy, out-of-office white guys with perfect haircuts.

Iowa matters — just not so much concerning health care reform. Regardless of the match-up the next 11 months will be exciting. OK, not if we get stuck with Romney versus Edwards, but let’s hope it doesn’t come to that.

John Edwards’ Dangerous Rhetoric

Former Senator John Edwards talks often about two America’s: “The America of the privileged and the wealthy, and the America of those who live from paycheck to paycheck.” His populist message resonates well within the Democratic party and it has kept him among the top three candidates in most every survey taken. Usually, however, he’s in third place, and that makes everything from raising money to garnering endorsements to recruiting volunteers a bit harder. That’s why the Iowa caucuses are so critical for Senator Edwards. He needs to finish at least second to claim momentum. A third place finish merely confirms he’s behind Senators Hillary Clinton and Barack Obama. Fourth place or lower and it’s back to North Carolina.

Perhaps that explains why Senator Edwards has taken his populist message to a new and dangerous extreme. Senator Edwards is seizing on the recent tragedy of a teenage girl in California to demonize health insurance carriers and their executives. Late last month, Cigna denied Nataline Sarkisyan a liver transplant on the grounds it was experimental and, consequently, not covered. Without the assurance of being paid by the carrier, Ms. Sarkisyan’s doctors would not perform the transplant. After public pressure, including pickets at their office, Cigna relented. Unfortunately, Ms. Sarkisyan died before the procedure could begin.

The story is sad and complex. It’s easy, and lazy, to simplify what happened and ignore the subtleties. Should, for example, the doctors have performed the surgery and then worried about the money? Should they have recommended a treatment that only had a 65 percent chance of keeping the patient alive for six months? The Los Angeles Times, in its extensive coverage of the case, has done a good job of presenting these nuances. Senator Edwards has not.

Senator Edwards could have used the incident to define the difficulty of creating meaningful health care reform. Because as the Sacramento Bee’s Daniel has pointed out, Medicare and Medicaid might have made the same decision as Cigna — obtaining experimental treatment is always a judgement call whether the decision is made by a private company or a governmental agency.

Instead, Senator Edwards chose to use the tragedy as political fodder, employer language that would make the Association of Demagogues proud. According to the Des Moines Register, Senator Edwards is using the incident to ostracize the insurance industry from civil society. Here’s how the Register reports Senator Edwards as describing what happened:  ”The doctors pleaded, the nurses pleaded, and finally, Americans started literally picketing and walking outside their offices…. And they finally gave in, and notified the family that they’d pay for it. But then a few hours later, she died. Because it was too late.”

This over-simplified description of what happened makes all insurance executives “Untouchables” in the mind Senator Edwards. Again from the Register: “The candidate paused for a second to let this sink in. Then his voice rose in indignation. ‘And people say to me that as president of the United States, they want me to sit at a table and negotiate with these people? Never. It will never happen.’”

I understand politics. I was Deputy Campaign Director for Tom Bradley in 1982 and worked alongside Joe Trippi, a Senior Adviser in Senator Edward’s campaign who has a significant impact on the Senator’s strategy and message (and who is someone for whom I have great respect). I understand the pressure to create an “us” versus “them” mentality in a tight election.

But Senator Edwards has stepped over a very important line. It’s one thing to debate the role of profits in America’s health care system. It’s fine to debate whether there should be private health insurance companies. Those are legitimate issues. But defining insurance executives — or anyone else — as unworthy to be in the presence of the president of the United States and, by implication, all right thinking people, that’s not legitimate. Once insurance executives are ostracized, who is next? Which executives or interest group is unworthy? Does the list continue to grow as the campaign heats up? Does the Senator’s enemies list include anyone who disagrees with him? This is a country built on tolerance of people and ideas. In descending into inappropriate rhetoric and a Nixonian mindset, Senator Edwards shows himself to be a politician who fails to grasp this vital aspect of America.

Maybe I’m being hypersensitive. But I’ve seen the ”these people” used too often in the context of bigotry and stereotyping. (In addition to political work I’ve held leadership positions in organizations like the American Jewish Congress and the Westside Fair Housing Council). So I hope Mr. Trippi is not responsible for Senator Edward’s descent into this kind of de-humanizing rhetoric. I know him to be better than that. I don’t know Senator Edwards, but I hope he returns soon to the realm of civil discourse.

Senator Edwards is desperate to do well in Iowa. If this demagoguery is any indication, however, he’s doesn’t deserve to.

California Health Care Reform Debate: Lesson for the Nation?

California enjoy their image of national trendsetters. Advocates on all sides of the health care reform debate in California are fond of claiming that what happens here will set in motion a reform movement that will alter the course of the presidential primaries and health care of the country.

I’m not so sure the specific elements of the health care reform package, passed by the assembly and to be taken up by the State Senate, is really going to alter the debate. Heck, I’m not sure it will even pass the State Senate. Assuming it does, what’s the lesson of Assembly Bill X1-1? That purchasing pools are the solution? They’ve been around, and failing, for over a decade. That $1.75 is the appropriate amount for a cigarette tax increase? That carriers must accept all applicants? That too has been around, and increasing premiums, for years. Tying guarantee issue of products to a requirement that all residents have coverage might be the element of ABX1-1 that most qualifies it as a model for the rest of the nation.  But I think the lesson California has to offer is more one of process than specifics. And the lesson is the need for a less partisan approach to the effort.

Health care touches everyone. It’s more than a political issue, it’s a deeply personal one. At the same time it has a tremendous impact on the big picture. It’s over 15 percent of the nation’s economy. It affects the fiscal stability of government, the competitiveness of businesses, and the financial security of families. There are few issues that influences both society and everyday lives as much as health care. Consequently, there are few issues with so many stakeholders as health care.

Getting buy-in for a health care reform package is, not surprisingly, a challenge. Policy makers have two choices: ram a partisan “solution” down the throats of the opposition or engage in a dialogue with them.

The former is tempting. In many ways it’s easier because it’s more about politics than public policy. Which elements of your constituency needs what provisions? Cobble them all together and slam the package through.

A nonpartisan approach is much more painful. There’s still a heavy dose of politics involved, but the resulting package needs to be able to stand up to the rigors of questioning and debate from a broad spectrum. The package –in total — needs to have a good chance of actually working. And it’s more likely to because it reflects ideas and input from a variety of viewpoints. It’s a slower process than a partisan effort. It’s a frustrating process. But in the end, the results are usually better.

The California’s health care reform debate illustrate this point.

To the extent ABX1-1, the Health Care Security and Cost Reduction Act, has any chance of passing, it’s because technically it is a bi-partisan bill. Governor Arnold Schwarzenegger is, after all,  a Republican. Senate President Pro Tem Don Perata and Assembly Speaker Fabian Nunez are Democrats. If the Democratic Legislative Leaders had a soul mate in the Governor’s office, the bill would have looked far different. The views of the business community and others would probably not have been ignored, but they would have been much further from the center of the debate. If the result wasn’t a single-payer solution it probably would have looked a lot more like Assembly Bill 8, the reform package passed by the legislature last year during the regular session, than ABX1-1. And regardless of whether one supports ABX1-1 or not, it’s a much better piece of legislation than either AB 8 or Senate Bill 840, the single-payer bill.

So California serves as evidence of the benefits of a bi-partisan approach.

However, ABX1-1 is only technically bi-partisan. Republicans in the legislature have been totally absent from the deliberations. To a large extent, this was their own choice. By refusing to accept any new taxes they made themselves irrelevant to the process, except as an obstacle to a purely legislative solution. Without the two-thirds votes necessary to create new taxes the Governor and the Democratic Leadership are turning to the ballot to fund the $14 billion health care reform plan.

Leaving Governor Schwarzenegger as the only Republican in the room is not a good way to insert the perspective of the Republican party into the debate. Even he refers to himself as being “post-partisan” and few would suggest he speaks for the core beliefs of the GOP. As a result, key elements of the bill did not get the full benefit of a truly bi-partisan debate. Would this have eliminated problem areas in the bill, such as the unlevel playing field created in favor of the purchasing pool? That’s a question California “nearly non-partisan” process can’t answer.

The partisan versus non-partisan approach to health care reform is already a part of the presidential campaign debate, at least on the Democratic side. Senator Barack Obama believes in the wisdom of bi-partisanship. According to the Boston Globe,“To Obama, Democrats have been unable to make progress on core concerns like universal healthcare because of a selfish Beltway political culture that puts partisanship ahead of the national interest; electing Clinton, he said, would perpetuate the existing ‘Washington game with the same Washington players.’

“‘You know that we can’t afford four more years of the same divisive food fight in Washington that’s about scoring political points instead of solving problems - that’s about tearing your opponents down instead of lifting this country up,’ Obama said last week.”

Former-Senator John Edwards, however, champions a more partisan approach. “‘You better send a fighter [to Washington]‘, he told voters Friday night in Davenport. But politicians are not his main targets: Special interests are the force that must be quelled.

“‘Corporate greed has infiltrated everything that is happening in this country,’ Edwards said.” Hardly an invitation for all sides to participate in the discussion.

This is where the California experience can educate the national debate — even if ABX1-1 never makes it past the Senate. It shows that even a “nearly bi-partisan” approach resulted in a better bill, one that had the best chance of any of the available alternatives to become law.

Health Care Reform, Polls and Presidential Politics

Bill Robinson, a Palm Springs insurance agent and voracious researcher on health care reform issues, recently circulated a gem of an article concerning a seeming contradiction in how Americans view the health care system. The gist of the article,  posted in November by The Century Foundation and written by Maggie Mahar, is that Americans consistently denigrate the health care system while simultaneously claiming, by huge majorities, that it works just fine for them, thank you.

Comparing results from several polls, Ms. Mahar identifies this apparent discrepancy as resulting from Americans’ satisfaction with their own current health care coverage, but insecurity about how long they’ll be able to maintain it. With premiums rising, coverage contingent on sometimes precarious employment and, if I can add to Ms. Mahar’s list, politicians constantly claiming the system is broken beyond repair, widespread insecurity is not surprising.

At the same time, there are plenty of polls showing that people don’t have a lot of confidence in how Washington runs things, either. This creates an interesting quandary for presidential candidates. Most voters feel the system needs substantive changes, yet they don’t trust the government to make things better.

It’s no surprise then, that none of the major Democratic presidential candidates have called for a government-run single payer system. Instead they call for plans that expand the size and scope of public programs to varying degrees, but preserves the private system. There are differences between the plans: Senator Barack Obama focuses on affordability, Senator Hillary Clinton, former-Senator John Edwards and Governor Bill Richardson place more emphasis on universal coverage, with Governor Richardson distinguishing himself by avoiding the creation of any new bureaucracies.

What’s significant, however, is that the second most oft used phrase by the candidates is that “no one will have to give up their current insurance if they don’t want to.” (Still holding strong in first place is “The system is broken.”) The Democratic candidates, consequently, get to have it both ways, to a degree. They get to say they’re going to fix the current system with new regulations and public programs, but they’re going to preserve private sector involvement. This may play well in the general election, but it’s not likely to excite many of the more strident constituents of the Democratic party who will accept nothing less than a single-payer system (cue the California Nurses Association).

Republican candidates face a different challenge. They have an aversion to new taxes (or cutting back on existing tax cuts). And they don’t like turning private sector services over to the government. So they focus more on affordability with few, if any, new public programs. This addresses the “my coverage is fine” dynamic the polls identified, but it doesn’t face up to the demand for change. The result is the inverse of the Democrats’ dillema: the Republican candidates’ positions will get them through the primary season all right, but it’s going to look weak after the conventions.

As the Kaiser Family Foundation surveys and other polls have shown, health care is one of the most important issues voters expect presidential candidates to address. And as Ms. Mahar points out, the polls also indicate a nuanced understanding of the issue by voters. Since the candidate’s messages must be equally nuanced, their positions tend to clump together, with obvious differences between the parties. Consequently, the specifics of the candidates’ health care proposals are not likely to be decisive in garnering support, at least not early in the primary season. What will be more important than specifics is how their proposals reinforce their core messages.

Senator Edwards, for instance, needs to show that his plan will help the poor and middle class. Which is why he emphasizes universal coverage. Senator Clinton’s program needs to underscore her claim of competency and experience, which she does by highlighting the differences between this plan and the one she pushed in her husband’s administration. Senator Obama represents a break with the past, which means his opponents do him a favor by attacking his plan. And Governor Richardson brings to the campaign broad government experience at the state and federal level. His plan underscores this by redeploying and expanding existing public programs, not creating new ones.

The importance of the health care reform issue, and of the candidates plans, will change over time. For now, however, they are mirrors of the candidates’ themes.  Which, given the seeming contradictions in the polls, is no doubt the wisest political strategy.