Diagnosis and Cure: Democrats Can Turn 'Obamacare' into Electoral Advantage

Republicans believe that "Obamacare" will provide them a mid-term victory.

It may.

But, only if the Democrats let them, their candidates run away from it, and do not grasp and execute what is required to turn it into a major electoral advantage. With Republicans banking their hopes on stoking dissatisfaction with Obamacare, a Democratic strategy to turn it into an asset could result in a stunning victory for Dems.

Politicians appear to have a habit of rushing headlong into electoral strategies assuming they understand the basic cause of their problems. Before prescribing a remedy, we physicians, by contrast, work hard to establish an accurate diagnosis. Treating the underlying cause is far more effective than just addressing symptoms.

If there is any political strategy that deserves the physician approach, it is healthcare. So let us begin with the diagnosis and then fashion the cure to treat the major problem. First, the background, or, as we call it, the "history of the present illness".

History of the Present Illness. At least since Ronald Reagan became president, polls have consistently found that the American people agree with Democrats on policy, but vote for Republicans anyhow. Thomas Frank analyzed this apparent disconnect between peoples' preferences and their votes in "What's the Matter with Kansas?" Frank's key observation was that Kansans were voting against their own self -interest because the right-wing had inculcated the feeling that their problems were due to a political elite that invented all kinds of policies and programs that cost them money and that they could plainly see, because their own lives were shattered, did not work.

The right-wing, of course, had no solutions. Indeed, what they did offer -- tax cuts for the wealthy and de-regulation, both anti-government policies -- turned out to be a disaster. One might have thought that that near catastrophe, culminating in the disastrous George W Bush presidency, might have shifted psychology, and, to an extent, it did.

But, the Right knows from history that their political success depends upon keeping the masses on the razor's edge of financial ruin so that their fear, anxiety, anger and insecurity can be manipulated.

Policies to fix the Republican economic catastrophe, therefore, were painted with the same anti-government brush to which they had so accustomed the people. Facts, of course, do not matter. One-third of the stimulus was a tax cut that is, in their world, not even supposed to "count" as spending.

No matter. The stimulus failed because the stimulus must fail; that it staunched the hemorrhaging of 7-800,000 jobs/month, stopped and reversed the free fall (8.9 percent decline in the last part of '08) of GDP and created or saved 2-3 million jobs cannot be acknowledged. Raising revenues by hiking taxes on the wealthy must hurt the economy and reduce job creation; that President Clinton increased taxes on the wealthy and had 23 million new jobs created during his presidency cannot be admitted.

Instructively, however, they could not sustain that critique with the rescue of the US auto industry. Why? It was too specific and concrete. The industry was on the verge of bankruptcy. The President put in money. The industry recovered, and is prospering.

But, they tried. Right-wing political(!) pundits reincarnated themselves as auto experts, and vented a lot of spleen criticizing the Chevy Volt. Every problem it encountered was transformed from an engineering issue to a political matter, as they delighted in those difficulties. They told their followers not to purchase a car from GM they mocked as "Government Motors". [Can one imagine MSNBC, e.g., telling people day-after-day-after-day not to shop at Target because of its bungling lack of concern for its customers? Of course not. But, this is what the Right tried to do to General Motors].

Now that GM has nearly $30 billion on its balance sheet, what do we hear from the Right? Silence. That should tell you something. [Democrats should be repeating and repeating this success, but, of course, Democrats believe they won the "debate" and thus remain silent as well. Winning the debate, and winning hearts-and-minds on a semi-permanent basis are not the same].

Because the Right has nothing to propose, only two avenues remain. They speak in grand generalities, using words that polls have shown to trigger positive feelings about the speaker and/or negative feelings about the "pathetic" (one of Newt Gingrich's favorites) opponents. What is their alternative to Obamacare? Freedom. (Take 2 with a glass of water, call me in the morning, and give me your credit card number so I can charge you). Common sense reform -- ok, what is that? Patient-oriented reform -- same question.

Or, they propose alternative policies whose only purpose is to muddle the debate. Raise the minimum wage? No, let us raise the earned income tax credit that, of course, they have no intention of doing, at least not without some draconian "offset".

Although it probably gives the Rightwing too much credit to suggest that this was planned -- after all, they really have nothing else but cutting taxes on the wealthy and eliminating regulations -- nonetheless, Democrats fall right into their trap.


Because Democrats do, indeed, identify problems and propose policies designed to address them, that is what they talk about. Public opinion polls demonstrating broad support for their ideas serve as their opiates, lulling them further and further into the weeds, exactly where the right-wing wants them.

Once Democrats are in the weeds with policies, Republicans concoct some disingenuous alternative (that usually, miraculously, costs nothing) that sufficiently muddies the debate that voters cannot decide and go with their guts, to which the right-wing has honed its appeal.

This problem has stared Democrats in the face for 3 decades, but they have never done anything to address it. Indeed, they barely recognize it. [In my occasional personal meetings with operatives, there is an even more foreboding answer: "we are already doing it", which is the kiss-of-death for any organization that believes it is addressing a major deficiency when it in fact is not].

Now, Obamacare. The politics around the Affordable Care Act (aka, Obamacare) is a textbook case of the Democratic party's failure to achieve wide public support for a policy that, indeed, enjoys wide public support for its individual components.

Democrats seem bewildered that people can love no lifetime caps, no exclusions for pre-existing illnesses, free mammograms, children on parents' healthcare to 26, the subsidies, and so forth, and yet have negative reactions to Obamacare (the "Affordable Care Act" means almost nothing). One of the most striking recent findings was that Arkansas citizens supported maintaining Medicaid expansion -- until they were told it was part of Obamacare, and support tanked by 19 points.

But, it is not bewildering at all. Although logically Obamacare should be the sum of its individual components, emotionally it is not. Indeed, Obamacare has nothing whatever to do with its individual parts. It is not even about one's own healthcare.

In the public consciousness, Obamacare is an amalgam of death panels, chaotic town hall meetings, a long drawn-out approval process, a 2000+ page law (insinuating complex and suffocating controls), a terrible website, broken trust (you can keep your healthcare), every penny of higher rates (despite rates increasing annually before it), every annoyance or unhappiness with the medical system, a black man's power to provide an enormous benefit and phony horror stories paraded through the press (whereas their debunking gets nary a word, but it would not matter anyhow).....all under the banner of "government-run healthcare" (note the parallel with GM as "government motors"), culminating in reducing your "freedom".

Republicans' antidote to Americans' perspective on Obamacare--a perspective they have created and repeated--is "freedom", "common sense health care reform", "patient and doctor oriented reform", and a few lame specifics such as tort reform and purchasing insurance across state lines. Neither would achieve anything, but both sound like "more freedom". [Republicans love the word "reform". It is very cozy. Change is a bit frightening].

Note, for example, this disconnect:

The skepticism among the uninsured revealed by this survey isn't reflective of what Enroll America workers and volunteers hear from the people they contact, Anne Filipic, the group's president, said during a conference call with reporters Wednesday. The emphasis during those interactions is on practical concerns, not politics, she said. "The focus is on the opportunities that are available to consumers". [Emphasis added].

So, in a nutshell, "Obamacare" is politics, not healthcare. The law's specifics are practical concerns about one's own health.

Diagnosis. Although the Democrats may believe they are 'fighting back', they aren't. Republicans shouting "freedom" (or, its antithesis, "government interference") and Democrats listing the laws benefits are two trains passing in the night. They do not engage one another. They address different levels of the human brain. And, the part of the brain the Republicans address is more powerful and controlling, and is unequipped to detect their lies and fraud.

Recommended Treatment. How do the Democrats engage the Republican attack on Obamacare targeting the same part of the human psyche?

As with all good medical practice, diagnosis determines the choice of therapy.

Republicans have taught us that so long as they can appeal to "freedom" without contradiction, they can infuse it with any content they choose--death panels, 2000+ pages, and so forth--and it really does not matter. Unopposed, the degree of cognitive dissonance they can create was illustrated by their shouts to "keep the government out of my Medicare". I myself have a crazy aunt who loves her Medicare and hates all government programs.

What if, instead, the Democrats seized the freedom discussion? For example,

"Obamacare is more personal freedom. Now that Obamacare enables you to not have to worry about going bankrupt if you get ill, is that more freedom or less freedom?"

"Now that Obamacare guarantees women that they cannot be overcharged just because they are female, is that more freedom or less freedom?"

"Now that your Obamacare insurance allows you to change jobs and not worry about losing medical coverage, is that more personal freedom or less personal freedom?"

"Now that you can see a doctor when you start becoming ill, instead of waiting until it is so serious that you have to go to an emergency room, is that more freedom or less freedom?"

"Now that Obamacare says you can keep your child on your health plan until age 26, is that more personal freedom or less personal freedom?"

"Now that Obamacare guarantees you cannot be denied insurance because of a pre-existing illness, is that more personal freedom or less personal freedom?"

Obamacare guarantees the American people new freedoms. Republicans voted more than 40 times to take these freedoms away from the American people. And, they have pledged to do it again."

I leave it to those better suited to craft the language more intelligently. My purpose was to diagnose the general problem, and urge that Democrats fight for Obamacare by learning to use its benefits to engage the same part of the brain as Republican use to attack it. Otherwise, the Republican message controls the part of the psyche most important for making choices. [Psychologists say that 98 percent of the decisions we make are emotional, and we then quickly rationalize them.]

A few months of coordinated, repetitive* messages linking Obamacare to increased personal freedom, and Republicans will have to use a different psychological approach. If they wish to engage on whether one has more or less freedom with Obamacare, let them.

And, then, the stage is set for the coup de grâce .

Obamacare needs to be fixed in some respects. Whom do you trust to fix it? The people who voted 40+ times to take away your freedoms and your healthcare, or those who put it in place, recognizing that it would take some fixing once we see how it worked?

Will anyone, really, trust a Republican Congress to improve Obamacare? Or, will they rob you of the freedoms Obamacare provides?

*It remains to be seen, of course, if Democrats can do "coordinated" and "repetitive".