On more than a few occasions in recent years, astute commentators (mostly in the blogosphere) have chastised Democratic politicians for talking strategy in public. To take just one example, instead of demonstrating their strength and principles in national security, the politicians say things like, "We've got to demonstrate our strength and principles in national security." The 2004 campaign showed the danger of integrating political strategy too much from the voter's end: John Kerry became the Democratic nominee in no small part because of the perception that he was "electable," a judgment that turned out to be based on faulty premises both about what makes a winning campaign and what Republicans would or would not stoop to (i.e. having their dynamic duo of draft-dodgers attack the military service of a war hero).
So the lesson many reasonably learned is that candidates should talk about substance, not strategy; what they want to do, not how people will perceive what they want to do; what their vision is for the country, not what their vision is for amassing votes. Leave the discussion of political tactics to the pundits.
But now that the three leading Democratic presidential candidates have laid out their plans for tackling the most pressing domestic issue -- health care -- it's time that they told us more about their political strategies. On this issue, voters can't -- and shouldn't -- judge who has the best plan without hearing a persuasive case for why each candidate can overcome the political obstacles that stand in the way of meaningful reform.
Without some hint not just about what kind of health-care system the candidates want to see but how they plan to accomplish its passage through Congress, voters won't know who really has the best health-care plan. Because if the "plan" doesn't include a strategy for beating back the formidable forces arrayed against it, it is guaranteed to fail.
Presumably, no one is more aware of this fact than Hillary Clinton, who unveiled her health-care plan on Monday. Her campaign is built around "experience," and when it comes to health care her message doesn't waver from this theme. Because of what she went through in 1993, she argues, she is the one best suited to get reform passed. She's fought that battle, she notes, and has "the scars to prove it." But when she talks about what she learned, the lessons she cites are about the public: People want to be able to keep their current insurance if they like it; a new plan has to be simple so people can understand it; you need a national consensus for reform; and so on (see this speech for details). The missing piece is what she learned about reform’s opponents.
In the years following the collapse of the Clinton administration's effort, the lesson many Democrats, including those in the White House, took from it was that health-care reform had to be incremental. Small steps, one thing at a time, nothing too dramatic, don't disturb the insurance-industry beast that could leap up to devour you at any moment. The Clintons had attempted to work with the insurance companies, who repaid them by unleashing every resource at their disposal to destroy the effort. So the prevailing sentiment seemed to be, don’t get the insurers angry. Meaningful things were still accomplished, foremost among them the creation of the State Children's Health Insurance Program (S-CHIP). But the most important thing to understand about the next round of health-care reform is that it will be one bitter, ugly fight. If Hillary Clinton realizes just how ugly it will be, and has a plan to prevail politically, she hasn’t said.
Don't imagine the right isn't preparing. No one needs to persuade Republicans in Congress of what William Kristol told them in a now-famous 1993 memo, that any plan, even one Republicans believed they could live with, would "revive the reputation of the party that spends and regulates, the Democrats, as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining government." He counseled Republicans not to work to achieve a compromise, but to kill Clinton's legislation outright.
Kristol may have the distinction of being more wrong more often about Iraq than any other pundit (fun quotation from April 2003: "There's been a certain amount of pop sociology in America … that the Shia can't get along with the Sunni and the Shia in Iraq just want to establish some kind of Islamic fundamentalist regime. There's almost no evidence of that at all. Iraq's always been very secular"). But his analysis of the effects of health-care reform was spot on, and it is even truer today. The coalition that came together to destroy the Clinton plan in 1993 has more at stake now, because the public is even more fed up and the entire discussion on health care has moved to the left.
You need look no further for evidence than the different way politicians are talking about government health insurance. Fifteen years ago, any mention of single-payer health care was practically taboo; although the idea is still treated with contempt by establishment commentators and hand-flapping hysteria by Republicans, it has nonetheless become part of the discussion. It isn't surprising that a vanity candidate like Dennis Kucinich (and yes, that's what he is) feels free to advocate single-payer. But now both Hillary Clinton and John Edwards include in their plans a public component modeled on Medicare but open to anyone. Edwards' Web site even states, "Over time, the system may evolve toward a single-payer approach if individuals and businesses prefer the public plan."
Neither one of them would be proposing a government insurance component if doing so would invite electoral catastrophe. They seem to be on reasonably safe ground; when a CNN poll in May asked respondents, "Do you think the government should provide a national health insurance program for all Americans, even if this would require higher taxes?", 64 percent said yes, a figure that can only terrify the executives at America's fine health insurance companies.
A Democratic presidency that begins in 2009 could ultimately resemble Franklin D. Roosevelt's election in 1932, when, after a dramatic Republican failure that resulted in wholesale public rejection of conservative ideas, a Democrat took the White House and produced a progressive transformation that defined politics for the next half-century. On the other hand, the next Democratic presidency could be more like Jimmy Carter's -- a brief interregnum following Republican disgrace that was largely a failure and preceded multiple Republican Oval Office terms and a resurgence of conservatism.
Obviously, a thousand different factors will influence the outcome of the next presidency. But we're approaching a consensus that health care will be one of the key domestic issues on which that presidency will be judged. The real lesson of 1993 is that the substance of any Democratic plan will have almost no impact on the political challenge it faces; no matter what the plan attempts to do, the industry/GOP alliance will fight it with the fury of a cornered animal. The question -- and what Democratic voters have not only the right but the obligation to ask of their candidates -- is how they intend to beat that alliance.
And we may have the beginnings of a real debate. Edwards has criticized Clinton for attempting to compromise with insurance companies, promising a more confrontational approach. Barack Obama, on the other hand, says the key to successful reform is "bringing people together in a way that builds consensus." But just as with the health-care plans themselves, the devil of political strategy is in the details. Just what kind of confrontation is Edwards proposing? What does Obama mean by consensus, and what will he do when the insurance companies launch a campaign against his plan despite his efforts to bring everyone together? How will Clinton respond when the next round of misleading "Harry and Louise" ads start blanketing the airwaves? Let's hear from them.