Health Care Reform Redux?

A classic saying in political science is that Americans hate Congress but love their legislators. This sentiment has been borne out over the past several decades as congressional approval ratings hover around 30% (PollingReport.com: Job Ratings, 2009) while the percentage of congressional incumbents winning re-election remain strong at around 90% (Huckabee, 1995). There have been many explanations put forth about this discrepancy but the one that continues in popularity is that most Americans view Congress as misguided, out of touch and slow to react. But, at the same time, they view their individual legislators as knowledgeable and responsive.

Not only can this phenomenon explain a great deal about the challenges surrounding Congress, but it can also help explain the current health care reform debate raging in Washington. While most Americans do not believe that the health care system as a whole provides the best quality and cost possible, they do believe that their own health care is excellent (CBS News Poll, 2009). As a result, politicians in this country have spent the past several decades trying to satisfy these competing interests. Because that has been so difficult, America has not been able to achieve a major overhaul of the health care system to date.

Why Things Should Have Been Different this Time

With President Obama’s strong push for a major health care reform, we are in the midst of the first dramatic attempt to change the system since Bill Clinton tried 16 years ago. Because Obama was supposed to learn from the political and policy debacle that was the Clinton health care reform attempt, the conventional wisdom was that this time, due to several factors, things would be much different.

The first factor was that Obama himself would make a difference. The size of his electoral victory and his strong commitment to the issue during the campaign indicated he would have the political capital he needed to push through tough reform. The belief was that he would also include Congress much more in crafting solutions; therefore, he would have a much friendlier audience on Capitol Hill.

The second factor was that the country would finally be poised to accept a major health care reform. The number of uninsured Americans increased over the past decade, while costs skyrocketed and coverage was reduced among those who were still insured, the thought was that the American people were now ready to alter the way health care is delivered in this country. Not to mention, that Americans just elected a president who ran on a platform of major health care reform.

Finally, the current status of the Republican Party was thought to be a key factor in helping health care reform be a true possibility this time. Because of the weakness of the party in terms of both numbers and popularity, most believed that any serious political opposition to reform would be very low (Ipsos Public Affairs, 2009).

Big Ideas Don't Always Lead to Big Changes

The conventional wisdom was wrong and now we are in the midst of an impassioned political debate. One look at the recent headlines show that all three of the aforementioned propositions have been undercut. One major obstacle to health care reform can be attributed to Obama's declining approval ratings. One article after another points to how Obama's poll numbers are heading south as he gets farther and farther away from the election (whether those poll numbers are going down because of the health care push itself remains up for debate) (Balz, D. and Cohen, J., 2009). This, of course, makes it much more difficult for him to rally congressional support for such politically tough decisions as health care reform. This is even the case among the more conservative members of his own party, as so-called Blue Dog Democrats are threatening passage in the House.

Another significant obstacle is the American public's skepticism of change. While more Americans realize the importance of health care reform than ever before, the gap between their overall perception of the system and their personal view has not moved much at all. So, again, while people want something done, the devil remains in the details (Fram, 2009).

One last obstacle that can't be overlooked is the power of the Republican Party. Even though the Republican Party may be considered unpopular (their approval rating is in the high teens and low 20s), they are proving to be a staunch opposition nonetheless (PollingReport.com: Republicans, 2009). This is not entirely surprising because they are primarily concerned with satisfying their base at this point (because their support is low) and that means basically saying no to everything. In addition, Obama's insistence that this be as bipartisan a process and result as possible (usually the case with such politically "dangerous" issues), means that the Republicans have a more important seat at the table than they would otherwise.

Any Hope for Health Care Reform on the Horizon?

What does this mean for the prospect of health care reform by the end of this year? Even though most Americans want something done, the U.S. system tends toward inaction when there is not an overwhelming consensus on a goal and on how to get there. Sometimes, when that consensus is absent, a very popular president can overcome that systemic paralysis. On the other hand, neither an overwhelming consensus nor a very popular president currently exists, indicating that the chances of a major overhaul seem distant. That being said, this is a health care debate and so predicting anything can be dangerous. One thing is certain: nothing should be assumed until a bill is on the president's desk.

References
Balz, D. and Cohen, J. (2009). “Poll Shows Obama Slipping on Key Issues.” The Washington Post.
CBS News Poll. (2009). “The Debate Over Health Care.” CBS News.
Fram, A. (2009). “Poll: Confidence Grows for Health Costs, Access.” Associated Press.
Huckabee, D. (1995). “Reelection Rates of House Incumbents: 1790-1994.” CRS Report for Congress.
Ipsos Public Affairs. (2009). Ipsos/McClatchy Poll: Health Care Reform.
PollingReport.com. (2009). Congress: Job Ratings.
PollingReport.com. (2009). Congress: Republicans.