Perspectives on the Health Care Debate
Not since 1935, the year of the Wagner Act and of Social Security, or 1964 and the great Civil Rights Act, has the Congress faced such a critical choice as it does now. The passage or failure of effective health care reform will determine the direction that the country takes for a long time. One can understand the debate from several related perspectives, both constitutional and geographic.
Ten or twenty years ago I read an interesting article in the New Republic arguing that the Senate had turned into the fatal flaw in our constitutional system, because it gave too much power to tiny states, many of which had little involvement in the great problems of modern life. Because those states were white and lacked industry, they were largely Republican, and their Senators played key roles in blocking liberal legislation and demoralizing Democrats around the country, the article argued. I thought the argument was interesting, and it certainly occurred to me in 2000 that the Senate--and the 100 electoral votes it represents--was the only thing that had made the lamentable presidential election of that year even close. George Bush beat Al Gore not only because he managed to escape with Florida's electoral votes, but because he carried 29 states to Gore's 22 (counting DC), giving him 14 more electoral votes unrelated to population. Take away those 102 electoral votes and Gore would have won. I am not sure but I suspect that is the only election in which this has occurred.
Now, however, this problem is re-emerging. The House, apportioned by population, seems ready to pass health care reform and the Democratic leadership is committed to a public option. In the Senate key positions are held by two Democrats from very small (in population) states, Max Baucus of Montana and Keith Conrad of North Dakota. Conrad in particular is trying to stop the public option and claims the votes for it are not in the Senate. When one thinks about this, especially in contrast to the two earlier great crises in American life in the 1860s and the 1930s, some interesting differences occur.
Differences between small and large states were far less significant in the mid-19th century, largely because the United States was still overwhelmingly agricultural. The main difference, of course, was between slave and free states. The smaller free states of the west opposed slavery for some of the same reasons as the larger states of the North: they wanted to preserve their own land for free labor and small farmers. (Ironically, the strength of the Democratic Party in the North was largely in urban immigrant populations, who disliked the Yankee elites and particularly despised black people.) Similarly, in the 1930s the depression had devastated farmers everywhere, enabling Roosevelt to put together a truly national coalition because he saved people all over the country from foreclosure and starvation. The paradox today is that those who need help the most--the citizens of the red states, including the smaller ones in the upper midwest and the mountain states, but especially in the South--have become most distrustful of the government and of the educated elites. The problem the President faces is to convince those people that broader, reformed health insurance will improve their lives, and it is not clear, in the current climate, that he can do so.
A second, unrelated problem may be equally serious. The New Deal, the New Frontier and the Great Society grew in tandem with the American labor movement, which provided much of the lobbying support and the votes for their programs. Over the last 40 years, as I have noted many times, unions in the private sector have suffered a spectacular decline. That is why, in my opinion, the right seems to be out-organizing the left during the health care controversy, successfully packing town meetings and turning them into bear-baitings similar to the confrontations I saw as a student more than 40 years ago between university Administrators and the SDS. (I'll be posting on that soon.)
There seem to me to be three sides to the health care debate right now. One is the insurance industry, determined once again to avoid real reform and to protect its profits, and its equally powerful allies in the drug industry. They are of course heavy contributors to all sorts of key legislators (including Max Baucus), and they are probably helping orchestrate the town hall protests (see below.) They are allied, as the President recognized on Thursday, with the Republican Party, which wants to replay the scenario of 1993-4 when its determined opposition sank the Clinton health care plan and paved the way for victory in the 1994 Congressional elections. And the strength of that party is among the roughly 30% of the population which evidently cannot reconcile itself to the election of Barack Obama and will therefore believe the most absurd accusations about him and the health care program--the ones who are providing the troops for the town hall meetings. Most of them are relatively elderly, although there are exceptions, like the young woman who asked Barney Frank why he continued to support Obama's "Nazi plan" the other day. (Frank's reply should be seen on youtube.) On the other side are younger, more educated Americans who want to see the new President bring intelligence, analysis, and sanity into various aspects of national policy. They have not found a way to make their voices heard yet.
We do not have a smoking gun regarding the health care industry's campaign, but one did emerge this week regarding another key issue, the cap and trade bill. The American Petroleum Institute has circulated a memo to all its members describing its strategy against the bill. It deserves to be quoted in full.
COPY OF EMAIL FROM AMERICAN PETROLEUM INSTITUTE TO ITS
MEMBERSHIP - OBTAINED BY GREENPEACE – AUGUST 2009
Dear API Member Company CEO/Executive,
As I have outlined in the past few editions of the weekly
“Executive Update,” API is coordinating a series of “Energy
Citizen” rallies in about 20 states across the country
during the last two weeks of Congress’s August recess. Most
of these will be held at noontime, though some may be at
different times in order to piggyback on other events.
Thanks to the leadership of API’s Executive Committee, I am
pleased to report that we have strong support for this
first-ever effort moving ahead. Now we are asking all API
members to get involved.
The objective of these rallies is to put a human face on the
impacts of unsound energy policy and to aim a loud message
at those states’ U.S. Senators to avoid the mistakes
embodied in the House climate bill and the Obama
Administration’s tax increases on our industry. Senate
Majority Leader Senator Harry Reid reportedly has pushed
back consideration of climate legislation to late September
to allow Senators time to get their constituents’ views
during the August recess. It’s important that our views be
At the rallies, we will focus our message on two points: the
adverse impacts of unsound energy policy (e.g., Waxman-
Markey-like legislation, tax increases, and access
limitations) on jobs and on consumers’ energy costs. And we
will call on the Senate to oppose unsound energy policy and
“get it right.”
Recent opinion research that Harris Interactive conducted
for API demonstrates that our messages on Waxman-Markey-like
legislation work extremely well and are very persuasive with
the general public and policy influentials. After hearing
that Waxman-Markey-like legislation could increase the costs
of gasoline to around $4 and lead to significant job losses,
these audiences changed their opinions on the bill
significantly. Opposition to the bill within the policy
influentials cohort grew 23 points, from 40% to 63%; with a
19 point increase in those who now “strongly” oppose the
legislation. The data clearly demonstrate the softness of
support of the current approach and very strong opposition
when people are educated about the potential job losses and
energy cost increases. Our expectation is to translate
peoples’ real concerns for job losses and increased energy
costs to all unsound proposals (e.g., Waxman-Markey-like
legislation, tax increases, and access limitations).
We have identified 11 states with a significant industry
presence and 10 other states where we have assets on the
ground. We also have attracted allies from a broad range of
interests: the Chamber of Commerce and NAM , the trucking
industry, the agricultural sector, small business, and many
others, including a significant number of consumer groups,
which have pledged to have their membership join in the
events in states where they have a strong presence. We also
are collaborating closely with the allied oil and natural
gas industry associations on these events.
While such efforts are never easy and the risk of failure is
always present, we must move aggressively in preparation for
the post-Labor Day debate on energy, climate and taxes.
The measure of success for these events will be the
diversity of the participants expressing the same message,
as well as turnouts of several hundred attendees. In the 11
states with an industry core, our member company local
leadership—including your facility manager’s commitment to
provide significant attendance—is essential to achieving the
participation level that Senators cannot ignore. In
addition, please include all vendors, suppliers,
contractors, retirees and others who have an interest in our
To be clear, API will provide the up-front resources to
ensure logistical issues do not become a problem. This
includes contracting with a highly experienced events
management company that has produced successful rallies for
presidential campaigns, corporations and interest groups. It
also includes coordination with the other interests who
share our views on the issues, providing a field coordinator
in each state, conducting a comprehensive communications and
advocacy activation plan for each state, and serving as
central manager for all events.
We are asking all API members to assist in these August
activities. The size of the company does not matter, and
every participant adds to the strength of our collective
voice. We need two actions from each participating company.
Please provide us with the name of one central coordinator
for your company’s involvement in the rallies. (We will look
to this person as your representative to assist the overall
effort.) If you will let me know ASAP, we can be in touch
quickly and provide that person with additional details
about the project.
Please indicate to your company leadership your strong
support for employee participation in the rallies.
(Unfortunately, we are already experiencing some delay from
your regional people since they are not yet aware that
headquarters supports the effort.) I believe that expression
of support to your company leadership is a fundamental
predicate to organizing quickly and achieving success in
The list of tentative venues is attached. Please treat this
information as sensitive and ask those in your company to do
so as well, as some of these places may be subject to
change, and we don’t want critics to know our game plan. You
can assume with confidence that the advocates for Waxman-
Markey-like legislation and the critics of oil and gas are
going to be very active, particularly during the August
Once the list of venues and exact rally dates are
determined, we will contact your company’s coordinator to
distribute the information internally and to coordinate
transportation to the venues, if required, for your
employees. In the meantime, your company’s coordinator could
assist us by telling us in which of the venues listed below
your company has facilities or employees who can
I look forward to working with you to make the August rally
project and the other advocacy steps we are undertaking to
deliver the policy outcomes we support with measurable
results. Don’t hesitate to call me with questions.
All the best,
Jack N. Gerard
President & CEO
Ohio (venue being finalized)
Indiana (venue being finalized)
Sioux Falls SD
What strikes me about this is the complete lack of interest in the details of the Administration's proposal--just repeated references to "Waxman-Markey like legislation," which is by definition bad. Greenpeace, which discovered the memo, pointed out that the $4 gasoline estimate comes from a study by the Heritage Foundation, which receives much of its funding from oil companies as well. The insurance industry has presumably sent out similar instructions. Because most educated, professional Americans of liberal views are not organized and because unions have become so weak, they--like myself, for instance--aren't getting any comparable instructions. That's a problem. Roosevelt's reforms faced the same mixture of determined and hysterical opposition, much of it from older Americans as well. He however rode into office on a much bigger wave of discontent, and even increased his majorities in Congress after the first two years of the New Deal. He made the United States the first truly advanced industrial nation in economic and social policy. The question now is whether we will fall out of the ranks of those nations.