Liberals are scratching their heads. How could the right wing Heritage Foundation come up with mandates and win with them, while the liberals have found it a losing political issue? What happened is that conservatives, knowing how to talk populist, spoke of the lower classes and welfare receivers as being able to avoid paying for their care and forcing us (read: middle class) to pay for them (read: the poor and unwilling to work or pay). In the United States, this is a winning argument that Reagan and others understood. The right wing philosophy of means testing and punishing the underclass which is righteous, because of the accepted, but erroneous assertion that the poor are either at fault or deserving of their lot in life. The rest of us must force them to work by making life too difficult not to work. In this way, the mandate was a method of forcing the underclass to “pay their fair share.”
Liberals have been able to take that politically winning issue and turn it into a losing argument quickly and effectively. Unwilling to play the same game of criticizing the poor for their lot in life, the liberals portrayed the mandate as a way to make average citizens who aren’t poor pay into the system, and then subsidize the poor through Medicaid and other methods. The liberals talk about how this will help the vast uninsured, which is well understood by Americans to indicate the poor and those unwilling to get jobs or jobs with health care.
By flipping the us versus them argument, it left the conservatives with an easy dismissal of the mandate. When the mandate, which former Gov. Romney supported on the state and federal level, he spoke about as a way to squeeze the poor and undeserving to pay into the system and decreased charity to the poor. Now that the liberals have switched the understanding of the mandate to be a burden on middle class, young and wealthy people, and a way to fund the poor getting care with only an indirect upside for those paying for health care, Romney can easily speak out against this unpopular effort. And Scalia can say that this is akin to making buying broccoli mandatory.
So should the liberals, speak about the mandates in the demeaning ways that the right wing used to, or should they continue to use the patronizing and moralizing methods that are their normal arguments. From a political point of view, it would seem smarter to use the easier to sell right wing method. But it may be too late and I doubt liberals have the capacity to be that mean-spirited and ends justify the means based.
There is an alternative that the liberals do not have the understanding and/or inclination to use politically. Change who the “us” are and who the “them” are. Currently the argument of the liberals and administration is that the health care reforms will not change most people’s health care, because they will be able to keep what they have. This is exactly the opposite of the truth and what should be said. Rather, under the new law, it will mark the first time that everyone can keep their health care and it can never be taken away or lost. No one will need to lose coverage because the change jobs, get sick, get pregnant, become an adult, start a new small business. This a a monumental change, as no longer can your insurance company deny you care, no longer does that lay off mean your family can be bankrupted in the two months it takes to get a new job, or by losing coverage at the new job due to a past illness or sunburn. The “them” is then the bosses and insurance companies and faceless HR bureaucrats who weasel out of any agreement you believed you had.
Once you have change the “us” versus “them,” you can address the mandate by referring to it as a way to keep the poor honest and the rich from weaseling out of paying their fair share. I do not have high hope for the liberals from learning to stop their losing rhetoric, after over twenty years liberals have not changed despite a few brave souls trying.
And now, finally having passed a comprehensive health care plan, the liberals may succeed in making it easy for the Supreme Court to reverse precedent and kill health care reform despite the fact the Republicans are succeeding in turning Medicare into a mandated buying of private insurance. Once the Republicans kill Medicare, they will use the courts to kill the mandate for the elderly too.
Health care itself is misunderstood by both most liberal and conservative pundits. Everyone receives preventative health care administered by the government every day of the their lives. Through vaccines that others get which keep us from getting sick, to the major efforts of food and safety inspections that protect everyone’s health by avoiding accidents, poisons and pathogens. And by being born with health care for the mothers avoids lifelong or limiting ailments that would impact health care costs as an adult. And avoiding health care by nursing a cold at home impacts economic output as does going into work with a cold impacts other peoples economic output. Health care is a societal issue, not solely an individual choice issue. When you consider how SARS impacted Hong Kong and Toronto, when spraying to diminish disease spreading insects and stopping the distribution of ailing livestock, the government support of clinical trials that depends on the participation of groups of people, the inability to talk about health care in politics as being societal and environmental issues rather than a market of individuals is one of the most dangerous and self-destructive characteristic of the United States.
Without a societal answer for health care we are unable to meet the goals set out in the Preamble of the US Constitution. Without a universal and comprehensive health care system, we are condemning our society to poorer health and less freedom to live longer, be entrepreneurial, change jobs without risking the lives of our families, enjoy healthy children and longer lives for our parents.