President Obama needs to become the educator in chief on healthcare reform. And he should start by telling Americans something most of them do not know: he and the Democratic Congress have saved the most popular healthcare program in American history, Medicare.
The White House should begin a campaign to remind Americans that because of the healthcare reforms Obama signed in 2010, Medicare is securely funded and monitored. The administration should also point out that the $455 billion reduction of Medicare spending will mostly affect unfair and wasteful taxpayer subsidies of private plans like Medicare Advantage. But it should be prepared to address other legitimate fears. Isn’t Medicare facing bankruptcy? Is this the start of formal rationing? How is the Independent Payment Advisory Board going to monitor and advise on cost control? How will state insurance exchanges lower costs and maintain quality?
These questions are important and must be dealt with in the implementation of the law. The Obama-led program could educate the public with town meetings, media briefings, interactive websites, blogs, TV and radio shows, and fireside chats. And the president should be backed up by the many allies for healthcare reform, including labor, some physician and hospital organizations, some insurance companies, senior groups and private-sector corporate leaders, MoveOn.org and doctor coalitions.
Why start with Medicare? Because it’s the easiest subject on which to begin educating people about what the administration has accomplished. The reform legislation is voluminous and complicated. Could it have been simpler? Maybe. But this is the best our officials could do after close to a year of deliberation.
Healthcare reform is worth defending, and the president had better do it fast. Why? Because it’s in jeopardy. The Republican victory in November was achieved in part by a commitment to repeal "Obamacare." The administration was confident the litigation by the state attorneys general was frivolous. But in December the Virginia attorney general succeeded in getting a federal judge to rule it unconstitutional for the government to compel Americans to buy health insurance. If the Supreme Court concurs, universal coverage and cost control will be severely jeopardized. Republicans have already introduced a bill in the House to repeal the law. If that is not successful, they threaten to "starve" it by not appropriating start-up costs.
In addition to the loss of the House, Democrats suffered major setbacks in the states, with Republicans now controlling twenty-nine governorships. Eighteen state legislatures converted from Democratic to Republican. These developments are critical in the implementation of the reform, since the law assumes cooperation by state governments. Those states dominated by the GOP may begin to thwart implementation.
What caused the erosion in support for this historic legislation only months after passage? Exit interviews November 2 showed a slight majority of voters in favor, but 58 percent of senior voters wanted it repealed. First, Democrats were unwilling to defend and promote the law in the campaign. Second, and more important, Republicans shrewdly demonized the legislation as "socialized" medicine and an unconstitutional government takeover of healthcare. Presidents Roosevelt and Johnson faced similar opposition to Social Security in 1935 and Medicare in 1965. But they educated the public about the programs and the need for higher taxes to operate them. Even though there were national elections before implementation, both laws easily survived without change.
The Obama administration, national Democrats and advocates of reform have retreated from this monumental law. They have hardly mentioned it since the midterm elections. It appears the strategy has been to hunker down and quietly move implementation forward for the next four years, when full coverage of 32 million Americans will take effect.
That approach is foolish and dangerous.
It’s foolish because educating Americans about healthcare is easier than politicians think. In 1968 I started, and ran, one of the first community health centers in the country. Many Republicans and physicians branded it socialized medicine. We were concerned about continued federal-state support. However, with extensive education and demonstrable results, the Republicans under President George W. Bush doubled funding. Now the Obama plan doubles the number of Americans who will be served by community health centers, to 40 million.
I have fought these battles for a long time—as a physician, as a two-term mayor of Louisville, Kentucky, as a county executive and as a candidate for the US Senate. I know which fights we can win, even in red states. And I know that a campaign focused on what this administration has already done to preserve and expand Medicare, along with universal health coverage for all Americans, is a winner. I also know that in this politically volatile moment, it’s dangerous to avoid the fight. The question is not, Can the Obama administration win this battle? It must win it if it is to have a second term. If the Republicans want to repeal healthcare reform, they will have to win the presidency. Republican strategists have looked at how they were able to defeat "Hillarycare" and then win control of Congress in 1994. They think defeating "Obamacare" will lead to capturing the White House in 2012. And they may be right.
President Obama can do right by the country and by his own political future if he begins a national conversation about healthcare reform. He should open the campaign right away, at a press conference next to the national Christmas tree, surrounded by some of the hundreds of children who are now getting coverage despite pre-existing conditions; by older children who will remain on their parents’ plan until age 26; and by seniors who are having the "doughnut hole" closed on their Medicare prescription plans and getting coverage on preventive measures like mammographies and colonoscopies as of January 1. It is time for Obama to use the bully pulpit.