How to Sink a Three-pointer Next Wednesday - Part I

In spite of a slight uptick in Barack Obama's job performance score in the Real Clear Politics index over the past day or two, the overall picture in the month-end polls is a continued decline in the American public's attitudes toward the president, Congress, and both political parties, especially the Democrats, and a tightening in the generic congressional vote since the beginning of the year. These same surveys also point to the increased importance over the past several months of health care reform to voters relative to other issues. For these reasons President Obama's speech to a joint session of Congress next Wednesday is crucial to the fate of his presidency and his party. Just how should the president shape this key speech to win the day next week and beyond?

Most obviously, recognize the clear importance of health care reform to the electorate. A late August Pew research survey indicates that health care has almost caught the overall economy in importance to the American public. Twenty-percent now say that health issues are the major problem facing the country today. That's about seven times higher than in January. By contrast, while a plurality still perceive the economy is most important, the number saying that fell from 53% in January to 27% currently. In addition, the number rating unemployment as primary dropped from 31% to 19%. Concern for the financial system also has been cut in half (from 16% to 7%). Overall, the percentage citing any economic issue has dropped from a near unanimous 80% at the start of the year to a bare majority (55%) now. In part, the increased perceived importance of health care reform is a self-fulfilling prophecy: if the media, the punditry, and the political community, including President Obama, say an issue is important, the public eventually catches on. As a result, the number claiming in the Pew research that they have heard "a lot" about Congressional efforts to reform the health care system increased from 41% in July to 53% in late August. This increased level of importance makes the outcome of the effort to reform health care crucial to the Obama presidency, its legislative initiatives in other arenas, and to the results of the 2010 mid-term elections.

Failure to properly address that issue in 1993, at least in part, cost the Democratic Party control of Congress and could do so again next year. Once the GOP took control of Congress in 1994, President Bill Clinton was forced to severely scale back his efforts to change other aspects of American society and eventually announce that the "era of big government is over." President Obama's speech to Congress on September 9 is an important first step in redefining the health care reform effort and setting the tone for the rest of his presidency.

Don't hesitate to take credit for perceptions that the economy has improved. There is another reason for the increased public concern with health care reform and the decline in concern with economic matters. Recent evidence suggests that the economy has improved recently. For example, U.S. productivity has achieved its highest level in years and studies indicate that the TARP policy, harshly criticized as a "bailout" for Wall Street, is actually making money for the federal government.

While few believe that the economy is completely out of the woods, the public has tentatively begun to detect these economic "green shoots." An Ipsos/McClatchy poll indicates that the number believing that the U.S. economy has "turned the corner" has increased from 3% in March to 11% in late August while the percentage perceiving that the "worst is yet to come" fell from 57% to 35%. Instead, a plurality (49%) says that the economy has "stabilized, but not yet begun to improve." Similarly, a CBS News poll indicates that more than a third (36%) believe that the national economy is "getting better," while only 25% say it is "getting worse." Most important, the percentage saying they are very concerned about a job loss in their household is down from 44% in April to 26% currently. Such Obama and Democratic policies as the Economic Recovery Act, the auto and financial industry loans, and the "cash for clunkers" program have played a part in these early signs of recovery. The president should not be shy in taking some credit for these economic gains.

Emphasize that the desire for health care reform is in the American mainstream and not something "radical," "socialist," or "Nazi." In spite of charges over the past several months by Republicans, conservatives, and gun-toting tea-baggers that reforming the health care system is somehow un-American, the CBS News poll indicates that a clear majority of the electorate favors either fundamental changes (55%) or a complete rebuilding (27%) of the U.S. health care system. There is surprisingly little partisan variation in the perception that the health care system should be reformed fundamentally or rebuilt. This is a long-standing concern; these numbers have changed very little over the past two decades. Moreover, in spite of the belief that the Medicare program is the "third rail" of American politics, most Americans also believe that it should be fundamentally changed (52%) or rebuilt (16%). Nearly half of seniors (46%) concur in this assessment. President Obama should make it plain that his call for health care reform simply reflects what most Americans have favored for many years.

Clearly explain, perhaps for the first time, what his and Democratic health care reform proposals will and will not do. The CBS News survey indicates that not even a third of Americans (31%) clearly understands the health care reforms currently under consideration by Congress. Two-thirds of all voters (67%), including 58% of Democrats, 69% of Republicans, and 74% of independents, say these proposals are confusing.

While the media and health care reform opponents bear some responsibility for the muddied waters, President Obama and his allies deserve their fair share of criticism. And, American voters are more than willing to give them blame. Less than a third of the electorate (31%) and only half of Democrats say that the president has clearly explained his plans for health care reform. With four or five different health care reform bills before Congress and the president's surprising reticence, before now, to strongly involve himself more than sporadically in the issue, the public's confusion about what health care reform entails is certainly understandable. To date the president has largely let others carry the ball in the effort to reform health care and his opponents have taken full advantage of the vacuum. The president's address to Congress next week is a big opportunity to fill that void by clarifying and simplifying what he and his congressional allies are proposing.

Provide a clear list of the specific benefits of his health care reform proposal. Letting others define his health care reform policies has been very damaging for the president. Since June, according to CBS, the number that disapproves of his handling of health care matters has increased from 34% to 47% while the percentage who approve has fallen from 46% to 40%. As a result, Pew says a plurality now oppose (44%) rather than favor (38%) the health care proposals now before Congress. And, yet as a late July Time Magazine survey indicates, when pollsters present voters with a listing of the specific elements of the health care reform package, solid majorities support most of them.





Provide tax breaks to small businesses to make healthcare coverage for their workers more affordable




Require healthcare insurance companies to offer coverage to everyone who applies, even those with pre-existing health conditions




Provide coverage almost all Americans, even if the government needs to subsidize healthcare for those who can't afford it




Raise income taxes on those earning more than $280,000 annually to help pay for healthcare for those who can't afford it




Create a government sponsored public health insurance option to compete with private health insurance plans




Create a national single-payer plan similar to Medicare in which the government would provide healthcare insurance for all Americans




Require all but the smallest businesses to provide health insurance to their employees or pay a penalty




Tax employer-provided health insurance to pay for the additional cost of expanding healthcare to those who can't afford healthcare now




Peter Hart and Bill McInturff combined most of these specific elements in a single question in their July survey for NBC and the Wall Street Journal and described it as "the health care plan that President Obama supports." A clear majority (56%) of the public said they favored the plan. Only 38% were opposed. These numbers were virtually unchanged since the question was first asked in April. When poll respondents clearly hear and understand the specific aspects of President Obama's health care reform initiative, most favor those elements individually and when they are combined. Next week the president should take advantage of his opportunity to provide the same clarity to the entire American public.