What Happened?

“What we have here is a failure to communicate.”

“The Captain” as played by Strother Martin, Cool Hand Luke, 1967

So how did we get here, Captain? How, after coming to within a millimeter of plugging the leaky ship we call health care, are we now on the verge of the vessel rolling on its side and sinking into an inky sea of name calling and recriminations?

The short answer to “what happened,” of course is Massachusetts. The searing incompetence of Martha Coakley’s senate campaign, a White House political office snoozing at the switch and the genial allure of Scott Brown in the Bay State has made for some very unpleasant mathematics in the Senate.

But more important, by January 1 the public—both in Massachusetts and nationally—had become squirmy to the idea of reforming such a large part of the national economy. While no one poll is Delphic, the sum of polling data suggested that roughly half of Americans had serious doubts about where reform was going.

Two years ago the public was overwhelmingly supportive of a major health care overhaul. A Kaiser Family Foundation/Harvard School of Public Health survey then found that 59 percent of the public supported a universal requirement for families to have insurance and for companies to supply it.

By last summer—just six month ago—public support was still high, while organizations from the American Academy of Family Physicians to labor unions to the pharmaceutical industry both supported reform and opened their checkbooks to lobby their support.

What went wrong was that the administration and the moderates and progressives in congress lost control of the communications war and ever since have been on the defensive.

There was a lot for everyone in the legislation: closing the Medicare drug “doughnut hole,” guaranteeing insurance even if you’ve lost your job and taking steps to moderate health costs. But by its very nature health reform is complex and not very sound bite friendly. The reformers message veered from “health care reform” to “health insurance reform.” No Democrat could convincingly describe how reform would save taxpayers money nor guarantee that taxes would not go up. There was no antidote to the accusation that support from Louisiana and Nebraska were paid for with special earmarks.

Meanwhile, opponents solemnly warned of socialized medicine, death panels, and gutted Medicare. The hostiles played on the understandable concern about the rising cost of government and that no one really understood how much reform would cost us.

In a politically charged environment, the simple message always trumps the complex. Isn’t that the first law of political pr?

What President Obama and his allies failed to do was to boil down reform messaging to the key points that the majority of Americans would like—that it is linked to economic survival, that it would create greater security and that many benefits, such as guaranteed coverage would start the moment the legislation was signed.

The Social Security Act is a massive, jargon-ridden document, yet everyone understands and embraces its basic elements. The President had the opportunity to position health care legislation similarly, but failed to.

Here’s good news if you believe in reform: When you divide health care reform into individual elements the public even now supports it. A Kaiser Family Foundation survey released last Friday confirms this:

“The January Kaiser Health Tracking Poll, conducted before the Massachusetts Senate vote, finds opinion is divided when it comes to the hotly debated legislation, with 42 percent supporting the proposals in the Congress, 41 percent opposing them and 16 percent withholding judgment. However, a different and more positive picture emerged when we examined the public’s awareness of, and reactions to, major provisions included in the bills…

“For example, after hearing that tax credits would be available to small businesses that want to offer coverage to their employees, 73 percent said it made them more supportive of the legislation. Sixty-seven percent said they were more supportive when they heard that the legislation included health insurance exchanges, and 63 percent felt that way after being told that people could no longer be denied coverage because of pre-existing conditions. Sixty percent were more supportive after hearing that the legislation would help close the Medicare “doughnut hole” so that seniors would no longer face a period of having to pay the full cost of their medicines.”

Clearly the Dems bollixed the message.

Where do we go from here? At best it will be months before a new legislative roadmap is drawn. With any luck, the administration and its allies will pair and trim the proposal in a way that will get it back on track with some Republican support. But will not have all of the elements needed to completely right our health care boat and in the meantime millions of Americans will be at risk of losing health coverage and at risk of economic ruin. Conservatives haven’t so much won as the public has lost.

(This note was published earlier this week on Jack O’Dwyer’s Web site. Thank you, Jack.)