After Health Care Reform Comes the Congressional Elections

As even President Obama’s sternest critics admit, the passage of comprehensive health care reform last night is a historic moment in American public policy. It represents a giant step toward completing the American-style social insurance state, and it underscores the deep divide between the two political parties over the role of government. The middle ground has all but disappeared.

Because that is the key issue, despite the passage of the bill, Democrats remain on the defensive. Trust in government is near historic lows, and many Americans who desperately want health care reform doubt that capacity of our public institutions to deliver it.

That is why the task now shifts from legislation to persuasion. As even the president’s staunchest defenders admit, the White House lost control over the public argument last summer and didn’t regain it until just a few weeks ago. The consequence was a near-death political experience that no Democrat wants to repeat. The president and Democratic congressional leaders should now take a page out of the Republican playbook: get together, review the evidence, decide on the key points about health reform to be driven home between now and November, agree on the short, memorable phrases they will use to make those points, and then do everything possible to get Democrats to repeat that message until election day.

It was said half a century ago, and remains true today, that Americans are ideologically conservative but operationally liberal. If the debate this fall is purely ideological, the Democrats will lose it. If the debate is about specifics—what the bill does for me and my family—they have at least a fighting chance of prevailing. Because public expectations have been driven down so far, the truth can only benefit the party that has pursued universal health insurance since the 1930s and whose political future now rests on public acceptance of that accomplishment.