So the word is that Mitch Daniels is getting more serious about running for President. I think that is a good thing, but I'm not optimistic about his chances of actually getting the Republican nomination - this apart from the suspicion has earned among social conservatives. There is a reason why the House Republican Pledge was so weak on health care policy and did not offer a serious and specific plan to bring the budget deficit under control. The House Republicans were giving the people what they thought the people wanted. Hearing about the kinds of long-term economic changes we need will be complicated, shocking and boring to much of the electorate. Candidates who try talking in detail about a serious reform agenda will find it some combination of difficult and dangerous. If you were a hack political consultant advising a presidential campaign, which message on health care would you advise a prospective presidential candidate to articulate?
1. Talk about repealing Obamacare. Especially talk about restoring the cuts to Medicare. Then talk about how you are for tort reform and against socialized medicine.
2. Talk about repealing Obamacare but also talk about how you are for policies that will cause most of the viewers to lose their employer-provided health insurance and transition them to buying policies on the individual market, but that those policies will leave them with more take home pay and better health care security. Also explain about how you plan to cut projected spending on Medicare and convert Medicare into a voucher to buy private insurance, and that while this plan is tough, it will give the elderly better care and more choices than the death panels that will come from centrally rationed care.
The first path is far easier on many levels. It pushes familiar buttons. It is reassuring. The only people who seem to risk losing anything are trial lawyers (you know like John Edwards.) The second approach is more responsible on policy but much more difficult politically. Most people like their employer-provided health insurance (except for the premium increases.) From what they know, buying comparable health insurance on the individual market is much more expensive. Cutting Medicare and then giving old people some money to buy health insurance just sounds crazy. There are explanations of how our system of comprehensive health care prepayment (which we call "insurance") makes health care more expensive. There are explanations for how kinds of health insurance with lower premiums where you pay for routine costs will leave you with more money and at least equal health care security. There are explanations for how a defined contribution version of Medicare will give the elderly better care and better (though never perfect) options than the death panels that are the outcome of government-run medicine. You have two minutes to make the explanations and please stop talking when you see the light turn red. The majority of the audience comes in having no idea what you are talking about. They know Republican are for tort reform and interstate purchase and restoring the cuts to Medicare. Now you say you want to uproot what they have always heard was the greatest health care system in the world.
McCain actually had a pretty good health care plan in 2008 but he only mentioned in passing and only barely tried to defend it from attacks. Explaining or defending his health care plan would have taken too much time away from taking cheap shots at Romney's decision to go into private business, complaining about earmarks, and pretending that he hadn't been for amnesty before he was against it. Anyway, it was complicated, couldn't be condensed to a slogan like "drill baby drill" and maybe McCain just didn't give a damn.
Daniels seems a lot more serious about domestic economic policy and he has more going for him than just seriousness. A lot of the ideas behind market-driven health care reform seem counterintuitive given the experiences of most Americans. Daniels has already instituted at least one health care policy that saved the government money while increasing the take home pay and maintaining the health care security of recipients. Being able to point to real world outcomes is at least as good as the best explanation.
But even with a record of success, increasing public understanding of the health care and entitlement reforms we need will include an enormous upfront investment in expanding public understanding. It would be enormously helpful if a high profile presidential candidate didn't take the easy way out and instead worked at expanding public understanding of reformist health care and entitlement policies. Such an approach would have costs in the short-term and those costs might mean reducing one's chances of being nominated in 2012. But not taking the easy way out will make it easier for public figures in the future to talk about and advance similar policies. The more people who connect HSAs with more money in their pockets the better. The more people who connect a conservative version of Medicare with better care and more choices and no death panels the better. It would be great if every major contender for the 2012 Republican presidential nomination emphasized responsible plans for dealing with the scope of our economic problems. To have even one candidate do such a thing would be an improvement over 2008.
Run Mitch Run.