Breaking Unhealthy Habits

Like a specter, the unpopularity of Congress' reform proposals haunted the ultimate goal of universal health care all winter long. This issue weighed heavily on the minds of Democratic senators as they moved toward a final pre-Christmas vote on their version of reform; it became explosive after Scott Brown's unexpected win in the Massachusetts special election. Brown's victory needn't have been a devastating blow to reform—there's always been a clear legislative path forward—but the message it sent to Congress, rightly or wrongly, was that the bad poll numbers associated with health care could have real consequences on Election Day. And that's made a big difference ever since.

But a funny, though little noticed, thing happened as the wounded cause of reform limped toward the finish line: The polling started to turn around.

Take a look at the aggregates available on Barack Obama's job approval rating on health care is still in negative territory but trending upward. Responses to the question of whether you support or oppose Obama's health-care plan are increasingly favorable, too. A new survey from Public Policy Polling also confirms the trend and offers some details about the underlying dynamic -- the gap between Obama voters' assessment of Obama's job performance and their assessment of his health-care plan has been nearly eliminated. Obama's fans, in short, are coming home.

While voters of course assess politicians by their stances on issues, voters' own views are also informed by which politicians are taking which stances. Voters are often simplistically pictured as holding a set of beliefs first, and then accordingly judging politicians based on whether they act in a way that keeps with those beliefs. But in many cases, the causality almost certainly runs in the other direction. People are more deeply attached to their party identity -- or their self-conception as independents -- than they are to their view of complicated pieces of legislation. They also have strong feelings about famous political leaders. Many voters reason heuristically and figure that ideas espoused by leaders they admire are ideas worth embracing.

This mechanic explains the relative success of the Republican Party's strategy of blanket obstruction. Many Republicans are genuinely so conservative that they could never vote for a universal health-care bill. Conservatives of Paul Ryan's ilk want to see consumers buying health care on their own in an unregulated marketplace, abandoning people to the vicissitudes of life unprotected -- a nice deal for the wealthy, as long as they stay fairly healthy.

But for many other Republicans, the substantive basis of their opposition is mysterious. Obama's health-care plan, for example, is basically the same as Mitt Romney's, a plan supported by Scott Brown, among others. Olympia Snowe's top health-care adviser can't give a coherent explanation of why she opposes the bill, especially because she voted for similar legislation out of the Senate Finance Committee. Many prominent Republican politicians used to support an individual mandate to purchase health insurance until Obama took up the cause.

And this GOP non-cooperation has effectively made what should be seen as a bipartisan, moderate cause into something radical looking and controversial. Were Brown, Snowe, Romney, and others supporting this bill, people who think of themselves as independents or moderate Republicans would probably support it, too. Instead, the mere fact of Republican obstructionism made the bill look bad. Even worse, with Republican votes off the table, for months all Democrats did was fight among themselves. They argued over the value of negotiating with Republicans, over the public option, over the treatment of pharmaceutical companies, over the wisdom of even pushing for comprehensive reform in the first place. In the past month, we have finally seen an end to the intraparty squabbling and a reunification of Obama fans behind Obama's plan.

What's more, I think there's good reason to believe that trends will continue in this direction if Democrats press ahead and pass the bill. For one thing, passage will simply generate a couple of weeks of positive process stories. Instead of long magazine profiles dwelling on the question of whether Rahm Emanuel ruined everything or whether Obama screwed up by not listening to Rahm, we'll get stories second-guessing GOP strategy and praising Democrats for their tactical brilliance.

More important, when the bill passes on a party-line vote, all the bickering will be behind us, and we'll fundamentally have a straight-up partisan clash. And guess what? For all the political snags health care has hit, Democrats continue to have a massive generic advantage as the party Americans trust on health care. A March AP/Roper poll found Democrats up 48-37 as the party that would “do a better job of handling health care." In January it was 48-38.

Last December, at health care's low point, an Ipsos/McClatchy poll showed Democrats with a 40-36 edge as the party likely to “do a better job" on health care. In late November 2008, at Obama's high point, it was a staggering 62-23 edge. Last fall, Gallup found that 55 percent of Americans trusted Obama on health care, 48 percent trusted congressional Democrats, and only 37 percent trusted the GOP. This advantage is extremely enduring. Going way back to the 2004 exit polls, John Kerry had a massive edge among voters concerned with health care.

This advantage has been obscured by the process-heavy nature of the press coverage, the intraparty arguments, and the unity of the Republicans. But even that hasn't eroded the underlying strength of the Democratic brand on this issue. And that means that if Democrats can finally move past questioning the precise content of the reform package and just lock it down, they will be well positioned. In a head-to-head matchup between the party that's trusted and the party that isn't, the trusted is bound to come out ahead. All that's needed is enough self-confidence to get over the last hill and have that debate.

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