My friend, Keith, from New Orleans, just emailed to say he attended a local “town meeting” on health care and tried to get a word in favor but was almost hounded out of the room.

Why are these meetings brimming with so much anger? Because Republican Astroturfers have joined the same old right-wing broadcast demagogues that have been spewing hate and fear for years, to create a tempest.

But why are they getting away with it? Why aren’t progressives — indeed, why aren’t ordinary citizens — taking the meetings back?

Mainly because there’s still no healthcare plan. All we have are some initial markups from several congressional committees, which differ from one another in significant ways. The White House is waiting to see what emerges from the House and Senate before insisting on what it wants, maybe in conference committee.

But that’s the problem: It’s always easier to stir up fear and anger against something that’s amorphous than to stir up enthusiasm for it.

The White House has just announced a web page designed to rebut some of the insane charges that the right is instigating. That won’t be enough. The President has to be more specific about what he’s for and what he’s against. Without these specifics, the right can conjure up every demon in its arsenal while the middle and left can only shrug their shoulders.

“It’s impossible to fight fearmongering lies about specifics with nothing but positive principles.”

The President needs to be very specific about two things in particular: (1) Who will pay? and (2) Why the public option is so important — and why it’s not a Trojan Horse to a government takeover.

(1) Admit that taxes will have to be raised and that cost-savings won’t be sufficient to achieve nearly universal care. But be absolutely clear that taxes will be raised only on the very top. The President needs to decide whether he favors a surcharge on the top 2 percent, or a cap on tax-free employee benefits (which would affect only the very top), or some combination, and then announce which he prefers and why.

(2) Say unequivocally that the public option is essential for controlling costs and getting private insurers to offer people better deals, not at all a step toward a government takeover of health care.

— Being the one public plan, it will have large economies of scale that will enable it to negotiate more favorable terms with pharmaceutical companies and other providers. (Here, he must clear up any confusion about any deal made with Big Pharma.) But this won’t lead to a government takeover of health care. The whole point of cost containment is to provide the public with health care on more favorable terms. If the public plan negotiates better terms — thereby demonstrating that drug companies and other providers can meet them — private plans can seek similar deals.

— It will have low administrative costs — Medicare’s administrative costs per enrollee are a small fraction of typical private insurance costs — but that’s no problem, it’s a strength. One goal of health-care reform is to lower administrative costs. Competition with a public option is the only way to push private plans to trim their bureaucracies and become more efficient.

— While it’s true that the public won’t have to show profits, plenty of private plans are already not-for-profit. And if nonprofit plans can offer high-quality health care more cheaply than for-profit plans, why should for-profit plans be coddled? The public plan would merely force profit-making private plans to take whatever steps were necessary to become more competitive. Once again, a plus.

— The public plan won’t be subsidized by government. Subsidies go to families who need them in order to afford health care. They’re free to choose the public plan, but that’s only one option. They could take their subsidy and buy a private plan just as easily. The public plan may not dip into general revenues to cover its costs. It must pay for itself. And any government entity that oversees the health-insurance pool or acts as referee in setting ground rules for all plans will not favor the public plan.

Now’s the time for specifics. It’s impossible to fight fearmongering lies about specifics with nothing but positive principles.


Robert Reich.JPGRobert B. Reich is Professor of Public Policy at the Goldman School of Public Policy at the University of California at Berkeley. He has served in three national administrations, most recently as secretary of labor under President Bill Clinton. He has written eleven books (including his most recent, Supercapitalism, which is now out in paperback). Mr. Reich is co-founding editor of The American Prospect magazine. His weekly commentaries on public radio’s “Marketplace” are heard by nearly five million people. This entry appeared on his blog.

Copyright 2009 Robert B. Reich

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