On Tuesday morning, House Speaker Nancy Pelosi met with a bunch of journalists and bloggers from assorted progressive media outlets. As they asked her about the stimulus package, health care, and her relationship with the White House, she mainly stuck to talking points and hailed President Barack Obama, his budget, the stimulus legislation, and the policy agenda she enthusiastically shares with the White House. She declined to bash Rush Limbaugh (or even talk about him), and said she had no plans to apply pressure on Republican legislators from districts that Obama had won in November.
But what was intriguing was how she foreshadowed the health care reform fight to come. With the White House holding a health care summit this week, the Democrats in Congress are gearing up for the titanic legislative challenge of passing a major health care reform package. In years past, the champions of health care reform have relied on a simple slogan: There are 40 million Americans without health care coverage, and they deserve it. (Now, it's 48 million.) Yet Pelosi noted that delivering insurance to this group of Americans will not be the political or rhetorical centerpiece of the latest health care reform effort.
The "appeal" of this push, she said, will not be that 48 million people don't have health care insurance. "What is important to the bigger population," she explained, "is their own health care." She noted that with health care costs rising faster than any other costs, the key issues these days are the impact of these increasing costs on the economy, on the quality of the care delivered, and on federal entitlements (meaning the costs of Medicare and Medicaid).
Pelosi was signaling how congressional Democrats will be selling their drive for health care reform. She said that the package will focus on science and technology and include major investments in biomedical research, preventative health care, and electronic medical records. She noted that when technological improvements in maintaining medical records render it easy for health care providers to compare the medical treatment of a low-income person with a certain disease with a wealthy person with the same illness, both patients will benefit. That is, the more patients in the information pool, the better for all, including those who already have coverage.
So health care reform will be pitched not primarily as a benefit (or handout) for the uninsured, but as a way to deliver higher quality health care at a lower cost with fewer errors to those who posses some degree of coverage, especially those in the anxious middle class.
Pelosi did say that universality--meaning coverage for all, or close to all--will be a key component of the package. But she and other House Democrats have obviously calculated that concentrating on providing coverage to the uninsured will not win over sufficient majorities in the House and Senate. Given that there are indeed more covered than uncovered Americans, her political calculus makes sense.
The bottom line: the battle cry will not be, "Health care for all!" Instead, it will be "Better health care for you--and also the rest of us." Given how the Hillary Clinton-led crusade for health care reform flamed out terribly in the 1990s, this sort of tactical shift may be warranted. It may even be wise.
BTW, Pelosi also said that legislation to end the don't ask/don't tell policy regarding gays and lesbians in the US military is a lower priority than both legislation related to hate crimes against homosexuals and a bill to prohibit workplace discrimination against gays and lesbians. Before bringing to a vote a measure to kill don't ask/don't tell, she said, "We will have to create an environment in which we will win." And she said she hoped that a cap-and-trade climate change measure will be passed by the House by the end of the year, as part of a larger bill covering alternative energy funding and the development of a smart grid.