By David Shribman Special from the Pittsburgh Post-Gazette
WASHINGTON -- President Barack Obama asked for a national debate on health care, and he got his wish. The problem for the Democrats, and consequently for the president, is that the national debate is still going on. Technically called the Patient Protection and Affordable Care Act, sometimes referred to as the ACA and often described as Obamacare, the overhaul of the American health care system was signed into law almost exactly four years ago. And yet the debate rages on -- and will continue to do so if Republican lawmakers, strategists and potential presidential candidates have their way.
Other issues in American life have persisted politically for more than four years -- slavery, of course, monopolized the political debate for a third of a century, and Vietnam for a decade -- but such endurance is rare, and in ordinary circumstances the likelihood of an issue with high political attention in April remaining at the top of the mind in November is very small.
The Republicans are wagering that health care will be different, and they surely take comfort in polls that show continuing public skepticism if not hostility toward the health care law. Overall, Americans disapprove of the 2010 act by a 54-to-43 margin, a range that in the Gallup poll has remained generally consistent since last fall.
It is true that disapproval of the health care law varies substantially by party identity. Look carefully at those Gallup numbers and you will see that Republicans are as much as 17 times more likely to disapprove of the law than are Democrats. That is a stunning figure but, given the contemporary political atmosphere, not out of synch with the polarized national conversation.
In ordinary times Democrats might actually take comfort from those findings. If the overall margin against the law were 11 points and their partisan rivals were 17 times more likely to oppose it than Democrats themselves, then there might be a glimmer of hope for them. But Gallup also tells us that independents are as much as five times more likely to oppose the law as Democrats. That's trouble.
But it is not a surprise, and the Democrats have their talking points ready. They are saying, though not everybody is believing, that in this fall's midterm congressional elections they can run on Obamacare, not run away from it. Here's the argument, provided in an interview last week with Debbie Wasserman Schultz, the party chair:
"Are Republicans really going to ask 8 million people to give back their insurance and to take their kids under 26 off their health care and to deny affordable coverage to people with pre-existing conditions? They're obsessed with opposing the president, even if opposing the president hurts the middle class."
She acknowledged that Democratic candidates in some races may prefer to express skepticism of the health care law -- "It will be an individual decision," she said -- but insisted that the issue is a winner, even in her state, where in January a Republican won a special election in a Tampa-area district carried by Obama in both 2008 and 2012. "That was truly a special election," she said.
The importance of health care in November depends in some measure on the magnitude of two issues -- the level of the law's applicability and the level of the law's opposition.
The Gallup survey shows that two-thirds of Americans believe they are unaffected by the health care law, and the division between those who believe the law has hurt them (18 percent) and those who believe it has helped them (15 percent) is tiny.
Though the Obama administration has highlighted the 8 million people who have signed up, the newly insured constitute only 4 percent of the country and, given established voter participation patterns, represent an even smaller part of the voters in a midterm election. Though these newly insured skew Democratic by a 54-24 margin, they are generally younger than the population overall and thus are far less likely to vote.
Plus these factors: Democrats hope the opposition to the health law will wither away much the way the opposition to Social Security disappeared over time. The GOP ran against Social Security in the 1936 election and their nominee, Gov. Alf Landon of Kansas, lost all but two states.
The difference, however, is that virtually everyone paid into Social Security, giving almost all Americans a stake in the system and, eventually, benefits from the system, an advantage not replicated in the health law.
In addition, the people who dislike the Obama health law have a higher level of political intensity and involvement than do the people who support it.
Obama and his allies will portray the plan as a success, arguing that 15.6 percent of Americans now are uninsured, down from 18 percent a year ago. (Within March alone, according to Gallup, the rate of uninsured dropped more than a point.)
True -- but as recently as the beginning of the 2008 general election, when Obama was the Democratic nominee, the rate was even lower (14.4 percent). Team Obama is going to have to have an answer for that.
In fact, the Democrats may continually have to provide health care answers, or a series of revolving answers. There is every indication that the Republicans who hope to ride into a Senate majority on the health care issue also hope to ride into the White House on it. Most of the likely presidential candidates have stated unequivocal opposition to the Obama health care bill.
All this raises a vital strategic question for the Republicans: Might it actually be better for the GOP to fall just short of a Senate majority in November than to win a majority in the chamber?
The answer may be yes. If they inch up against the Democrats but don't actually seize Senate control, they'll have little hope of overturning the Obama plan or, given the president's certain veto of any repeal legislation, substantially weakening or defunding it. They will force Democratic senators who supported the legislation to squirm as they affirm their 2010 vote and leave the health care plan in place as a pinata: something they can bludgeon to their advantage in the 2016 primaries and the presidential general election.
The Republicans can win by losing. And the Democrats can lose by winning. It's a cynical outlook, to be sure. But it is perfectly suited to an age of cynicism.