The New Health Dialogue

So Joanne began asking me about my grad school classmates’ thoughts on health reform. These fine individuals will be running hospitals at the manager level soon, and some at the C-suite level in a decade or less. Their views matter. So I did what any graduate student with a Hill background would do. I formed a small focus group.

 

Although I intended this first post to be about my classmates'  health reform views, I decided I need to first write a bit about the context, and their politics, because it turned out to be more interesting and less predictable than I expected.

 

To select four participants for the focus group, I listed my classmates into four columns: male Democrats, male Republicans, female Democrats, and female Republicans. (Note that these were my best party affiliation guesses after knowing these individuals for three semesters -- there was no questionnaire.) From there, I picked one person from each category whom I thought would best represent the “average” views of a heath executive with their same gender/party affiliation. I came up with Richard, Tim, Jane, and Michele (respectively).  ("Jane" asked that I not use her real name.)

 

Each graciously agreed to spend ninety minutes with me at the Grant House last week discussing their views of the health reform bills. But as soon as we began the meeting, they wanted to know why they were chosen; speculation included ethnic diversity and that they were all political moderates. Then I revealed that each person was chosen because I thought he/she represented one party or the other. Jane said yes, she considers herself a Democrat. Michele wasn’t offended that I thought she was a Republican, but considers herself “50/50” split between the two parties and held that position even when pressed. Tim maintained that he was a centrist. And Richard, to my surprise, considered himself “60% Republican.”

Hmmm. How could I have gotten this so wrong?

OK, I said, let’s go around the table and say how we voted in 2008. Jane and Richard said Obama, while Michele and Tim said McCain. Voila! I was right. Or so I thought, until things unraveled further.

The Democratic Jane, I learned, had voted for Bush in 2004, while Michele -- my "Republican" -- quickly chimed in to say she voted Kerry. Tim said he voted for Bush, and Richard, despite being civically engaged and quite politically aware, didn't vote in 2004 because he disliked both candidates. Of the four participants, only Tim voted for the same party’s presidential candidate in 2004 and 2008 -- yet he still doesn’t necessarily identify with that particular party, the Republicans.   

I think this is telling as we continue the Massachusetts Senate post-mortem. Outside of hyper-ideological Washington, regular people change their political views based on how much they like one candidate and what they think about the direction of the country. From what I can see from Richmond, Scott Brown was a really strong campaigner. Despite the fact that Massachusetts voters are bluer than most, they produced a major once and future Republican presidential contender in Mitt Romney. In fact, Romney’s near-miss in the 1994 Senate race against Ted Kennedy shows how close Massachusetts came to electing a Republican senator fairly recently. 

The underlying theme here is incumbency. Once a senator wins an election, it is fairly hard to unseat him/her (see “Lieberman, Joe”). Massachusetts hasn’t had an open senate seat since 1984 -- nearly three decades. With an open seat and Democrats controlling the White House and with supermajorities in Congress, a strong candidate can bring the pendulum back the other direction.

This doesn’t mean that health reform is any less important. As has been pointed out on this blog, the majority of MA voters motivated by health reform voted for Coakley. Stakeholders continue to support reform, too. Congress has an obligation to get back to work on this issue and ensure that the health care system can be made more accessible and sustainable. 

Subsequent posts on this theme will examine the health reform views of Richard, Tim, Jane, and Michele. Stay tuned for their views on changing the delivery system.