Will Health Reform Fail Like Social Security Reform?

These days it is fashionable to compare Obama's health care reform to Bill Clinton's failed attempts to reform health in 1993, as Matt Bai did most recently, and most extensively, in his New York Times story. But maybe the best allusion isn't to Clinton, but to George Bush and Social Security reform -- the most recent blockbuster, partisan battle to change a major entitlement program.

At Time, reporter Jay Newton-Small compares the current debate over the public option for health care to the debate over privatizing Social Security, which reared its head after the 2004 election and promptly crashed and burned. Could the same thing happen to health care? I wouldn't be so sure. In many ways, the Social Security debate is not the right template for the health care reform debate.


First, let's consider the parallels.

1) In 2005, the first year after his reelection, President Bush made Social Security reform the centerpiece of his economic agenda, as Obama has done with health care in his first year.

2) Bush kicked off a 60-day tour to drum up support for the measure, just as Obama and Organizing for America have announced national campaigns.

3) The SS debate was always fiercely partisan, with all Democrats (and a handful of Republicans) facing down the majority of the GOP. The health care debate holds a clear mirror, with all Republicans (and a handful of Democrats) facing off against the Obama-Pelosi juggernaut.

4) Finally, President Bush ultimately supported reforming SS to to preserve benefits for less well-off Americans while shaving off benefits for wealthier workers. This brings to mind Obama's plan to make health care available, and affordable, for less fortunate Americans, which is part of an agenda that Obama expects to pay for by raising taxes on richer Americans.

But there are also ways that health care reform avoids the natural pitfalls of SS reform. Here are some that come to mind:

1) The Wrath of Senior Citizens.  Social Security privatization threatened to permanently change a system that was putting money into the pockets of senior citizens. Why does that matter politically? Because Americans 65 and older make up about 12 percent of the population and three-fourths of them say they vote. That means that in 2008, they probably accounted for nearly 20 percent of the vote. By September, Newton-Small notes, 70% of seniors were on the Democrats' side, and when you've so overwhelmingly lost the senior citizens, you've lost entirely.

But the public option isn't about revolutionizing senior citizen's health care. In fact, if anything it's about creating a Medicare-like (that is, government-run) option for Americans under 65. Compare the AARP's response to the Social Security crisis (which they called a "myth") and health care reform, which they call the "most pressing domestic" issue today. That's the seniors. What about the the demographic most likely to benefit from health care reform? They're also more likely to stay on board in terms of popular opinion. Sixty percent of uninsured Americans are under 35, which is precisely the demographic most likely to support Obama.

2) Americans Never Really Wanted to Privatize SS Anyway.
Bush faced an uphill public opinion battle all the way on Social Security.From the first polls in January and February of 2005, it was clear that most Americans didn't feel that SS was a serious problem, and only a super-minority ever sympathized with Bush's urgency. On the contrary, about 75 percent of the country considers health care a major problem or crisis today. Obama appears to be working with more breathing room than Bush ever enjoyed.

3) Bush Was a Bad PR Guy. As this Brookings study of the failure of Social Security reform points out, the more Bush talked about Social Security, the more Americans cooled to it. It might be too early to say that the same could happen to Obama, but I don't think it's controversial to say that Obama will be a better salesman for his entitlement reform than Bush was. Rhetorically, it's clear that Bush lost the argument to incrementalists, other public figures arguing that SS could be salvaged with modest benefit cuts and tax increases, rather than an overhaul.

4) Was Bush Saving or Scrapping SS? A lot of people weren't so sure. Crucially, the Social Security Administration. A New America Foundation article remembers that the SSA wrote reports detailing the "steep benefit cuts and significant borrowing being proposed to repair the system." I would argue that Obama's health care push is fundamentally different, because rather than revamp our health care system, the bill I expect to come out of Congress this fall would primarily offer uninsured Americans the option to enroll in some sort of government-provided system that negotiates lower prices and competes with private insurers to bring down costs. As a matter of PR rather than policy, it's easier to advertise that kind of reform as supplementary -- even "competitive" --  rather than transformational.