Why is health care reform unpopular?

Obama isn't giving up, but efforts to revive health care reform seem to be failing. It is worth remembering that Democrats could still pass the bill if they chose to. I still think they should. House Democrats could use their big majority to pass the Senate measure. But they cannot bring themselves to do it. Democrats with substantive objections and Democrats who fear an electoral backlash have fallen in with Republicans to block the reform.

The politics is complicated but fear of electoral reprisals is plainly one critical component. Should it be? Megan McArdle thinks that Democrats would be crazy to press on with an unpopular bill. Nate Silver questions this. He thinks the bill's unpopularity is suspect. He thinks many people are misinformed or mistaken, and will come round once they see it working. He says it is "better to be strong and wrong, especially when you're actually right." It would be political suicide for Democrats to abandon a cause they have championed for so long.

From my point of view, this is the equivalent of a Republican saying: "You know what, my opponent is right - lower taxes are a bad idea on principle."

Americans liked the idea of health care reform well enough in 2008. What changed their minds? And how easily might they change them back?

Opinion polls offer little guidance. Gallup's Frank Newport says that his research indicates no great failure to understand the bill. Silver, looking at the numbers, is unconvinced: the polling, he says, is consistent with the idea that opposition to the bill is misinformed.

My take on Gallup's numbers was different. Like Silver, I'm sure people are confused. But I'm not so sure they would like the bill more if they understood it better. Only 25% of people opposed to the legislation are concerned about higher costs, for instance. More information might drive that number up. It probably ought to. (I support the reform despite believing that it will raise costs.) The same goes for the 28% who said they were worried about greater "government involvement" in health care. Silver sees this category containing "incorrect beliefs" about death panels and socialized medicine. Sure. But it includes valid concerns too. This is a bill which increases government involvement in health care.

I think opposition is driven less by specific concerns of this sort and more by general disgust and exhaustion. As this saga has dragged on and on, it is incredible to me that nobody has tried to explain and justify any specific reform to the general public. The process has been unfathomable, and entirely inward-looking. People see that a major complex change in the works. This promises to transform services that most of them (remember) are satisfied with, so they have something to lose. But nobody is in charge. Nobody is even talking to voters about it, except to pat them on the head now and then and say "trust us". I'm surprised that the majority opposed to reform is not bigger.

I do think opposition would eventually subside if the bill were passed, and that some of its provisions would in the end be so popular that there would no going back. But the bill is an unfinished work. It will need to be fixed almost as soon as it is passed. So the issue does not go away. Meanwhile, costs as well as (prospective) benefits will be apparent. The pendulum would not swing back by November, that's for sure. Meanwhile the party would have stuffed an unpopular measure down the country's throat.

Is Silver's argument about repudiating a core belief the clincher? Not at all. Democrats do not need to repudiate a core belief. They could say, "We are right, and you know we are right. But we have failed to make our case and do this well. We need to work on this. We remain committed to comprehensive health care reform, and will come back soon with a better, simpler plan, capable of commanding wide support." What's wrong with that?

Politically, nothing. That's the trouble. That's why health care reform may fail. I still think the House should seize the moment and pass the Senate bill. But I'm not running for election.