Dean's Blind Spot

Maybe one reason former Vermont Gov. Howard Dean and so much of the digital Left can so casually dismiss the Senate health care reform bill is that they operate in an environment where so few people need to worry about access to insurance.

The 2004 presidential campaign that propelled Dean to national prominence was fueled predominantly by "wine track" Democratic activists-generally college-educated white liberals. (In the virtually all-white 2004 Iowa caucus, for instance, exit polls showed that two-thirds of Dean's votes came from voters with a college degree.) Those are the same folks, all evidence suggests, who provide the core support for online activist groups like MoveOn.org or Dean's Democracy for America and congregate most enthusiastically on liberal websites. (According to studies by the Pew Internet & American Life Project, college graduates are more than twice as likely as those with only a high-school degree to communicate about politics online.) Along with Dean, those digital Democratic activists are generating the loudest demands to derail the Senate bill.

Some individuals in these overlapping political networks undoubtedly face challenges with access to health care, but as a group college-educated whites are much less likely than any other segment of the population to lack health insurance.

The latest annual Census Bureau figures show that in 2008 just 5.96 percent of college-educated whites lacked health insurance. For whites without a college education, the share without insurance jumps to 14.5 percent (the number is surely higher for non-college whites who are not union members). Among African-Americans, the share of those without insurance rises to 19.1 percent. Among Hispanics, the share of those without insurance soars to a daunting 30.7 percent, the Census found.

In his Washington Post op-ed Thursday, Dean wrote: "I know health care reform when I see it, and there isn't much left in the Senate bill." Yet the bill that Dean so casually dismisses would spend, according to the Congressional Budget Office, nearly $200 billion annually once it is fully phased in to help subsidize insurance coverage for over 30 million Americans now without it. That's real money--the most ambitious and generous expansion of the public safety net since the Great Society under Lyndon Johnson. And that money, based on the Census results, would flow most into minority and working-class white communities.

Minorities don't seem to have much doubt about their investment in this debate. In November's Kaiser Family Foundation health care tracking poll, two-thirds of non-white Americans said that their family would be better off if health care reform passes. Though the evidence suggests that non-college whites could also receive a disproportionate share of the bill's spending (since they constitute more of the uninsured), they are dubious: just one-third of them believe they would be better off, a reflection of the mounting skepticism about government such blue-collar whites are expressing across the board. Yet the most skeptical group is the college-educated whites, the same constituency that has the most access to health insurance today: only about one-fourth of them expect to be better off under reform.

Against the backdrop of those attitudes, it's instructive to compare Dean's blithe disregard for the Senate bill to the more measured and sensible tone that Andy Stern, president of the Service Employees International Union, struck when he held a teleconference Thursday to discuss the debate. Stern recapitulated the concerns that many on the Left hold about the bill--the adequacy of the subsidies for the uninsured, the bite of the "Cadillac" tax on high-end insurance plans. But Stern also insisted: "We can't just focus on what we don't like--it's the largest expansion of coverage since Medicare, it's the largest expansion in Medicaid; with the bill it would make things way better than what our current system does, for our members at least."

Stern didn't commit to endorsing the final bill, but he pointedly refused to join Dean in urging the Senate to tear up its work. Stern can't surrender to the vanity of absolutism because he represents a predominantly lower-income and minority constituency with a tangible stake in the outcome of this epic legislative struggle--not only for themselves but for their relatives, neighbors and friends. For much of the constituency that Dean and the digital Left represent, by contrast, the health care debate may be largely an abstraction--just another round in their perpetual struggle to crush Republicans and ideologically cleanse the Democrats.

No president has ever come as close as Barack Obama is today to moving the nation toward universal health coverage; no universal coverage bill had ever before passed the House, nor has one ever advanced as far in the Senate as the bill now under debate. For Dean to insist that Senate Democrats start over after that grueling struggle is a little like suggesting that American troops on the outskirts of Berlin in 1945 should have retreated back to France because D-Day wasn't choreographed just right.

The broad mass of college-educated white voters are an increasingly central component of the Democratic coalition. But it remains a challenge for the party to manage the expectations of that community's most liberal segments because they tend to see politics less as a means of tangibly improving their own lives than as an opportunity to make a statement about the kind of society they want America to be. That is not a perspective that encourages compromise or pragmatism. It may be easier for Dean, and the activists cheering him on, to view the Senate bill as an affront to their values precisely because so few of their interests are directly at stake in the fierce fight over this imperfect but landmark legislation.