The public debate over health care the last six months has focused an inordinate amount on "process," the single simplest word to shoehorn together a mess of parliamentary maneuvers like reconciliation, the filibuster, the "deem-and-pass" and the "up or down."
Many Americans, the theory goes, were turned off more by the process of creating the bill than the policy in it — in part because they didn't know what was in it anyway, but also because a drawn-out process suggests if lawmakers can't agree on things, centrists should be suspicious. Republicans gladly fanned this narrative by translating hard-to-grasp political jargon into cable-ready sound bites: Democrats, they warned, were trying to ram the bill through.
Now that reform has become law, this dynamic turns into a question for the November midterm elections: Do Americans really care about process? Democrats are betting they don't, that the farther removed we get from last Sunday's climactic vote (and all the gamesmanship, deal-cutting and controversy that preceded it), the more voters will come to focus instead on what's in the law for them.
The GOP suggests otherwise, that coaxing health reform through obscure — and ambiguously constitutional — parliamentary gymnastics will offend voters.
So who's right?
In the absence of a political-scientist-approved poll on the topic ("As an American, do you care about legislative process a lot, a little, not at all or what's that?"), most signs suggest it wasn't — and won't be — a big factor.
For one thing, polarized public opinion has remained fairly constant ever since the breakdown last fall of bipartisan compromise in the Senate finance committee, after which it became immediately clear any bill would have no Republican supporters.
"That's a recipe for pretty stable public opinion with pretty strong polarization," said John Sides, a political scientist at George Washington University. "It's stable because the information flow isn't really changing. What you have is a consistent set of messages in support of the bill and opposed to the bill. The content of those messages may change, but by then it doesn't really matter."
To the extent process does matter, a lengthy and messy debate gives political leaders more time to aim fire, and public opinion more time to harden. But most people aren't reacting to the process itself. Opposition to the bill, rather, grew most dramatically before anyone even started talking about things like reconciliation.
"For me, the whole, 'Well, it was process that did it,'doesn't hold water,'" Sides added. "What happens is that, OK, in August it's death panels, and in December we're talking about the Cornhusker compromise. What you're really doing is just giving people, in this case opponents, additional reasons to oppose the bill. You're not actually changing anyone's mind."
Public opinion also did not change significantly during the process-intense final hour, starting with Obama's February health care summit (which was notable for Obama's frequent pleas that Republicans stop talking about process).
One Gallup poll that same week came the closest to directly measuring the impact of process on public approval of the bill (warning: it lacked good experimental design). Respondents were asked first if they supported a bill similar to the one outlined by Obama and Democratic leadership. Then they were asked if they would support passing that bill through reconciliation. The margin changed, in opposition, by 3 percentage points.
Another opinion poll conducted since the bill's passage on Sunday confirms that a segment of people who have opposed the bill over the last six months have done so because they felt it wasn't progressive enough. Joshua Tucker, a professor of politics at NYU, expects we'll now see most of these people switch sides.
"The big narrative struggle is to try to figure out now: Who are these remaining people who oppose health care reform?" he said. "If it's just the core of the Republican Party, maybe that helps get people out, but it doesn't mean that you've suddenly got this new reservoir of voters who are going to be peeled off by Republicans in 2010."
The most effective GOP argument about process also only works if a majority of Americans continue to oppose the law as it now exists. Party leaders have charged that Democrats used sneaky tactics to pass a bill against the will of most Americans. If the second half of that statement ceases to be true, the first half loses much of its power. If a plurality of Americans come to embrace reform, who cares how it was passed?
There is one other key factor: Many political scientists predict the November election won't be about health care at all, let alone how the health care bill was constructed. Historically, midterms tend to be about the economy, and the economy will clearly be a very big deal this year.
Expect Republicans nevertheless to conflate the two events — the passage of health care and the November election — when Democrats inevitably lose some seats (as foretold by another historic pattern).
"Eric Cantor has already stated it: Any loss is ergo about health care reform," Sides lamented. "It's bogus to say that now, and it'll be bogus to say it then without some pretty direct and specific evidence. But people interpret election outcomes in whatever ways suit their agenda."
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