Oh, Massachusetts!

There’s sure been enough harsh talk around the health care bills coming out of the House and Senate – and I mean from people who support universal health insurance – forget the Tea Baggers and the Rush Limbaugh audience for the moment. On the one hand, you’ve got people calling for unseating Representative John Conyers because he voted for the final House bill – and he was the prime sponsor of the single payer bill! On the other, there’s people dismissing any objections to the bills’ shortcomings as the cavalier nitpickings of a privileged group that already has health insurance and doesn’t really care much about anyone else who doesn’t. But the hyperbole crown has got to go to the blogger who produced the headline “Raul Grijalva Flirting With History’s Greatest Monster Status.” And what crime did the Arizona Representative and Congressional Progressive Caucus Chair commit to join the ranks of Hitler, Stalin, and Attila? Why, he said that instead of passing the Senate bill as is, the House should send the Senate smaller individual bills that wouldn’t include items such a tax on pre-existing health insurance plans. Imagine that!

The voters of Massachusetts have lately become notorious for forcing a total tactical regrouping on the national health care debate by electing a Republican to finish Ted Kennedy’s Senate term. But the politics of that New England state also hold some interest in this debate in a largely unrelated way – the similarity between the ongoing quandary faced by advocates of expanded government services there and the dilemma that the current national health bills have posed for supporters of health insurance reform.

The “Massachusetts problem” stems from the fact that it is not only one of just seven states in the nation with a “flat” income tax but it also has a constitutional prohibition against establishing a graduated income tax – i.e., the kind we’re all familiar with on the federal level, with rates that climb in higher income brackets – and numerous efforts to amend the state constitution have failed. The flat income tax, combined with the state’s sales tax, has the effect of making the state’s overall tax structure regressive, which seriously hinders any attempted redirection of resources within the state. You may be able to steer services and goods to the poor, but the money to do so will come from the middle rungs on the economic ladder and not the top. The Massachusetts dilemma, then, has generally boiled down to this: Do you ignore real needs or do you address them in a manner likely to eventually lead to a “middle class” taxpayer revolt such as the state’s 1980 “Proposition 2 ½” property tax limitation or California’s more famous Proposition 13.

The national health care debate has faced no similar constitutional barriers, but the political barriers have proven every bit as formidable. The President and congressional leaders could have put forth a bill offering a more serious solution to the problem – whether single payer, another type of universal nonprofit health insurance, a government-run health care system, or something else entirely – but they chose not to. The $20 million in campaign contributions the health care industry gave Barack Obama (nearly three times the amount given John McCain) may not have in themselves bought a non-health insurance industry-threatening proposal, but it was probably at least a good predictor of the type of bill we would ultimately see.

So far as the debate within the left goes, both sides might do well to simply concede the other’s central point: It is both true that the bills that came out of Congress would expand health insurance coverage significantly, although not universally, and that they would not fundamentally alter the expensive and wasteful private for-profit health insurance industry that lies at the root of the problem – except to further entrench it by mandating the purchase of its services.

If we’re willing to grant the significance of both the bills’ strengths and their weaknesses, we might find ourselves then able to sympathize with the votes of both of the individuals who are arguably the most left-wing members of each congressional branch, even though they voted the opposite way: Senator Bernie Sanders was a “Yes” when one more “No” would have brought the Senate discussion to a halt, while Representative Dennis Kucinich voted “No” when there were a few House votes to spare and he could thereby highlight the vast gulf between the bill as it was and what it ought to be.

Just a couple of weeks ago, concern about the potential downside of passing the Senate or House bill as currently written might have been dismissed as academic, but it can’t be now – or at least it shouldn’t be. And for the fact that we now know that, we are indebted to MoveOn.org and Democracy for America for having the foresight and wherewithal to secure the services of the Research 2000 polling company to ask a few questions of the Massachusetts electorate. What they found was so at odds with the general “anti-big government” or “anti-insider” interpretations that dominate the mainstream media as to demand the closest attention from anyone with a serious interest in finding a real solution to America’s health care problems.

The poll’s target group was people who had voted for Barack Obama for President but did not vote for Martha Coakley, the Democrats’ Senate nominee; and further divided into those who had actually voted for Scott Brown, the Republican winner, and those who stayed home. When asked if they favored or opposed “the health care reform proposal recently passed by the U.S. Senate,” not terribly surprisingly, both groups opposed it – the Brown voters by a 48–32% margin and the non-voters by a 43-34%. And here’s where things veered from the accepted norms of political discourse: when those opposed were asked if they thought the Senate bill “goes too far or doesn’t go far enough,” the 2008 Obama voters who’d taken a pass on the Massachusetts election said it didn’t go not far enough, by 53-8% margin. And so did those who voted for Obama in 2008 and Brown in 2010 – by a 36-23% margin!

And just so there wouldn’t be any misunderstanding as to what going “far enough” might mean, the pollsters also posed the question “Would you favor or oppose the national government offering everyone the choice of a government administered health insurance plan — something like the Medicare coverage that people 65 and older get — that would compete with private health insurance plans?” Both groups said yes – the Obama voters who stayed at home by a 86-7% margin and those who came out and voted for Brown by 82-14%.

Probably we shouldn’t entirely blame the mainstream pundits for the difficulty of incorporating the results of this poll into the national analysis. The fact is that the poll’s results are counterintuitive – people just don’t expect voters who felt the Senate health care bill did not go far enough to vote for a Republican. Counterintuitive, but true, however. Undoubtedly, some will simply reject the messenger like one woman who described her response to reading the MoveOn data thusly: “All I could do is roll my eyes. This is the second time I’ve been ready to unenroll.”

Others may find fault with the electorate itself, like one who thought, “I guess people do not measure the consequences of their vote.” But voters must deal with the choices they are presented as best they see fit (or stay at home) and the choices they have are not always logical. After all, there was no candidate on the Massachusetts ballot advocating going further than the Senate bill, now was there? It’s not just the voters who need to deal with the consequences of their actions – so do the members of Congress who gave us the bills currently at hand.

On January 1 of this year, a Rasmussen Reports poll found voters nationwide opposing the Congressional plans by a 58-39% margin. The poll also found a majority opposed to a single-payer health care system by a 52-34% margin. In other words, the spread against the Congressional plan – 19 points – was greater than the 18 point spread against a single payer plan, even though single payer has never had the benefit of so much as a single Congressional hearing or vote! Although it was dismissed as a non-starter from the outset, at this juncture it’s hard to see how the White House and Congressional leadership would have done worse if they’d had the political will to stand up to the insurance industry with a plan of which the President once said, “The truth is that unless you have a what’s called a single-payer system in which everybody is automatically covered, then you’re probably not going to reach every single individual.”

Opponents would have derided it as “big government,” to be sure, but it would have had the substantial asset of offering an actual solution to a major problem. Instead, the Democratic leadership chose to offer another type of “big government” solution, one that would involve ever more complex regulation of potential insurance company abuses, along with subsidies to allow lower income individuals to pay the bloated premiums those companies demand. And that’s big government that we can’t all believe in. As they’ve long known in Massachusetts, there’s consequences to these things.

Full disclosure: Tom Gallagher, Demockracy senior writer and columnist, served six years in the Massachusetts House of Representatives.