In the March 2010 issue of the American Journal of Public Health, Dr. Vicente Navarro of Johns Hopkins outlines his thoughts on where President Obama got it right and wrong on health reform. Of course, he begins by citing the pressing need for reform–the 47 million uninsured and 102 million underinsured–but his critique is less about whether reform is needed or not (he clearly thinks it is sorely needed) and more about the many barriers to implementing that reform.
For example, there’s the fact that the “Gang of Six” on the Senate Finance Committee actually represent only some 3% of the U.S. population–giving them a relatively huge and undemocratic amount of power. Of course, our Constitution was designed so that small and large states enjoyed equal representation in the Senate. This is just an artifact of that.
Obama’s mistakes according to Dr. Navarro include an overemphasis on increasing the efficiency of the system (which people have interpreted to mean they will be giving up benefits to help cover the uninsured), focusing on the coverage expansion as a moral issue requiring compassion (when a focus on solidarity would go further), and alienating a non-trivial number of progressives by abandoning the idea of single-payer.
It is this last point, he suggests, that could cause Democrats to suffer at the polls later this year. Why? It’s simple: If they feel alienated from the party, registered Democrats are more likely to stay home, while Republicans turn out in droves. Looking back at history he notes: “The ‘Gingrich Revolution’ was in large degree a consequence of the abstention of the Democratic grassroots. I am afraid that the same could happen in 2010.” That doesn’t mean that the peoples’ will will have changed, but it does mean that the direction of the country could change because people stayed home out of apathy.