My political communications professor was fond of saying, "you can't fight frames with facts" and that is precisely why health care "reform" must first be about countering the political obstacles to implementation. If your goal is some form of universal, state-subsidized health care, then it is useful, as others have pointed out, to look at the history of similar successful endeavors to determine whether we are in the right political moment to create something on par with Social Security or Medicare. It is my belief that we have not yet arrived at that moment, though it is very likely we will in the near future.

When Social Security was created and the federal government's scope greatly expanded, it was done under extraordinary circumstances. Not only did the Great Depression create the conditions for the welfare state to become salient, but voters translated those conditions--vague need and desire for change--into a Democratic supermajority in government. In fact, only the unelected federal branch--the Supreme Court--had to be forced on board by Roosevelt's court-packing scheme. But the voters who provided the Democratic electoral realignment did not request specific policy details, nor did they understand them. The power of interest groups to demand specifics was not in the 1930s what it is today. Voters provided the institutional advantage for Roosevelt's Brains Trust to hammer out the specifics (notably Keynesian economics). And although Democrats remained in the majority for a generation, the landslides of 1932 and 1936 were political moments that could not be easily replicated.

A very similar thing happened during the next large wave of federal expansion during the 1960s. Lyndon Johnson, master of parliamentary maneuvering and consensus-builder, was able to exploit sympathy for Kennedy's vague and bold pronouncements to push his ambitious domestic legislation through a Congress that while not as unified as the one Roosevelt had, nonetheless was a unique legislative opportunity. Combined with the crushing of Goldwater in 1964 and the widespread assumption that the liberal consensus was here to stay, Johnson was able to promote his Great Society.

These historical details are conspicuously devoid of any real opposition to Social Security or Medicare, and for good reason. There wasn't an organized criticism. In the 1930s there wasn't a "conservative movement," and in the 1960s that movement was only beginning to become self-aware. National Review was the first point of organized opposition, decrying Eisenhower's slow-paced adoption the welfare state as a "Dime-store New Deal." The movement was envigorated by the Goldwater campaign but even though future supply-side demigods like Milton Friedman were providing the critical intellectual and academic foundations for rejecting the welfare state, they were advising a campaign that was hindered by its candidate more than anything else. It wasn't until the 1970s that the conservative movement spawned a coherent and independent (from the GOP) public policy network to advance conservative arguments against the welfare state. And even during Nixon's tenure in the White House, the EPA was created in what today would be considered anathema to movement conservatives.

Today, of course, the conservative movement is fluid, disciplined, well-funded, and ubiquitous. It can't simply be ignored so when considering Democrats' chances for establishing universal health care one important item to note is that there is a network of opposition that did not exist during the New Deal and Great Society. Furthermore, the legislative resistance to those programs was only overcome through reliable majorities in Congress that Democrats do not today possess, but might in the future. This is why the details of the policy are not very interesting to me because they are irrelevant to the fight against the conservative movement's counter-arguments. You can't fight frames with facts.

And what is the conservative frame that must be overcome? In the simplest terms it is libertarian, republican, and based on the conservative conception of freedom through the catch-all ideology of individualism. For what I think is a very typical of the conservatives of this generation, consider this post from National Review's Corner by Jonah Goldberg:

Maybe, just maybe, France and Denmark can handle the systems they have because they have long traditions of sucking-up to the state and throne? Marty Lipset wrote stacks of books on how Canadians and Americans have different forms of government because the Royalist, throne-kissing, swine left America for Canada during the Revolutionary War and that's why they don't mind big government, switched to the metric system when ordered and will wait on line like good little subjects. Liberals constantly invoke Sweden as a governmental model without paying much heed to the fact that Sweden's government succeeds as much as it does because it governs Swedes. And maybe, just maybe, the reason America doesn't have a sprawling European welfare state is that America isn't Europe. And, unlike some of our liberal friends, Americans don't want to be Europeans. Indeed, that's why so many Europeans move to America, so they can be Americans.

I found this link at another blog, whose author mused "Instead of arguing about the efficacy and efficiency of a policy (in this case government run health care) Goldberg says we can't have it because American culture would reject it. When someone like Goldberg stars [sic] using culture, it's a sign that they can't argue for their point with hard facts." It's true, Goldberg isn't making an argument based on evidence, but that's only part of the story. The "American Culture" argument is such that irrespective of whether it is true or not, conservatives believe it. Thus not only is the conservative solution to the health care problem superior for various cultural reasons, it has the backing of conservative academia (think tanks) AND--this is key--they believe the American people are on their side (i.e., Americans are naturally conservative). This, I submit, is the biggest obstacle to ushering in universal health care in this country. It doesn't matter that the American people have long supported universal health care in opinion polls (though they are, of course, conflicted on the details), they have never had a medium through which to make those desires salient, except the flatness of an opinion poll (which dulls the urgency of the desire) and that allows the well-honed and market-tested message of the conservative movement to speak on behalf of "the people." The only real competition in the realm of ideas is a long-standing liberal dream to make universal health care a reality. Yet the details receive the most attention and while the details will someday be important, they count little towards the immediate and future political battles. You can't fight frames with facts.

The very use of the term "health care reform" implies the existing system needs to be fixed. But the "big thinking" is quite the opposite: the current system is broken (indeed, it is "Sick") and needs to be replaced with something completely different. Since radical change has never had legs politically, terms like "reform" persist. But when both conservatives and liberals talk about reform, the conservatives instantly have the advantage. The only way to erase that advantage is to counter every conservative claim about creeping socialism (fight the frame with a counter-frame based on fact) and continue building a Democratic majority in government. With that majority and a weakened conservative message machine, Democrats just might (although not in the near term, due to the fiscal disaster wrought by Bush--not a good time to propose expensive domestic legislation) be able to pull off universal health care. And then they can start worrying about the details.