The Political Stream

Health Reform Under Bush >> The Political Stream (last updated 12.18.16)

The National Mood under GW Bush

General Public Mood

Although the war in Iraq was foremost on potential voters’ minds during much of 2007, especially during a fractious national debate during the spring and early summer about the Bush administration’s proposal for a troop “surge,” voter interest in the war declined dramatically as the monthly rate of U.S. combat plummeted by the end of the year. By early 2008, amidst growing evidence that the U.S. economy was entering (or would shortly enter) a recession, the economy quickly vaulted to the number one issue of concern. Health care often was 2nd or 3rd on the list of voter priorities, as shown by this table of voter sentiment in each of the state primaries/caucuses.

Presidential Mandate

Bush’s margin of victory provided more evidence of a mandate in his second term than his first, but even this was quite limited for several reasons:

Governmental Forces

Party Control

Presidency. In 2000, Republicans won back the presidency after 8 years of control by Democrats. Bush won the electoral college narrowly 271-266 but lost the popular vote by 0.5% (more than 500,000). A loss in any of 30 states would have flipped the election, but Florida had the closest margin: a swing of just 269 votes in Florida would have given the election to Democrat Al Gore; this represents 0.0003% of votes cast, making it the closest presidential election in history (p. 330). According to CNN:

  • Taken as a whole, the recount studies show Bush would have most likely won the Florida statewide hand recount of all undervotes. Undervotes are ballots that did not register a vote in the presidential race.
  • This goes against the belief that the U.S. Supreme Court handed the presidency to Bush, or took it away from Gore.
  • The studies also show that Gore likely would have won a statewide recount of all undervotes and overvotes, which are ballots that included multiple votes for president and were thus not counted at all. However, his legal team never pursued this action.

In 2004, Bush was re-elected presidency, expanding his electoral college margin (286-251) and obtaining a majority of the popular vote (3.5% or more than 3 million votes). Even so, a swing of 3 states would have flipped the election, but Ohio had the closest margin: a swing of just 59,388 votes would have given the election to Democrat John Kerry; this represents just 0.0480% of votes cast, making it the 7th closest election in American history (p. 330).

The Presidency

President Bush entered 2008 with very low public approval ratings, although the turnaround in Iraq had produced a slight uptick in his popularity. Given the philosophical divide between the president and Congress on health care, coupled with the antipathy engendered by Bush’s success in twice using his veto power to thwart Democratic ambitions to expand SCHIP, there was widespread skepticism that there would be agreement on any major health initiatives in the president’s final year in office.

Federal Bureaucracy

General Accountability Office head David Walker continued his efforts to educate the public and policymakers about the looming crisis in Medicare. The Congressional Budget Office in December 2007 released a report showing for the first time that if health spending growth relative to GDP growth continued at the same pace through 2075 that it had during the past 50 years, health care would absorb 100% of GDP by 2075.

Congress

The Supreme Court

State Government

Organized Political Interests

Physicians

Health Insurance Industry

Business

Labor

Bureau of Labor Statistics figures show that “union membership as a share of the total work force rose last year for the first time in a quarter-century, inching up to 12.1 percent from 12 percent the year before. A total of 7.5 percent of private-sector workers were in unions, and 35.9 percent of public-sector workers.” Total union membership was 15.7 million in 2007 (Greenhouse 2008).

Consensus-Building

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