PdF Question: How Did the Internet Affect the Health Care Battle of 2009-10?

With the year-long debate over health care reform now entering its denouement (or a new chapter), how do you think the internet affected the course of the political battle?

That's the question I just sent to several dozen longtime friends, colleagues, fellow-travelers, and participants at the frontlines of the intersection of technology and politics. Over the next hours and days, I'll share their answers.

But here's a stab at starting the discussion.

First, a little black-and-white oversimplification. In 1993-4, as now, Democrats controlled all three branches. They had the White House, a 56-44 majority in the Senate and a 259-176 majority in the House. Then, as now, tens of millions of Americans lacked health insurance (roughly 40 million then, roughly 50 million now). Then, as now, powerful and entrenched interests spent tens of millions on lobbying and campaign contributions to influence the process, the bulk of which went to oppose reformers' efforts. But this time, Congress voted for a major reform bill. Last time, the bill died, stillborn.

What was different? Lots of things. Bill Clinton was arguably a weaker president than Barack Obama, as he was elected with just 43% of the vote, compared to Obama's 53%. Last time, the bill was crafted almost entirely in secret by a White House task force led by Hillary Clinton; this time the bill was crafted almost entirely in the open, with hundreds of hours of televised hearings, bill texts posted online before votes, and seemingly nonstop coverage and commentary. Last time, the White House sought to co-opt the major incumbent players, particularly the insurance companies, with a "managed care" approach that essentially gave them a green light to reduce costs by limiting care but failed to get their full buy-in; this time the White House sought to co-opt the major incumbent players, particularly the pharmaceutical industry and the hospitals, by cutting secret deals that promised to protect their interests in exchange for tens of millions of pro-reform TV ads. Last time, the White House was trying to sell a bill that its own advocates had difficulty explaining; this time, it appears they managed to drill through several key message points about the bill's benefits. Last time, the Democratic barons of Congress thought they were impregnable and couldn't imagine losing their majority; this time, the defeat of 1994 hung like a ghost over their cloakroom.

Given these differences, was the internet even a significant factor in the health care battle of 2009-10, and in the ultimate outcome of the vote in Congress? Obviously, there's no way to separate all these factors and settle the argument, and personally I suspect that some combination of Obama's greater popularity, the higher level of public engagement over a somewhat clearer bill, the neutralization of some of the major lobbies, the awareness among Democrats of the risks of failure, AND the internet (that is, people using the internet), tilted the debate and the ultimate outcome in the Democrats' favor.

What was the internet's role?
1. It forced the process much more into the open. For better and for worse, the sausage-making process is now much more transparent. As Nancy pointed out last week, without a formal change in the rules, Congress is starting to post major bills online 72 hours before a vote. This is what happens when you have many more eyes watching. Any attempt by the White House to repeat the Clinton process of crafting a bill over months of secret negotiations would have blown up in its face. Yes, there were still many back-room deals, from the Billy Tauzin-PHrMA deal to the "Cornhusker hustle" and the "Louisiana Purchase" but we know about them, don't we?
2. The relatively open process fueled a lot of passionate engagement on all sides, with rightwing blogs, GOP outfits like Freedom Works and Tea Party protesters along with leftwing blogs, Democratic efforts like HCAN and OFA, and MoveOn and the PCCC all turbocharging their efforts by using the latest tools for connecting, coordinating, collaborating, raising money, and moving messages and troops. The overall effect was for many more voices to speak effectively in the process. It appears that most of these voices tended to make the discussion more polarized, but I think that may be an oversimplification. MoveOn, for example, may have worked for most of last year to push the debate to the left, but in the last few weeks, after its membership voted overwhelmingly to support Obama's approach, it helped rally progressive activists to support the bill.

Did all this increased transparency and participation make the bill more or less popular with the public? Did it make legislators more or less likely to vote for it? Those are the hard questions to answer. More as the answers to my query roll in...