Obama's Health Care Mistake?By The Editors
Updated, Aug. 19, 5:55 p.m. | Karlyn K. Campbell, a professor of communication studies at the University of Minnesota, joins the discussion.
With Republican opposition to health care reform hardening by the day, the Democrats may be forced to push forward on their own. President Obama, who has barnstormed the country and called for bipartisan buy-in, has been met with vociferous attacks on his motives, and has spent considerable time fending off objections to ideas that aren't in any plan.
Did President Obama make a strategic mistake by letting Congress take the lead in crafting legislation while he talked about general principles without having his own specific plan to present to the American people? Or has he, by going this route, avoided the blunders of the Clinton administration when it took on health reform in 1994?
- Theda Skocpol, professor of government
- Peter Wehner, former deputy assistant to President George W. Bush
- Glenn Greenwald, Salon.com
- Celinda Lake, Democratic strategist
- Karlyn K. Campbell, professor of communication studies
Saps and Fakers
Theda Skocpol is a professor of government and sociology at Harvard University, and the author of "Boomerang: Health Reform and the Turn Against Government," a book about the failed 1993-94 Clinton effort at comprehensive health reform.
President Obama may not have been mistaken to let Congress work on this for several months, not getting too far out in front with specific plans of his own.
But once it became clear by mid-July that the Senate Finance Committee's group of six included people acting in bad faith, just trying to delay and dilute the process, he should have switched course. He should have crystallized a clear message and basic points of a plan that his supporters could mobilize around, and that the general public could understand.
Democrats would be better off to go down fighting for real reform anything less would backfire on them.
Instead, the president just keeps muddling things. A low point in the mess was when he said he "did not agree" with "death panels." How could he possibly validate this as if it were a policy disagreement? He should have declared, loud and clear: there are no death panels; it is a lie from people trying to defeat reforms!
It is important to be clear who is acting in bad faith, trying to scuttle a reform effort that the nation and millions of its citizens badly need. The Republican Party is acting as a spoiler for extreme purposes, and the news media has enabled this by not asking hard questions about lies and bad faith from so-called conservatives, including some Democrats as well as Republicans.
Senator Grassley, in particular, has acted abominably in all this. He has now admitted that he never intended to vote for the "compromise" he has delayed the Finance Committee to work out! And he helped to spread the "death panel" lie.
President Obama and Senator Baucus and the Democratic Party end up looking like saps, because they played along with fake "bipartisan" signals from Senator Grassley et. al., and let things be delayed until disputes among Democrats could be sparked. That has been the Republican and health insurance industry game plan all along.
As a scholar who has studied 100 years worth of failed efforts at universal health reform in America, none of this surprises me much. But it is disappointing to see the president and the Democrats paint themselves into a corner, when they were at a high-mark of electoral and public support.
The issue in U.S. politics today is stark: not government versus the "free market," but what kind of government and for whom? Is government authority going to be used to guarantee private profits to monopolies, or to spread security and opportunity to the majority?
The current health reform battle poses this issue starkly. Will President Obama settle for new rules and population mandates that guarantee monopoly profits to private insurers? Or will he fight for a robust public option or better yet for letting individuals and businesses buy into Medicare if they choose to do so? It is not at all clear what he will choose. But his choice will define his legacy.
Democrats would be better off to go down fighting for real reform, rather than to impose an insurance company tax on working and middle class Americans by forcing them to buy private insurance at inflated prices.
That would be no reform at all and it would backfire on Democrats within a few years, as people would resent this and rising costs for public programs would continue to undermine them.
President Obama has prided himself on avoiding President Clinton's mistakes. But actually he has replicated them in new ways, by imagining that insider deals with industry people and attempts at bipartisan negotiation and "reasoned arguments" would hold sway.
That never happens in U.S. health reform debates. It is a battle, pure and simple, and the folks who are most intense and willing to mobilize and exaggerate always win.
Cheerleader in Chief
Peter Wehner, a senior fellow at the Ethics and Public Policy Center, has worked in the administrations of Ronald Reagan, George H.W. Bush and George W. Bush, where he served as deputy assistant to the president.
As a general rule, it's hard to succeed as a salesman when you don't have anything in particular you're selling. In that respect, President Obama has over-learned from the failures of HillaryCare. In that instance, the Clinton administration wrote a bill under the cloak of secrecy and attempted to ram it down the throat of Congress. In this instance, the Obama administration has deferred almost completely to Congress, which means it has lost control of the process and is creating enormous confusion. Witness the last few days, when the administration distanced itself from the "public option," which riled up liberals and forced the White House to re-embrace what it will eventually have to jettison.
Obama can't argue for a specific reform or calm fears because he is championing "reform" rather than concrete plans.
With the House and Senate working on very different and in some respects competing pieces of legislation, the president is having to defend widespread criticisms of them in order to avoid alienating Hill barons whose support he will eventually need. Nor can he effectively argue on behalf of specific reform or calm specific fears, since he is championing "reform" rather than concrete plans. The White House need not have written legislation, but it should have produced clear outlines in advance.
The effect of all this is that President Obama looks more like a cheerleader than a leader. He is speaking out all the time, and his words are being devalued by the day. The more he talks, the more support for the reinvention of health care collapses. The "great communicator" is mobilizing enormous and growing opposition to his plan.
It would be a mistake, however, to blame President Obama's problems primarily on a failure of communications. ObamaCare is sinking because his plan is unwise, unworkable and terribly expensive. The White House is doing a poor job selling its plans but even a first-rate salesman cannot sell a defective product.
Who's Driving Reform?
Obama administration officials have been content with the impression that they have allowed Congress to take the lead in negotiating and drafting the health care bill.
But this image of the White House as passive observer is quite dubious. News reports and leaked documents strongly suggest that the administration secretly engineered a deal with the pharmaceutical industry whereby the White House would oppose efforts to negotiate for lower drug prices and drug importation a clear violation of Obama's campaign pledge.
It defies credulity to suggest that President Obama and Rahm Emanuel have meekly ceded responsibility to Democratic committee chairmen.
Given that the president's signature is required for the enactment of any health care bill, it simply defies credulity to suggest that President Obama and Rahm Emanuel who built his career controlling the inner workings of Congress have meekly ceded responsibility for the drafting and negotiating process to Democratic Committee chairmen.
Ultimately, one can only speculate about the extent of the White House's role because virtually all negotiations have been conducted in complete secrecy also a clear violation of Mr. Obama's oft-stated campaign pledge. At a January, 2008 Democratic primary debate, he vowed that health care reform would be achieved "not by negotiating behind closed doors" but rather by "broadcasting those negotiations on C-SPAN."
In a 2008 interview with The San Francisco Chronicle, he elaborated that his C-SPAN commitment would ensure that "the public will be part of the conversation . . . . so if a member of Congress is carrying water for the drug companies" by opposing price negotiations, they will be "shamed" into abandoning those industry-beholden positions.
But the exact opposite has occurred: the negotiations have taken place in secret; it is the White House that appears to be carrying water for the drug companies by opposing price negotiations; the pharmaceutical industry is so delighted with what they think will be the ultimate plan that they are spending large sums of money to advocate for it; and the elimination of the "public option," when combined with mandates that force uninsured citizens to buy high-priced private health insurance, would vastly increase the profit of these industries, as well as the overall costs of health care.
The alternative "co-op" approach is the brainchild of a Democratic Senator, Kent Conrad, who is incapable of explaining how it would reduce costs. The Times reported yesterday that "the co-op idea is so ill defined that no one knows exactly what it would look like."
Two Wisconsin House members yesterday said a co-op in their state "hasn't saved the state any money whatsoever." All that, combined with the fact that the House contingent standing in the way of a public option (Blue Dogs) are the favored recipients of industry largesse, should generate great skepticism towards the ability of co-ops to control costs.
In this context, it appears likely that the "public option" was never a serious White House commitment, but merely a bargaining chip to string along progressives, one which would be ultimately sacrificed to secure industry and Blue Dog support. Either that, or the president failed to use to his substantial institutional weapons to compel party support for his plan (note how, in the past, Rahm Emanuel was extremely aggressive, even threatening, in pressuring defiant House progressives to support legislation the White House favored).
Neither option reflects well on Mr. Obama. Health care reform was as vital to his campaign as any other commitment arguably more so and, for whatever reasons, he has failed to take a stand for (if not actively renounced) its central planks. It is now left to the progressive members of House to fulfill their commitment to oppose any health care plan that lacks a "public option."
Getting Your Own Party On Board
Celinda Lake is a Democratic strategist who has worked for senators, governors and members of Congress. She is involved in the health care issue, working for a number of groups and labor unions promoting health care reform.
There's no easy or good way to do health care reform. Obviously, there are real enemies to reform, so it's really tough no matter now you do it. The advantage of getting the legislation from the House and Senate is that you get Congressional buy-in, rather than having some members of your own party oppose you from the start.
The flipside is, it's harder to get the message out and harder to control the message. And we've suffered from having the message scattered with so many versions out there rather than one version.
It's a trade-off. Not having one version out allows President Obama to keep the dialogue on principles and preserves the popularity of the main spokesperson a bit longer. And it prevents his own party from being divided from day one. But I think maybe the president's team overlearned the lessons from 1994 and underestimated the difficulties of this approach.
Of course, there was going to be a fight no matter what. I think the president does have his own plan. And he will have to give clear direction when the legislation gets into House-Senate conference.
He Hasn't Made the Case
Karlyn K. Campbell, a professor of communication studies at the University of Minnesota, Minneapolis, is the co-author of "Deeds Done in Words: Presidential Rhetoric and the Genres of Governance."
President Obama did not make a mistake. If he had laid out a specific plan, members of Congress who have struggled toward a compromise would rightly feel cheated. His mistake has been not to make the case that we cannot afford to go on as we are.
Until the public understands the escalating financial crisis of the status quo, there won't be popular support for any substantial change.
Medicare and Medicaid contribute substantially to federal deficits, and state governments have cut these programs because of budget shortfalls. The costs of employer-provided health insurance rise steadily, partly because of payments based on fee for service.
Much of the public seems to not understand the escalating financial crisis of the status quo. Until they do, there won't be popular support for any substantial change, and President Obama has not made this case.
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