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Why Barack Obama Should Sit Back and Wait

rahm.jpgA lot of commentators are beginning to call for President Obama to take charge of health care directly. Put on your fierce face with Congress, advises Michael Tomasky. Bang some heads together, agrees Todd Gitlin. Be Lyndon Johnson, urges Robert Reich.

Don't, says Ezra Klein.

At least, not yet. It's true that last week was a bit grim on the health-care front. But amid the bad news, there was an encouraging trend: The damage was localized. David Gregory's tweets notwithstanding, the HELP Committee's CBO fumble was understood as ... the HELP Committee's CBO fumble. The Finance Committee's decision to wait a bit longer on health reform was understood as internal to the Finance Committee. The Tri-Committee proposal out of the House was covered as the lower chamber's opening bid.

In 1994, President Bill Clinton exhausted his political capital guiding the development of the legislation. Barack Obama, by contrast, has saved his to push for its passage. Once Finance and HELP and the House Tri-Committee have laid down their markers, then the White House will, and should, get involved. They'll have to figure out which edges need to be sanded off for political passage and which priorities are too important to sacrifice on the altar of senatorial ego. But there's no reason to rush that moment. For now, the White House should have as little to do as possible with the various legislative products. Let the committees absorb the blows of the bad weeks. Let the early coalitions present themselves. Let the Republicans show their strategy in the mark-up sessions. Let the CBO score all the different options. Let the legislature familiarize itself with different revenue options. Wait. Wait and wait and wait. Wait until Congress has pushed this as far upfield as it's able.

Then open up the White House. Then have Obama on TV. Then have Rahm on the phone with legislators. Then take Olympia Snowe for a ride on Marine One. The White House can exert explosive force on a piece of legislation, but it can only do so effectively for a short period of time. That was the mistake Clinton White House made in 1994. By the time their legislation was near reality, administration officials were so deeply involved that they couldn't add external momentum. It is not a mistake that Rahm Emmanuel, who watched it all happen firsthand, means to repeat.

Related: The lessons of 1994.

Photo credit: Charles Dharapak -- Associated Press Photo

By Ezra Klein  |  June 23, 2009; 7:16 AM ET
Categories:  Health Reform  
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i agree with this very much.
half of the people that live on my street voted for mccain, and are adamantly, vehemently against what they call "socialized medicine." they are furious.
i think obama needs to use his political capital carefully and skillfully.
and i believe that he will.
the danger is when you think that everyone else is unconditionally thinking in the exact same manner as you are, and wants exactly what you want. the truth is, he has a whole country of people to work with.

it seems to me that many of his supporters assumed that as soon as he was elected, he would be able to change everything immediately, just as they wished everything to be.
this does not happen in a family, in a marriage, a job situation, or anywhere in real life, when you are trying to work out differences and exist in harmony.
i know barack obama realizes this. i am surprised that considering the incredible failures he has inherited, that people have not been able to be more patient with his efforts to turn things around; considering how blisteringly polarized the country is in almost every way, and the enormity of the problems, the straits of the economy, and the corruption in our system.
we can all be the change we wish to see, with hard work, unity and patience.
i feel like we are living the story of rumpelstiltskin.
we have given obama wheat, and we expect him to work through the night, to spin it into gold.
i think he is going to do the best he can. he is pulled in many tides and i think we need to maintain our voice, but also our patience in the process.
that is just my opinion.

Posted by: jkaren | June 23, 2009 7:55 AM | Report abuse

It is amazing to see that when it comes to ‘damaging’ taxpayers, Congress can be so effective; but really is incapable of coming together and solving the issues we face. (And as and when Congress does compromise, we have to endure not so pleasing faces with big smiles of Ben Nelson, Snowe, etc. splashed all over front pages as great ‘statesmen and stateswomen’ of America!) The way Congress is making these reforms, in the end all its members are going to be a laughing stock and in that sense it makes a case for White House to wait until Congress is totally debunked.

Posted by: umesh409 | June 23, 2009 9:45 AM | Report abuse

I don't think we've done the research needed to figure out how to fix our system yet.

If, as Atul Gawande says, Medicare - the government entitlement program that provides health care coverage to retirees - is the "best source" for health care costs, then we are operating out of a position of ignorance. (And Ezra, can you please explain WHY this is so?)

Pricing/cost structure of health care for the rest of us SHOULD be readily available. If it is not, then we need to understand better how pricing is determined, before we can develop a solution to the problem. Health care pricing is ridiculously complex and almost impossible to understand from the consumer side.

Here's an example....

I have five-year-old twins who recently went to the ped for their annual well-child checkup. My insurance (NOT MEDICARE - just the ordinary health insurance available on the free market) sent me an EOB for this visit.

The ped's office billed the insurance company more than $1000 for our visit.

$1000 to look over two very healthy little girls during their annual visit (a visit that is required before they can attend kindergarten.) The ped spent 40 minutes max with us. $1000 for less than one hour of work.

Now that is for two girls, who each received two federally mandated vaccines. The bill included several hundred dollars for the vaccines, several hundred dollars for the office visit, some money for the "developmental check" that one would assume would be a part of the office visit, but required an extra charge, and several vaccine administration fees (extra to shoot up the kid with the federally mandated shots!)

And let's face it, the ped settled for less than than $1000. She actually got $600 from insurance and wants $70 more dollars from me. Some of that will cover the cost of the four vaccines (two per girl.)

My health insurance company rep assured me this was a typical bill for such a checkup.

I want to know how co-ops will change the billing structure for health care. I want to know how ANY OF THESE PLANS will simplify the billing so that patients are not spending gobs of time negotiating payment of covered expenses. I want to know WHO'S GOT ANY CLUE ON HOW TO PREVENT HEALTH CARE COSTS FROM SPIRALING FURTHER OUT OF CONTROL.


This bill reflects the pricing today for a well-child checkup that is required by law at each public school before the child can attend.

WHY DOES IT COST MORE THAN $500 for a 20 minute visit?


Posted by: anne3 | June 23, 2009 10:29 AM | Report abuse

Yeah, also, worth remembering (as you remind us earlier) that Schumer's on the mother. That brings me some modicum of calm.

Yeah, he has his strengths and weaknesses, but I suspect he is eminently qualified to expend his capital* in getting either a compromise or a public plan on the table.

*capital shaped like an aluminum baseball bat

Posted by: ThomasEN | June 23, 2009 11:36 AM | Report abuse

But sitting back and waiting affects what kind of bill is crafted. If Obama wanted a much better bill than the one thats likely to come out of the senate, he wouldn't have to go spend political capital on the hill, he could use the bully pulpit.

Think about how Bush sold the Iraq war, it may have been horrible policy but it was tactically brilliant. Obama could start giving speeches and his team could fan out over the various news networks and start building grassroots support for a strong health care bill and put obstructionists in congress on the defensive.

I think we have to admit that Obama is every bit as much in the pocket of the insurance industry as the "centrist" Senators standing in the way. Obama could be shifting the debate publicly - this is one of the most rhetorically inspiring politicians of my lifetime - but he chooses not to. Not because its some tactical plan, but because he truly won't mind if the bill that crosses his desk is a watered down reform bill with limited efficacy. He'll be able to say he fought for its passage, but he'll also be able to say to the insurance industry that he didn't fight to make it something they couldn't live with.

Posted by: Matt40 | June 23, 2009 11:43 AM | Report abuse

Dark clouds on the horizon as the stupid spending debt starts coming due. With inflation and the other problems the debt is going to cause the longer Obuma waits the harder it is going to be to drive the Country further into the stone age with more debt.

Posted by: Bubbette1 | June 23, 2009 6:27 PM | Report abuse

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