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How Much Power Does Obama Have?

PH2009081103566.jpgThe calls to make Jon Cohn president -- he'll only be 47 in 2016! -- remind me of a post I wanted to write about our current president. Dan Froomkin, in his first missive at his new home, wrote that the final months of health-care reform will bring "our fuzzy president" into sharper focus. That's correct, I think. But it may be the opposite of what we need. Before I get all counterintuitive on you, though, here's Dan:

One possibility is that Obama, to everyone's surprise, will come out with a strong bill much like the one he promised his supporters during the campaign. It is conceivable, after all, that the reason Obama hasn't publicly issued ultimatums and twisted arms and busted heads is that he believes it's best to do those things in private -- and only when the time is truly ripe. In this scenario, which I call the Obama-as-community-organizer scenario, the community's needs are finally met, but in a way such that even those who had thwarted the people's will are allowed to save face.

The other possibility -- well, I call that one the Obama-as-pushover scenario. In this one, Obama will come out of it having given away the store -- having neither significantly improved the health-care system nor lowered its costs, but rather having created a new entitlement that primarily benefits the health insurance, pharmaceutical and hospital industries.

As Dan says, we've not yet seen Obama's negotiating style come into focus. But we will soon. That said, I don't know how many times a president has to fail to solve this problem before we admit that it's not a matter of presidential messaging, or toughness, or will, or strategy. FDR, Truman, Nixon, Carter and Clinton all took runs at this prize. All of them failed. And Lyndon Johnson went for Medicare and Medicaid because he was daunted by the challenge of comprehensive health-care reform.

The executive simply has limited power here. If the store gets given away, it's probably not because Obama didn't want any of the stuff in it. If a strong bill survives the process, it's probably not because Obama was just so irresistibly persuasive.

But either way, even the best of the bills on the table would simply be a partial fix for our coverage problem, not a root-and-branch reform of our wildly inefficient, fiscally destructive health-care system. Obama made those compromises because, on the one hand, the public is afraid of change, and on the other hand, the Congress is stocked with folks who will scare them further and do their best to block needed reforms, and on the third hand -- government is many-handed beast -- industry has a lot of money and a lot of clout.

Compared with the structural power of Congress to block legislative change, the tendency of the public to fear legislative change and the capacity of industry to fight legislative change, the president just isn't that powerful. A perfect performance by Obama may, in other words, not even be enough to pass an imperfect bill, much less a perfect bill. That goes for Cohn, too.

By Ezra Klein  |  August 12, 2009; 3:01 PM ET
Categories:  Health Reform  
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Next: What Health Care Can Learn From Whole Foods


Well, stated, Ezra! Congress is dysfunctional, but so are we! Look at the public behavior, the utter lack of rationality and pragmatic problem solving. The civilized developed world looks at us with puzzlement that we would be the only such nation who denies its own citizens basic universal access to primary health care, and we are so prone to the disinformation, fear mongering, and obstruction by the vested interests while they pick our pockets.

We are content to pay 29% of Americans govt. provided health care (Gallup) including the blow hard GOP senators who claim to hate it so much, while denying the same right to ourselves.

As Pogo stated so eloquently, "We have met the enemy, and he is us!"

Posted by: cmpnwtr | August 12, 2009 3:31 PM | Report abuse

What are you talking about? Bush and Cheney increased the power of the Executive branch a few hundredfold. The President should be able to raise the dead and fly at this point. Extraordinary rendition for Blue Dogs. Waterboard the teabagger. It's all constitutional because we say it is. Obama really has no excuses not to crush his enemies, drive them before him, and hear the lamentation of their women.

Posted by: jeirvine | August 12, 2009 3:48 PM | Report abuse

True, on the whole. But it's hard to look at the (admittedly scant) evidence and come away with the conclusion that Obama is trying his best and being thwarted. He doesn't have the appearance of someone banging his head against a brick wall. I think you have to pin an eventual failure (in whatever terms you define that) at least partly on his choices.

Something has just been missing so far from his efforts to sell this--well, a lot of things. He hasn't effectively communicated his ideas about reform to the public: one of those infomercial-style TV appearances, in which he clearly described the problem and his solutions, would do wonders. He seems to have delegated too much responsibility to Congress; you've blogged, Ezra, about how he's above all a "congressionalist" president, and how that's tied in with what happened to Clinton, but it really was a colossal error to miss the recess deadline. And this error was compounded by (so far) badly losing, indeed almost conceding, the August message war.

Obama is, or was, a lot more popular than Clinton, who, after all, didn't even achieve a majority, and who certainly didn't have as much ability to beat down on the opposition rhetorically (Republicans being far more odious in the public eye now than then). Obama also has larger congressional margins to work with than did Clinton. But whether due to caution or simple lack of desire, Obama took what he thought to be Clinton's "lesson" deeply to heart, and he may well pay for it. I think if Obama had started making his case--not started privately telling legislators to get moving, but REALLY made the case to the country and publicly pressured congress to act--early on, instead of letting the process get bogged down in the excrement of committee and watching support for healthcare and his administration slowly dribble away (as he must have known it would, with the economy not looking to make a decisive turnaround and without any popular achievements to point to), we wouldn't be in this situation.

Of course, counterfactuals and hindsight and all that, but Obama's backseat role in this was (a) his choice, (b) likely not the right one, and (c) almost certain to impact significantly on how this ultimately plays out.

Posted by: fumphis | August 12, 2009 3:48 PM | Report abuse

Your work keeps going downhill each day. At what point are you just going to change your logo from your face to a symbol of Obama/Biden in 2012. You have a supermajority in the senate and the house. Obama is far more popular then those running the show in congress and there are many new faces. If he wanted to get it down, he could. The reality is the left doesn't want to take on the massive risk for a program that could massively fail, is widely expensive and scares the crap out of the largest voting segment of our population (the upcoming baby boomers).
Now your already making excuse for your hero. This blog would be more appropriate at the Nation or DailyKos than a major newspaper.

Posted by: Natstural | August 12, 2009 3:53 PM | Report abuse

"not a root-and-branch reform of our wildly inefficient, fiscally destructive health-care system."

O.K. you understand; I understand. So why are you not blogging every day about low MLR's, comparison's with other countries, the myths of wait times, rationing and government interference in other countries, the waste of physicians filling out forms for insurance cos., the vast waste of both physicians and patients fighting with insurance cos to get paid, the fraud of the Lewin group and "reasonable and customary," the suppression of the basic facts on health care in the media, the lack of coverage of the people and the polls that support single payer, etc., etc., etc., etc., etc., etc.,

I know you mention these things time to time, but you appear to know what's going on. Why not join me and Steffi, and David, and Marcia and Oliver..... on the front line? We can sure use someone with a soapbox.

Posted by: lensch | August 12, 2009 4:19 PM | Report abuse

lensch- "So why are you not blogging every day about low MLR's, comparison's with other countries, the myths of wait times, rationing and government interference in other countries, the waste of physicians filling out forms for insurance cos"

That pretty much describes the last two years of Ezra's blog, up until the past few months or so when Congress actually started getting somewhere. Then the focus turned to more inside baseball health reform process coverage. Shame really, because Ezra was really good at clearly outlining the issues and linking to good sources of info.

Posted by: jeirvine | August 12, 2009 4:29 PM | Report abuse

This is the stuff we put them on Mount Rushmore for, or give them real estae on the Mall. This is the job description, and if Obama didn't want the "failure is not an option" he shouldn't have run. This is why we have the horror of primaries and campaigns.

This is an emergency, a catastroph. Failure will not only kill a lot of people, but possibly bankrupt the nation. This is the show. What, if FDR had lost WWII, you would cut him some slack and say "he tried his best?"

You are starting to understand what being a "serious" person is. It means not failing. Ever. Or at least having amazing historical successes that more than compensate for losses. The ratio is like SS + winning WWII + saving the country from Depression to court-packing. Or civil rights + Medicare + War on Poverty vs Vietnam. Some think the last is still a close call.

Obama is nowhere near that class, not even in the top half of Presidents. Obama is not a serious person, and I guess neither are you, Ezra.

And we saw Obama's negotiating style during last fall's bailout battle, and the stimulus. He tries to give as much as possible. No wait. He gives anything and everything to get a bill. But sometimes compromise and concession will fail.

Posted by: bobmcmanus | August 12, 2009 4:52 PM | Report abuse

You are making lame excuses for the President. He has contributed to his own lack of power with his interminable preference for compromise before even getting started on a campaign. As one of the commenters above noted, the Presidency has gotten stronger recently but it has been Obama's choice to do a lot of what he has done. While we are and were all impressed with his speaking ability that apparently has not yet translated into an ability to lead government with the same aplomb. I'm hoping for all our sakes it is not too late for, as Dan said in his article, him to come into focus in a way that shows that he has some spine.

Posted by: michaelterra | August 12, 2009 7:04 PM | Report abuse

You can't let the thieves reside in the temple if you seek to clean it.

Granted, BHO has a lot on the plate but to deligate so much to the execrable likes of Max and Chuck and their minions like Jim Messina et al:( well, that's not taking care of the people's business.

He shall be judged inversely to the reflected joy of the insurance companies and big pharma after the bill is signed. The happier they are the worse off he and all of us will be.

Posted by: perhapsnot1 | August 12, 2009 7:29 PM | Report abuse

-Ezra has indeed exhibited great energy and has been very informative. But he has not so much been an objective voice or an advocate of anything really transformative like single-payer as he's been a subtle champion of kludgy reform like co-ops; all, it seems, for the sake of political expediency, the holy consensus of the DLC, Snowe, and Specter types an to sop the greedy maws of industry.

The President was elected partly by courting the middle. But I think he must realize now that a new campaign needs to be waged from more extreme ground given the disingenuous cretins he formerly partnered with. Ezra has recently been toying with this realization.

Posted by: perhapsnot1 | August 12, 2009 7:45 PM | Report abuse

EzK: "A perfect performance by Obama may, in other words, not even be enough to pass an imperfect bill, much less a perfect bill. That goes for Cohn, too."

The more relevant question would seem to be if a much-less-than-perfect bill can survive a lousy performance by Obama. At this juncture it certainly looks as if the President's decisions to:

(1) give his party's Congressional leaders a free hand in drafting the bills;

(2) try to extort concenssions from health care industry groups in private negotiating sessions; and

(3) try to shift the message from cost savings to protection from rapacious insurers midstream;

...all look like blunders in retrospect.


Posted by: tbass1 | August 12, 2009 8:38 PM | Report abuse

I really enjoy reading comments to see all the arm chair quarterbacking. "You see what he should do" or "that was an obvious mistake." Right. But seriously funny. I neeeded a laugh today. Thanks.

Posted by: rldestef | August 12, 2009 8:48 PM | Report abuse

I don't see why there's such an attachment to single payer. Single payer is used by one major western country in the world, Canada, and we don't see that model being something that the rest of the industrialized world is determined to adopt for themselves. I think it's fine to advocate for it in an Overton Window sort of sense (the conservatives should be THANKING the liberals that we're willing to compromise with conservative solutions to the point where insurance companies are still allowed to exist), but I don't see why the best solution is to adopt a system that only our northern neighbor has seen fit to go along with.

Posted by: tyromania | August 12, 2009 8:48 PM | Report abuse

health care reform is a fierce battle and it is being waged now!

obama has to get real support from key elements of the establishment and a bill through 2 houses of congress

so far there is movement toward reform and there is some resistance

personally i don't think there is that much resistance

arlen spector seems to be the poster boy for town hall meeting disruptions and the hostile crowds at his town hall meetings have as much to do with the upcoming election for the senate seat he now holds

the GOP is getting conservative groups
organized in pennsylvania

spector and sestak will battle in a democratic primary and the winner will face a well-financed, noisy, heated gop conservative campaign

Posted by: jamesoneill | August 12, 2009 9:00 PM | Report abuse

Here's a thought on how to deal with the backlash, and the "Don't let the government ruin my medicare" business: switch gears, and promote medicare for all. Then no one could complain about the unfathomable things that will be done under a reform plan.

Posted by: gr128 | August 12, 2009 9:02 PM | Report abuse

I wonder though, if President Obama was really willing to go 100% all out, willing to use all political capital and money, make any enemies, not think about how this would affect any other future attempts to pass bills (just for the sake of argument, although there is a case that once the public saw how much better things were with a good universal health care bill, this would generate so much gratitude and confidence, like with the New Deal, it would much more than pay for the political capital used, enemies made, etc., especially over the long run), then how much power, as President and as leader of the Democratic party, could Obama have to get a good bill passed?

Most presidents hold back their ammo, their options, on any given bill, out of concern for not having the ability to pass future bills as Clinton did in not wanting to anger Senator Byrd by trying reconciliation to prevent a filibuster (from Jonathan Chait's 2007 book; for details, see here:

What if Obama didn't?

Posted by: RichardHSerlin | August 13, 2009 4:19 AM | Report abuse

The substantive lesson seems to be that health-care reform should be approached in reasonable pieces that can attract a unified majority and can be explained and justified to the public. Obama wanted to go down in history for a vast reshaping of health care, though, so he gambled on hitting it big.

The procedural problem is that Obama had no plan. Despite the fact that the details of health-care reform were one of the biggest differences in the Democratic primaries last year, he seemed to think that if he tossed the issue to Congress, the party would somehow unify behind something or other that he could sign in a quick ceremony.

When that didn't happen, he had no plan B. Taking the issue to the people was never supposed to happen. Now he's left with nothing concrete to sell to the public: he can't say for sure whether there will be a public plan, an exchange, an individual mandate, or cost control. People don't know where Obama stands on these critical points. It's not inspiring to tell America, "Support whatever we don't compromise away in committee."

Posted by: tomtildrum | August 13, 2009 10:39 AM | Report abuse

tyromana - What are you talking about? SAre you using some bizarro deinition of single payer? Perhaps you do not regard it as single payer when people are allowed to purchase supplmentary coverage after every one gets basic coverage through a national plan. O.K., let me put it this way. All other industrialized countries have a universal government controlled health insurance plan. None of them have uncontrolled for profit insurance. Even the Netherlands' new system requires each insurer to offer a basic plan written by the government to any one that wants it and the price is set by government. That may not be single payer, but it's a far cry from the US system.

Those of us who push for HR676, Medicare for All, envision supplementary private plans for those who can afford it. This sytem would be very similar to those in many other countries (France, Italy, Spain, etc.). I call it single payer.

Posted by: lensch | August 13, 2009 1:31 PM | Report abuse

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