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Has Obama Played Health Care Exactly Right? Does It Even Matter?

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The White House's legislative strategy is coming under a lot of fire lately. Some observers think it's been too focused on bipartisanship. Others believe it overly solicitous of Congress. But congressional expert Norm Ornstein thinks that it will eventually come to be seen as quite wise:

The Obama strategy since his election has been based on a gimlet-eyed and pragmatic assessment of the prospects and limits afforded by public opinion and the political process. A naive president would have assumed that, after a landslide victory, huge coattails, swollen partisan majorities and a high approval rating, he could have it all -- and pushed hard and early for a far-reaching, soup-to-nuts upheaval of the health-care system. Obama and his strategists understood that would not work. ...

Enacting reform the way it should be done -- with broad bipartisan leadership support and broad bipartisan majorities -- was simply not in the cards in today's political universe. Bipartisan support was clearly a non-starter in the House, if less so in the Senate, but past experience also showed that finding partisan majorities, even with healthy margins in both houses, would not be easy. Bill Clinton had almost identical Democratic support in the House and Senate, but he could not find a formula to keep his partisans together. Trouble with Blue Dog Democrats in 1994 nearly derailed health reform in the House and slowed it enough to prove disastrous in the Senate. Ideological, regional and urban/rural splits always make uniting Democrats a challenge. In 2009, unlike in 1994, every issue has a filibuster line drawn in the sand, making the hurdle 60 votes more often than 50.

How to prevail under these difficult circumstances? The only realistic way was to avoid a bill of particulars, to stay flexible, and to rely on congressional party and committee leaders in both houses to find the sweet spots to get bills through individual House and Senate obstacle courses. Under these circumstances, the best intervention from the White House is to help break impasses when they arise and, toward the end, the presidential bully pulpit and the president's political capital can help to seal the deal.

No health reform bill can be enacted unless the House and Senate each pass a version, and that has been the single-minded goal of the White House. If the Senate has to resort to reconciliation, it can only work if more than 50 Democrats are convinced that it is the last resort -- that every effort was made to compromise to include significant Republican support. Thus, the White House signal on the public option. Once both houses pass versions, no matter how disparate, a conference committee can find a way to meld the bills -- no doubt with heavy White House input -- into one plan that goes back to each house for up or down votes. There, the pressure on lawmakers to support health reform will be much greater, as will the ability to break filibusters by urging all Democrats, even if they can't support a bill, to vote for cloture as a procedural issue.

The odds remain reasonable that a solid, if not dramatic, health reform bill can make it through this process and become law. Any bill, under these conditions, will be a major accomplishment. The odds have been improved, not damaged, by the president's approach.

Broadly speaking, I agree with this analysis. And whenever you hear someone complaining that Obama has given too much power to Congress, remember that the great complaint about Clinton's reform effort was that he took too much power away from Congress. We have a tendency to work backward when trying to understand why something is going wrong, and that necessarily leads us to think a lot about tactics. But it doesn't answer the question of whether the outcome would be different if the opposite strategy had been tried. Under Clinton, it was tried. And it failed. Obama's strategy has brought him a lot closer than Clinton ever got, although it's also been yoked to a much more modest piece of legislation.

It's also worth pointing out another problem with this sort of thinking: The passage of needed reforms shouldn't be predicated on perfect legislative tactics from the executive branch. Congress is supposed to want to solve problems, after all. Asking them to legislate in the national interest is not some sort of imposition, or break in the routine. They're the branch of government that actually passes laws and makes changes. The president, after all, cannot pass legislation over the objections of Congress. But Congress can pass legislation atop the objections of the president. If legislative progress is dependent on the perfection of the executive branch, this country won't see much progress, because presidential administrations are seldom perfect, and they don't have that much power over Congress, anyway. Our political system has to be more robust than that.

Photo credit: AP/Brian Snyder

By Ezra Klein  |  September 1, 2009; 12:08 PM ET
Categories:  Health Reform  
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Comments

I think this is simply BS:
"If the Senate has to resort to reconciliation, it can only work if more than 50 Democrats are convinced that it is the last resort -- that every effort was made to compromise to include significant Republican support."

Anyone with a brain knows the Republicans were going to oppose, oppose, oppose, and try to drag things out until they could lie enough to kill it. And the Dems let them.

And I note that yesterday, I said that the Gang of 6 wasn't dead, that the BS kabuki dance would continue, and it would kill reform totally.

Posted by: AZProgressive | September 1, 2009 12:25 PM | Report abuse

I have no problem with their legislative strategy to date. Where they disappointed me was when they had no media strategy for August. That's when the screamers took over. It didn't have to be this way. Team Obama should have taken the focus off the president and put it on the regular folks who are suffering in the strangle hold of the current system. The needed a gimmick to counter balance the screamers. They came up short. They need a refresher course in PR 101.

Posted by: mayelinden | September 1, 2009 1:18 PM | Report abuse

Norm Ornstein is wrong and so is Ezra. If it doesn't matter that Obama has played health care exactly right, why did Ezra even bother reading the candidates' health care proposals?

"The passage of needed reforms shouldn't be predicated on perfect legislative tactics from the executive branch."

At this point I wondered why this column matters. The passage of needed reforms is predicated on a vision from the executive branch. Unfortunately, the executive branch never got around to informing Congress what it wants to see in the bill that Congress sends over.

This whole column is a waste of time. Why did the Post hire you again?

Posted by: cab91 | September 1, 2009 1:23 PM | Report abuse

Right on Ezra, this is the path I have seen all along for this sort of legislation. Obama has seen that until there are final versions out of all these committees, and maybe even until the committee bills are merged for passage through each house, Obama's only option is to crack the bully pulpit whip at people. We already know from his campaign that he sees his role as not being another Bush who moralizes and hyperbolizes every issue into a "for or against" America/the President but someone who uses leadership and delegation of power to its proper place (be it with regional campaign heads or Senators) instead of appropriating new ones and trying to win every second of the battles at hand. Sometimes he takes loses, sometimes he struggles, but at the end of the day his eye is on the path needed to pass substantial legislation.

Posted by: PaulW99 | September 1, 2009 1:26 PM | Report abuse

"The passage of needed reforms is predicated on a vision from the executive branch. Unfortunately, the executive branch never got around to informing Congress what it wants"
@cab
That's idiotic my friend, one of the reasons we divided the government is because each branch should be able to act independently towards the act of governing. If the Senate was intended to be directed by the President I don't think the Constitution would have been written as it was. As for Obama not telling Congress what it wants, that's absurd on its face if you have been reading/paying attention to anything at all about the behind the scenes efforts by Obama to get a bill to the floor of each house.

Posted by: PaulW99 | September 1, 2009 1:34 PM | Report abuse

It's not just a question of the White House deferring to Congress. After what happened with "Hillarycare," I think most people agree that Congress needs to be on the ground floor. The problem is that Obama has been completely hands-off. There's a leadership vacuum on health care right now. The White House has been maddeningly noncommittal and vague about what should be in the bill. I think they're afraid to take ownership lest the bill fail and the failure reflect on Obama.

I'm glad there's not a lot of hubris in this administration, but it comes off as a lack of confidence and/or cravenness. Probably it's a combo of the two. Or maybe the cravenness comes from the lack of confidence, and that's why the White House's most memorable contribution to this process has been a backroom deal with Big Pharma. Impressive!

Or, hey, maybe our eyes are lying and Obama really is doing Everything Exactly Right. Kinda doubt it, though.

Posted by: caitiedidit | September 1, 2009 2:25 PM | Report abuse

The problem with Obama being specific now is it means 2 tough votes for Democrats in each house, once on the initial passage, once on the conference report. As Clinton found out with his carbon tax proposal back 1993, if you whip the caucus hard to get initial passage and then compromise in conference, you lose the trust of members of Congress and you put them on record for something that didn't pass.

Posted by: bharshaw | September 1, 2009 2:30 PM | Report abuse

Success has a hundred father/mothers, and failure is an orphan. Time will tell whether the strategy has been good or not. Obama ran on an ethic of bipartisanship, and that worked. He has to at least say he tried. And for all his drop in polls, the Rs are not the least bit popular with their extreme over the top partisanship. So he can say he tried, and it's time for the Dems to show they can govern and do right by the country. I'm inclined to agree with Norm Ornstein, who's one of the better observers on the Congressional politics scene.

Posted by: cmpnwtr | September 1, 2009 2:44 PM | Report abuse

"Success has a hundred father/mothers, and failure is an orphan. Time will tell whether the strategy has been good or not. Obama ran on an ethic of bipartisanship, and that worked. He has to at least say he tried."

what is so discouraging, is how the struggle never seems to end.
as soon as hope sets the table, the demons are flocking and peering in at the window.


Posted by: jkaren | September 1, 2009 3:07 PM | Report abuse

*****Anyone with a brain knows the Republicans were going to oppose, oppose, oppose, and try to drag things out until they could lie enough to kill it. And the Dems let them.*****

Azdemocrat: First, healthcare reform was never supposed to reach BHO's desk before November, or so, so up to this point AFAIK everything's on track to the extent that could be hoped (as you say, we knew all along that the GOP was bound to play an obstructionist role). Second, I think that, by really making a major, very public and well-documented effort at bipartisanship, Democrats will reap a public relations victory at the end of the day, when a unipartisan bill eventually makes it to Obama's desk.

I predict come New Year's, people will once again be marveling at how (yet again) they underestimated the political acumen of Obama, Axelrod, and Emanuel.

Posted by: Jasper99 | September 1, 2009 3:26 PM | Report abuse

"Azdemocrat: First, healthcare reform was never supposed to reach BHO's desk before November, or so, so up to this point AFAIK everything's on track to the extent that could be hoped (as you say, we knew all along that the GOP was bound to play an obstructionist role). Second, I think that, by really making a major, very public and well-documented effort at bipartisanship, Democrats will reap a public relations victory at the end of the day, when a unipartisan bill eventually makes it to Obama's desk.

I predict come New Year's, people will once again be marveling at how (yet again) they underestimated the political acumen of Obama, Axelrod, and Emanuel."

Posted by: Jasper99 | September 1, 2009 3:26 PM | Report abuse


thank you, jasper99!!!!!!!!

Posted by: jkaren | September 1, 2009 3:49 PM | Report abuse

Instead of focusing on the 24 hr. news cycle and the sportscasters who pose as news media, I think it's best to focus on Chuck Schumer,Chair of the Senate Rules Committe and remember the final bill (two bills) are coming out of Conference.

There will be two bills, and the Senate will be the place to watch. The first one is pre-reconciliation. It will be an easy one, with 60 plus votes- a tight insurance regulation reform instituting the exchange, and the minimum standards to compete, including community standards, open access, no previous conditions, no recision, and so on. These are all popular reforms.
The second bill will be post-reconciliation and will be harder, but will garner the 51 and even more. It will be the finance and public option part of the policy. Schumer will be the one who shepherds the Senate rules to make sure this thing gets through under reconciliation. Schumer is a hard ball player and will do what's necessary to get it done.

All this is doable and given the politics of it and the constituencies, it will pass. And it will prove to be popular by 2010.

Norm Ornstein's observation are consistent with what Ezra posted back on July 24.

http://voices.washingtonpost.com/ezra-klein/2009/07/why_democrats_will_at_the_end.html

Posted by: cmpnwtr | September 1, 2009 4:36 PM | Report abuse

thanks for the link, cmpnwtr, I missed that earlier post of Ezra's.

What's appalling if you go read it is the long column of comments following the post, just filled with vitriol and contrariness.

By comparison, today's resident counter-commenters seem far less numerous. Maybe things are getting better. And if so this illustrates the point of today's post - one has to take the long view always :)

Posted by: wapomadness | September 1, 2009 5:01 PM | Report abuse

Ornstein is exactly right, I think.

Mayelinden in the comments above is also correct I think. But maybe all this August noise works out okay. What is interesting is that by pushing the public insurance choice or "public option," the Dem progressives appear to have pushed the Repubs into making a political mistake, which is to start a level of lies and screaming that cannot be sustained in intensity for 14 months until the next election, without everybody turning them off in the meantime. All this screaming could serve their further downfall. But the bill has to pass this year, and it must be simple, simple, simple, to explain and understand.

Posted by: Lee_A_Arnold | September 1, 2009 5:17 PM | Report abuse

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