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The age of diminished presidential expectations


From the comments:

I am getting supremely annoyed at the argument that Obama made "it" (meaning health reform) happen, unlike his Democratic predecessors. The fact is that while the current reform produces near-universal coverage, it does so by basically departing from the core principles of those prior Democratic leaders. Even Clinton proposed a more progressive reform than this one.

I mean this is an ok first step on a very, very long road. It's NOT the kind of fundamental transformation Truman, Carter, etc... were proposing. Medicare -- passed by a Democratic president at a time when much of his party was on the edge of revolt over race and war -- was a far more radical and consequential achievement than Obama's far more stable Democratic majority can accomplish today.

The strength of Barack Obama's young presidency has been its depressing realism about the limits of legislative achievement in the age of the filibuster and unrelenting partisan polarization. Health care might pass -- and might is an important word there -- because Obama didn't try to do too much. Big as people think this bill is, it really only affects the insurance situations of 30 or 40 million Americans, most of whom would be otherwise uninsured. Helping 30 or 40 million people is a big step forward, but it is not reform of the health-care system. It is an expansion of it.

Similarly, Obama isn't drawing lines in the sand on universality (as Clinton did), or on full auction of carbon permits. Christina Romer told the administration it needed a $1.2 trillion stimulus, and the administration settled on $800 billion because that seemed passable. And it still didn't get a single Republican vote in the House. We live in an age where we expect, and arguably need, the president to do much more, but where the structural constraints confine him to doing much less. Obama, by aiming squarely for the middle of that Venn diagram, will probably manage to do quite a lot, while still not doing nearly enough. He won't content himself with noble failures, but we will not see full solutions.

Photo credit: Jay Janner/AP.

By Ezra Klein  |  December 1, 2009; 11:42 AM ET
Categories:  Health Reform  
Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   StumbleUpon   Technorati   Google Buzz   Previous: How Medicare and Medicaid helped health-care reform
Next: To repeat, the CBO found that premiums go down under health-care reform


Maddeningly, these problems are solvable.

Posted by: adamiani | December 1, 2009 11:49 AM | Report abuse

I look at it like Social Security, which was only available to white men in non-farm jobs when first passed in 1935; it took a number of add-ons and tweaks to transform it into the universal saftey net we have today. This is also the reason I think having a public option on the books is important, even if it covers zero people. Tweaking a useless public option into a legitimate program is easier then inventing one whole cloth later when or if it is necessarily.

Posted by: flounder2 | December 1, 2009 11:54 AM | Report abuse

What are we arguing here? You say, "Obama isn't drawing lines in the sand on universality (as Clinton did), or on full auction of carbon permits." Well, yeah ... and Clinton didn't get one step closer to universality or a carbon tax. Are we comparing robust proposals that never happened to more modest ones that probably will? I'm not finding this a particularly convincing line of argumentation.

Posted by: JJenkins2 | December 1, 2009 12:15 PM | Report abuse

"...we will not see full solutions."

You don't get solutions in a declining empire. Solutions are for polities on the rise. If lucky, you get bandaids.

Unfortunately, the planet needs more.

Posted by: janinsanfran | December 1, 2009 12:19 PM | Report abuse

"Obama, by aiming squarely for the middle of that Venn diagram, will probably manage to do quite a lot, while still not doing nearly enough."

Here's where we part ways, Ezra: you're content to take comfort in speculatives, the conditional tense, "will probably manage" and the like. Over the past months your arguments on the various facets of healthcare reform -- from single-payer to the PO to Grassley vs. Baucus to even triggers -- have shifted like quicksilver. Your single consistent thread has been to exonerate the administration of any blame if a bad bill gets passed (or if the effort collapses altogether, which could still happen.)

Do you believe the administration has made mistakes as the debate unfolded this year? If so, could you elaborate in a post? And if not, why not?

Posted by: scarlota | December 1, 2009 12:20 PM | Report abuse

In the first eight months the President provided no direction to Congress or the public, while in the backrooms he was hatching a detailed health industry bailout plan to which, had he expressed it in January, the public would have said no thanks.

Was I unrealistic to expect more from him? I guess so.

Posted by: bmull | December 1, 2009 12:30 PM | Report abuse

I also think that point is factually incorrect. Truman settled for incrementalism in the same way. Instead of universal care, the AMA and Dixiecrats were immovable in their opposition, so to sell it politically, Medicare was pared down to an entitlement to the aged (and not the more stigmatized mean-tested model); and to avoid the AMA it only included (at first) hospitalization.

Health reform has a long and storied history of reaching big and settling for less.

And, again, as history shows, just as Reagan and the AMA went from opposing Medicare to defending it to the death, so too is it safe to assume that once operationalized even a middling reform will, after a generation, make all the Bachman's and Inhofe's look like the healthcare equivalents of Strom Thurmond and his opposition to desegregation.

Posted by: ThomasEN | December 1, 2009 12:42 PM | Report abuse

But by preemptively surrendering, Obama concedes the terms of debate. We needed a much bigger stimulus; so Obama should have floated $1.9 trillion then moved down. We need to bring down health care costs; so Obama (or Congressional Dems) should have started with single payer and moved from there.

No matter how centrist his proposals, the entirety of the GOP will claim that it's extremist fascistic communism. So we may as well do what we have to do to negotiate to a good policy. Obama's penchant for starting in the middle means he winds up further compromising, with poorer policy results.

Posted by: eelvisberg | December 1, 2009 1:07 PM | Report abuse

But if he's bold about changing the system itself, that is substantially possible at some strategic time in the not too far future with an all out effort, as there's strong evidence that using the nuclear option we can abolish the filibuster with just 50 committed senators and the V.P.

For more on this, please see the last three comments of this post:

Posted by: RichardHSerlin | December 1, 2009 1:38 PM | Report abuse

Wow, thank you for the response Ezra. I take your point but I guess I'm dissatisfied with this:

"Obama, by aiming squarely for the middle of that Venn diagram, will probably manage to do quite a lot, while still not doing nearly enough. He won't content himself with noble failures, but we will not see full solutions."

Fair enough, and it's true that an achievable expansion of our current system is miles better than a failed proposal for universality. But "not seeing full solutions" really isn't satisfactory. It certainly isn't what most of us were expecting when we worked to elect Obama and expand the Democratic majority. That may be why you see a 25 point gap between Democratic and Republican plans to vote in 2010 (

Legislative realism is great for passing statutes, but it strikes me as really iffy politics right now. People want leadership, but meekly backing down to appease Joe Lieberman or Ben Nelson (let alone Joe Wilson) just doesn't show it, even if backing down is in service of larger legislative goals. This is particularly painful b/c the fear of LOSING people like Lieberman or Nelson has forced Obama to slow down on purely Executive Branch action like climate change, softening DADT, and revising the Bush terror policies.

I agree that it's unfair to blame Obama, or even the larger Democratic Party, for this impasse. But at this point it's their problem even if it isn't their fault. And it seems to me that the worst endgame for a "legislative realist" strategy would be for the party to suffer an electoral reverse that prevents it from passing any legislation at all.

Posted by: NS12345 | December 1, 2009 1:46 PM | Report abuse

shorter Ezra:
the Obama administration -- good enough!

Posted by: goadri | December 1, 2009 2:18 PM | Report abuse

We can't afford to wait for forty years to evolve to a decent healthcare system; we can't even afford ten. This is not a reform, it is a last ditch attempt to avoid reform.

I would like to know how many of the 30+ million uninsured are single or childless and how they will be helped by this bill. I keep reading about the subsidies available for famillies and nothing about how childless singles or couples are supposed to be able to afford this mandatory coverage.

This is not universal healthcare, or even universal health insurance. It is more of the same dysfunctional model that is bankrupting individuals, families, companies, and government.

Posted by: Athena_news | December 1, 2009 2:22 PM | Report abuse

Singles will be eligible for the Medicaid expansion up to 133% of poverty. Many singles employed in businesses that currently don't offer coverage will be covered. They'll also be eligible for subsidies, which you can calculate here:

Beyond that I guess being covered counts as a benefit in and of itself, even if the government is forcing you to pay for it...

Posted by: NS12345 | December 1, 2009 4:43 PM | Report abuse

Americans are fools. Now, Obama's the bad guy. It is exactly the same sort of nonsense that was lowered onto George W. Bush's head, up to 9-11. I think the invasion of Iraq was a foreign policy mistake, Katrina showed we need brains in there, and Bush's neglect of environmental issues was sad, but what amazed me most was the continuous opprobrium heaped on his head. It's just about all nonsense. Americans are whining idiots who complain when things don't happen immediately and when they don't get their own way. And it makes them easy to influence by public relations campaigns by special interests. Proceeding ahead, the Democrats will eat their own once again, then the Republicans will return to power, and then they'll get excrement thrown at them, too.

Posted by: Lee_A_Arnold | December 1, 2009 9:49 PM | Report abuse

too bad John Edwards voted for AUMF and cheated on his wife

Obama 2012 - At Least You Got Something

Obama was never a liberal and will never take a risk to push the country left. Another completed wasted opportunity by the Democrats. That $50M in start up capital from Sand Hill and Wall Street is certainly paying off however.

Posted by: PMuldoon | December 2, 2009 5:04 AM | Report abuse

Amazing!! A 1.2 Trillion dollar in the first 10 years manys times that in the next, massive increases in the government bureacacy, huge amounts of new government rules and regulations on an industry that was privately run, fines/taxes on people who won't buy the government mandated health insurance and to top it off a so called public plan which in the hopes and dreams of every liberal, including yourself Ezra, that'll eventually lead to a single payer fully government run healthcare system. That's incremental change?? Holy!! I'd hate to see what a major change looks like.

Posted by: RobT1 | December 2, 2009 8:12 AM | Report abuse

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