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Why did Barack Obama do health care first?


Joe Romm says that “future generations are likely to view Obama’s choice of health care over energy and climate legislation as a blunder of historic proportions,” which is certainly possible. But like Matthew Yglesias, I don't think it was a choice at all. I think if Barack Obama thought he could do cap-and-trade first and health-care reform second, he would have said so. In fact, he did say so.

In the second presidential debate, Tom Brokaw said "that there are going to have to be some choices made. Health policies, energy policies, and entitlement reform, what are going to be your priorities in what order? Which of those will be your highest priority your first year in office and which will follow in sequence?"

"Energy we have to deal with today," Obama said. "Health care," he continued, "is priority number two." Then came education. Of course, when Obama actually got into office, he flipped and went for health care first. The question is why.

As part of a piece I'm doing on political science, I spent some time talking to George Edwards yesterday. One of the ways people misunderstand the presidency, he said, is to focus too much on Richard Neustadt's argument that the chief power of the president is his ability to persuade. In fact, Edwards's research suggests that presidents are very poor at persuasion. The more they talk about an issue, the more the polls tend to move against them.

Edwards instead believes in something he calls "the strategic presidency." "Presidents come in and they think they can create opportunities," he says. "What really happens is they have to exploit the opportunities that already exist because they can't persuade." For Obama, the opportunities were a large Democratic majority that was united on health care but not on cap-and-trade, an economic crisis and associated deficit that seemed better suited to the security and potential deficit reduction possibilities of health-care reform than the energy pricing required by a cap-and-trade bill, and the reality that there was more existing infrastructure and readiness among the Democratic Party's allies to do health care than cap-and-trade. And so Obama went with health care. But I didn't think then, and I don't think now, that health care was his preferred fight.

Photo credit: By Charles Dharapak/Associated Press

By Ezra Klein  |  September 8, 2010; 2:08 PM ET
Categories:  Energy , Health Reform  
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Electrons don't vote. People worried about their health do.

Posted by: jamusco | September 8, 2010 2:18 PM | Report abuse

If future generations bother to think at all about Obama's choices, they will think he should have reformed entitlements.

Posted by: bgmma50 | September 8, 2010 2:23 PM | Report abuse

I think that Energy would have failed if done first and that Health Care only passed because it had failed in 94, Energy will have a better shot next time, granted it will be a while...

Posted by: tjproferes | September 8, 2010 2:36 PM | Report abuse

In other words, Obama learned the lessons of Clinton's first two years, worked with what he had, accomplished what he could, and avoided quixotic battles that would lead to nothing getting done.

Thanks for reminding me why I voted for the guy.

Posted by: mezcalero | September 8, 2010 2:40 PM | Report abuse

I firmly believe we are going to regret him not doing taxes first. We need a permanent tax structure to reduce the uncertainty in the economy. If taxes were done first, we could have the Bush tax cut argument already past us on an issue that directly effects the economy. It would have been politically better for Obama as well.

Posted by: lancediverson | September 8, 2010 2:45 PM | Report abuse

At the time of that debate moderated by Brokaw (Oct 5 2008 or thereabouts), gas prices were at about $3.50, down from the summer's prices above $4.00, but on Oct 5 no one knew that they'd be below $2.00 in little more than a month. Of course energy was first on the list at the time of that debate.

Posted by: bdballard | September 8, 2010 2:49 PM | Report abuse

At the time of that debate moderated by Brokaw (Oct 5 2008 or thereabouts), gas prices were at about $3.50, down from the summer's prices above $4.00, but on Oct 5 no one knew that they'd be below $2.00 in little more than a month (and the economy sinking with the prices). Of course energy was first on the list at the time of that debate.

Posted by: bdballard | September 8, 2010 2:51 PM | Report abuse

Energy – who is that Danish person who is Conservative who accepts Global Warming but says that we have time to address it.

I believe that is the crux of the matter. The urgency there is different.

The primary driver for Energy would have been 're-engineering' structure of our Economy. If Barack Obama had the 'full vision of American Economy' based on non-Carbon energy sources; that is a different matter. In other words, Energy could have been taken first if it was a piece in a puzzle of 'alternative structure of American Economy' instead of some kind of answer to Global Warming.

Of course, Barack Obama has never been near to that kind of vision for American Economy and he never landed solving that puzzle.

That is the Historic failure. When you do not have that framework and narrative; you land up on Train Station: bothering about which train can leave first because then individual policy issues are handled in bit of silos.

The damning indictment of Obama and Dems what you are seeing in all these polls is about this failure in grasping the 'centrality' of 'jobs and economy narrative'. American People do not want to get involved in all this discussion about which legislation should have been first when there is more and more evidence that Obama / Dems can be as clueless as GOP when it comes to offering truly fundamental vision / framework. This problem especially becomes acute for Dems because otherwise they are the ones who are wielding the big stick of 'government intervention'. Big Government is inherently detested in mature Democracies like USA unless it is deployed critically to get success for sure. Else it gets wasted to deepen suspicion of people and people get enthralled by those who are promising no such deployment of Big Government.

Posted by: umesh409 | September 8, 2010 2:54 PM | Report abuse

Comments by 'lancediverson'; that is something aligns with what I wanted to say too.

Obama simply punted that problem by creating Deficit Commission and essentially wasting the Nov 2010 election where political parties would have presented their vision about how to tackle deficit, put forward taxing structure, controlling entitlement and in general render the vision of American Economy. Today, there is not choice apart from being a 'Dem hack' waging the electoral battle like a lone warrior. Today, Obama has to carry the cross because he asked those tough votes from Dems in Congress while not bothering to such longer term strategic thinking.

Talk about 'above the fray' opportunity that would have presented to Obama if he would encourage Dems and GOP to engage in the full battle to thrash out mandate for these ideas via ballot box.

In Corporate parlance, you call this 'creative' or 'out of box' thinking. I believe David Axelrod and Rahm have miserably failed in this regard for the President.

Posted by: umesh409 | September 8, 2010 3:03 PM | Report abuse

"The primary driver for Energy would have been 're-engineering' structure of our Economy. If Barack Obama had the 'full vision of American Economy' based on non-Carbon energy sources; that is a different matter. In other words, Energy could have been taken first if it was a piece in a puzzle of 'alternative structure of American Economy' instead of some kind of answer to Global Warming."

That's exactly what he did with the Recovery Act. There are oodles of grants, tax-writeoffs, subsidies, and other incentives for more environmentally friendly technologies. In fact, you could safely argue that the Recovery Act has done more for the issues of Global Warming, Alternative Energy, and overall enviro-friendly initiatives than anything coming out of Copenhagen ever could.

I understand that he may not talk about the issue the same way that a preteen girl talks about Justin Bieber, and indeed, that may be his downfall. But to argue that he needs some sort of "Grand narrative" or something, in the face of staggering unemployment in the aftermath of the worst financial crisis in 80 years is crazy.

FDR had a narrative too. It was called the "New Deal." People now consider FDR awesome, but in 1938, with his "vision" and "narrative" of the American Economy in full swing, he lost 70 seats in the congresional midterms. People then didn't care too much for a "vision." FDR wasn't a bad orator either.

Pretty talk and "visions" don't amount to nothin'n if people are unemployed.

Posted by: mezcalero | September 8, 2010 3:08 PM | Report abuse

Electrons don't vote. People worried about their health do.

Posted by: jamusco | September 8, 2010 2:18 PM | Report abuse

problem with that is that you and he forgot that 85% of people "liked their healthcare plans" they just didn't care for how much it cost. Costs are increasing. Right, wrong or indifferent he's going to get the blame for that now.

Posted by: visionbrkr | September 8, 2010 3:19 PM | Report abuse

One of the arguments used to push health care reform was that US companies have to compete against foreign companies whose workers get their health care from national health agencies or in heavily regulated health care markets (like Japan) thus placing US companies at a competitive disadvantage.

You have to wonder how much of a role the Big Three automakers circling the toilet back in 2008-2009 played in setting the agenda. Much of the labor cost disparity between Detroit auto workers and the domestically produced 'imports' and foreign automakers was blamed on the health care expenses for current and retired auto workers.

It remains to be seen if the health insurance reform that was passed will help US businesses compete with foreign companies abroad and here in the US market. As businesses are finding out, there is no free lunch in health care. That cost curve is going to have to bent much further.

Posted by: tuber | September 8, 2010 3:20 PM | Report abuse

According to one of the lead stories in Time Magazine, "How the Stimulus is Changing America" (,8599,2013683,00.html), the ARRA was actually a significant way for Obama to pass energy legislation under the guise of economic stimulus. And if you think (as I do) that cap-and-whatever is only one piece of the energy puzzle (the much larger piece being direct investment in infrastructure and r&d), then Obama has already accomplished a hugely important chunk of "greening" the future.

Posted by: smithnd | September 8, 2010 3:33 PM | Report abuse

Ezra, you might want to consult Johnathan Alter's book on Obama's first 15 (ish) months for your piece, even if you don't agree with it. (I'm frankly more interested in your political sciency take.)

Posted by: Castorp1 | September 8, 2010 3:41 PM | Report abuse

Ezra, many of your posts about Obama's presidency have the same theme: The President is just an innocent bystander. The recovery from the recession is slow not because of an inadequate response from Obama, but because recoveries from financial recessions are always slow. The wave of Democrats loosing their jobs in November is not a referendum on Obama and his policies, the party in power always looses seats. And now the President is not responsible for his legislative priorities, they just happen naturally. I am beginning to agree with you. I think Obama just takes vacations, occasionally reads some prepared remarks off of a tele-prompter, and hosts parties in the white house. He could let one of his daughters run the country and we would not be any worse off.

Posted by: cummije5 | September 8, 2010 4:08 PM | Report abuse

Remember when Obama had an electoral mandate and 60 Democratic Senators AND the possibility of using reconciliation and the ticking clock of EPA regulation (the one arrow left in the quiver)

I don't think a case can really be made that he couldn't do energy...but I agree that healthcare was easier...though you'd never know it by how it all went down.

What's really confusing to me is why the House voted on energy before healthcare was finished....seems to me this made August 2009 more difficult and it will probably cost some Democrats their seat this mid-term making energy legislation less likely.

Posted by: Mazzi455 | September 8, 2010 4:43 PM | Report abuse

I still wish he had focused on energy first and health care second. It may have been "pie in the sky" but I was hoping a progressive, new, new deal type of investment in overhauling our energy infrastructure would create jobs and jump start the economy while giving our country a foundation for the future. I also thought most Americans would get behind this type of investment if it was packaged correctly, not as a defense against global warming, but as an inevitable new way of living.

Posted by: ania8 | September 8, 2010 5:22 PM | Report abuse

Give me a break. If Obama went with Regulations on energy aka cap and trade the tea party would still be going nuts. Hello the tea party backers the Koch brothers made their money in Oil refineries. Hell they would be screaming louder. I think the Alternative energy R&D Stimulus is what really caused the Koch brothers to start doling out more cash to make Obama miserable. As if the Cato wasn't bad enough, good I hate that think tank.

Posted by: veronica8 | September 8, 2010 5:25 PM | Report abuse

This piece is a bit off. Obama didn't really do health care at all. It was Congress which was itching to do health care before Teddy was gone. Obama simply worked privately with Baucus and made confidential, largely unpublished deals with big hospital chain CEOs, big medical insurance, and big pharma. He basically let Congress write the legislation, with Baucus as his point man, and his main activities were making public speeches supporting the public option while privately telling CEOs there would be no public option and covertly lobbying against the option. And when Reid and Pellosi said they were sure they could pass the public option by reconciliation, Obama suddenly accused Congress of being too slow, upstaged Congress with a high-profile but ridiculously short "bipartisan" Q-and-A session for TV, and then short-circuited the public option negotiations by submitting his own jerry-built list of reconciliation items. Obama's main real influence on the health bill was effectively blocking all the pesky and persistent proposals to have the public sphere play some kind of direct role in health insurance.

Twenty years from now the health care bill (which resembles problem-ridden Romneycare in MA), despite some small-bore improvements, will surely be seen as a disaster that failed to stop spiraling costs and that set back the cause of public health insurance in the US for the foreseeable future.

If Obama had just not interfered, we would probably have a public option now -- in short, a legal basis for real and realistic health insurance reform in the future. The health care bill was one step forward and two steps back, and private health insurance oligopolies are now tacitly recognized as "too big to fail," just as the five biggest banks in the US are, and health costs will soon swamp federal, corporate, and household budgets. Along with failure to create a robust jobs program, perception of the basic failure of the health care reform and financial reform bills among Dem and independent voters will surely hurt turnout in November.

Posted by: chris448 | September 9, 2010 12:30 AM | Report abuse

I am a regular visitor to Joe Romms blog- his is one of the best- and he is very smart.

Health care is a current & urgent need for many Americans- Obama chose this becasue of that need- and it has been the dream of every Democratic President since FDR.

On Energy & Climate change- this is a severe issue- that will be the most important in all human history- it will make the events of the 20th century look small.

Global warming poses very significant risks for the nation & world- not in 50 years but now. The amount of CO2 that is rising- and currently in the atmosphere is frightening- Obama knows this- he gambled- how big his gamble plays out remains to be seen.

However climate change & finding alternative energy sources will be the most important aspect of American culture and the economy for decades to come- we must begin to solve these problems now- the fate of human kind is in the balance.

Posted by: sleepership | September 9, 2010 6:43 AM | Report abuse

I think we have a little revisionist ass covering going on here. President Obama and Rahm Emanuel did not want to do health care first. They wanted to do a bunch of other stuff for their contributors who they owed a large number of favors. They did those things as in bailing out banks and GM, but the progressives screamed health care and now. They were forced into it and resented it. So to show their displeasure and tow the line with corporate contributors AKA health insurance companies, they created the health insurance reform bill from hell. The WH reacted petulantly when pushed, had a we will show you attitude, which is now biting them. Go back and read the statements from the WH in early 2009 as they did not want to do HC until 2012 or better yet in a second term.

Posted by: Mormaer | September 9, 2010 7:42 AM | Report abuse

I don't necessarily blame the President for capitalizing on the opportunities that presented themselves but I certainly hope that as he moves forward with comprehensive climate change legislation, he considers a revenue-neutral carbon tax, the solution the vast majority of the world's leading scientists and economists agree is best.

Posted by: SallyVCrockett | September 9, 2010 9:04 AM | Report abuse

Many Americans, especially American Seniors, on both the Left and Right are so angry and frustrated with the Post Office health-care Obama/Pelosi have jammed down America's throat that literally guarantees voters will turn out in droves to express their disdain for this inane,expensive and unwanted socialistic program and the corrupt manner in which it was passed.

November can't come soon enough!

Posted by: 2012frank | September 9, 2010 9:15 AM | Report abuse

The spasms of the 3rd wave in American politics, T baggers et all, is the real disappointment in the "change, yes we can" but should we? Not much has changed at all. At best, cosmetically. With regard to climate change, it's easy. Without regard to political party affiliation, any votes in a petroleum district are locked in. The T baggers sense this. With healthcare, similar. Vested interests. .... Meanwhile, the national debt is increasingly going to hamper future generations quality of life. I repeat, there has been no prevailing feeling of real change...... perception of it. More like S. O. S. different day.

Posted by: deepthroat21 | September 9, 2010 10:10 AM | Report abuse

Ezra Klein (and the president) should check the 09/05 Washington Post crossword, the answer to clue 69 across is "ITSTHEECONOMYSTUPID".

Posted by: Muscarella | September 10, 2010 2:24 PM | Report abuse

Ezra Klein (and the president) should check the 09/05 Washington Post crossword, 69 across - "ITSTHE ECONOMYSTUPID"

Posted by: Muscarella | September 10, 2010 2:27 PM | Report abuse

Ezra Klein (and the president) should check the 09/05 Washington Post crossword, the answer to clue 69 across is "ITSTHEECONOMYSTUPID".

Posted by: Muscarella | September 10, 2010 2:28 PM | Report abuse

I believe Obama thought he had a public mandate for universal health care. Unfortunately he was wrong and the first order of business out of the Republicans after winning this November election better be rescinding this health care initiative.

Posted by: Desertdiva1 | September 10, 2010 9:16 PM | Report abuse

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