MARCH 22, 2010
Earlier this month, in a profile of White House chief of staff Rahm Emanuel, I identified two tactical mistakes the president had made while trying to pass health care reform. The first was his extensive efforts to reach a bipartisan deal—in particular, allowing Montana Senator Max Baucus to negotiate with Republicans on the Senate Finance Committee through most of the summer before weighing in. The second was Obama’s decision to attack insurance companies late last July after months of trying to co-opt them and other powerful groups. "At the same time the administration was bashing insurers, it sought to preserve deals with drugmakers and hospitals," I wrote. "The new attacks sent mixed signals not just to the interest groups, but also to the public at large."
Now that a comprehensive health care reform bill is on a glide path to enactment, it’s worth asking if these criticisms still hold up. The answer, I think, is mostly yes, but with some important qualifications.
Start with bipartisanship. In retrospect, it appears that Baucus's Republican interlocutors--first Chuck Grassley, then Olympia Snowe--either were never really serious about cutting a deal or, more likely, came under so much pressure from their GOP colleagues that they couldn't cut one even if they wanted to. Whatever the case, the effort to court them was, as Emanuel's friend Paul Begala put it to me, akin to hunting unicorns beyond a certain point. In fairness, it was extremely difficult to discern Grassley's and Snowe's true intentions at the time--they certainly seemed sincere to people involved in the negotiations. (That's why I suspect the real obstacle was Republican pressure, not their own preferences.) Still, allowing the negotiations to continue through September rather than intervening in July, as Emanuel would have liked, exacted a real cost. It's entirely possible that reform could have passed well before the special election in Massachusetts if not for this frustrating interlude. Which would have avoided the subsequent near-death experience and enabled the administration to move on to other business. For that matter, it might have even denied Scott Brown the oxygen for his upset victory (by taking the focus off process and allowing Democrats to defend the bill on the merits).
Having said that, I don't want to imply that bipartisanship per se was a bad idea, or even counterproductive in practice. The journalistic accounts of health care's resurrection--like this one in The New York Times and this one in Politico--seize on the president's bipartisan health care summit as a turning point, and I agree with them. But the summit entailed a very different strain of bipartisanship than the one Obama embraced last summer. Rather than try to reach an actual compromise with Republicans, who'd long since demonstrated their intransigence, Obama deftly used the event to show that his openness to Republican ideas wasn't being reciprocated. This was a final straw in convincing wavering Democrats they'd have to go it alone if they wanted a bill, and it gave them a rationale for doing so in the eyes of voters. (My colleague John Judis and The American Prospect's Mark Schmitt have made variations of this point.)
As Emanuel himself told The New Yorker's Ryan Lizza last year, "The public wants bipartisanship. We just have to try. We don't have to succeed." For much of the year, Obama focused too much on the "succeeding" part. The summit was only about being seen as “trying.”
The attack on the insurers is a bit more complicated. As both the Times and Politico stories make clear, another key turning point in the health care fight was the news that Anthem Blue Cross, a California insurer, planned to raise premiums by over 30 percent this year--a fact the administration used to great effect in making its closing argument. The proposed premium hikes nicely distilled the Obama indictment of the current health care system. But the data point would have been unavailable had the White House resisted attacking the insurers, something Emanuel advised in internal discussions.
Still, the timing here is critical. When the White House decided to knee-cap insurers last July after having spent most of the year bargaining with them, we were still months away from the health care endgame. Max Baucus had yet to introduce a bill in the Senate Finance Committee (recall that Obama had given him until September to reach a bipartisan compromise). And, even once he unveiled his bill, it would still have to be debated and voted on in committee, then merged with the Senate Health, Education and Labor Committee's bill, then moved to the Senate floor.
Unfortunately, turning on the insurers so early in the game had damaging consequences. For one thing, it gave them months to campaign against the bill, targeting both Middle America and swing votes on Capitol Hill. (As it happened, their opening salvo--a deeply flawed study purporting to show that health care reform would raise costs--was so clumsy it backfired. But there's only so long you want to be fighting such a powerful and resilient group.) At the same time, it created something of a communications muddle. Because the administration couldn't afford any more powerful enemies, it had to defend its deals with Pharma and the hospitals. But, over time, it became dissonant and confusing to defend one set of deals with one group while attacking another.
Don't get me wrong. I'm not saying you shouldn't turn on any interest group you cut a deal with. In fact, though I was initially skeptical, the decision to take on the insurers proved critical in the end. (And, credit where due, Obama adviser David Axelrod deserves real props for this call.) I'm just saying that, if you're going to turn on an interest group you've cut a deal with, you should hold off until the last possible minute, which limits the time they have to exact revenge, as well as any dissonance that might arise from defending the alliances you need to maintain. The beauty of the Anthem news is that it came during the home stretch of the second push for health care. Had the administration waited until the home stretch of the first push before turning on the insurers--say, November rather than July--it might not have needed a second push.
Fortunately, one of the real virtues of this White House is its ability to adapt--the Obama high command rarely makes the same mistake twice. Round two of health care reform proved that it learned the lesson of its misguided bipartisanship, and that it had developed a much keener sense of timing. If the last two months are any indication, health care reform may only be the beginning of a string of big accomplishments.
Noam Scheiber is a senior editor of The New Republic.