JONATHAN COHN JUNE 24, 2011
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President Obama faces a knife fight for reelection next year. Of course, the catastrophic economy poses his greatest political challenge. He also faces implacable Republican opposition, two difficult wars, and a host of other toxic foreign and domestic legacies of the Bush administration. Have I mentioned that he is still African-American and has a funny name?
The president has created some problems for himself, too. He has struggled to combine the inside and the outside political game. During his first two years, his central strategy was to negotiate what had to be done to win passage of the stimulus, health reform, and other specific legislative measures. Passing bills is important, but other things matter, too. Loudly proclaiming victory for items such as a too-small stimulus has created more serious long-term vulnerability than the White House seemed to know.
With beautiful exceptions, the president has struggled to present a broad progressive message that extends beyond his personal appeal and political fortunes. He’s struggled in crafting a politically and programmatically effective response to the foreclosure crisis.
He too-often negotiates with himself, allowing Republicans to pocket preemptive concessions while paying little political price for their implacability. President Obama couldn’t stop Senator Richard Shelby from delaying and then thwarting the appointment of Nobel Prize economist Peter Diamond to the Federal Reserve Board. The president couldn’t stop Republicans from undermining the appointment of the distinguished health care delivery expert Donald Berwick to lead the implementation of health reform. What’s frustrating is that he hasn’t found a way to make Republicans pay a higher political price for their extreme partisanship—extremism that now seeks to hold hostage the full faith and credit of the United States.
There’s even a meme going around that health reform was actually the central strategic error of the early Obama presidency. On this view, it was a mistake to spend so long waging trench warfare to pass the Affordable Care Act. For example, Time’s Joe Klein believes that President Obama misread his mandate:
In 2008, Barack Obama wins a smashing electoral victory, largely because the public believes he’s a calm, cool adult who can lead the country out of an economic crisis. But for some crazy reason, he decides to focus much of his attention on passing a universal health care plan that has been the long-term dream of his party. This, despite polls that indicate nearly 80% of the public are satisfied with the health care they already have. The plan passes, but it’s so complicated, the public isn’t sure what’s in it (and is wondering why the President hasn’t focused similar attention on the economy), and Obama’s party is clobbered in the 2010 elections.
Klein personally supported health reform. So this indictment has added sting.
It’s not a stupid argument. Americans were baffled and dismayed by the prolonged sausage-making required to get ACA passed. Democrats made tactical errors within a sclerotic Senate process that left little margin for error. Health reform could have been more intimately linked in the public mind with the realities of a recession that was hammering state budgets and further unraveling employer-based health coverage.
Politically and substantively, the worst aspect of health reform is simply the long time-lag between the bill’s passage and the on-the-ground help ACA will eventually provide in millions of lives. ACA has already helped many people—those with preexisting conditions, young adults covered under their parents’ employer-based policies, for example. Yet of course most Americans don’t know what’s in the bill. Many key provisions have yet to kick in. ACA expenditures were back-loaded to meet a rather arbitrary budget target. It would have been better to have front-loaded things, to make more of an immediate difference for more people, and to bolster a faltering economy.
Regular readers of this space know many substantive reasons why health reform was both deeply necessary and deeply difficult to accomplish. If one believed health reform is important, 2009 was a unique historical moment to get this done. The process and the end product weren’t always pretty. Yet ACA will provide health insurance to an estimated 32 million Americans who would otherwise go uninsured. It addresses insurance company abuses and will reduce the number of Americans who contract cancer and thus lose their homes. It will provide $200 billion per year in economic help to low- and moderate-income families.
Health care reform was a central issue in the 2008 presidential campaign. Despite all the difficulties and the occasional errors, President Obama believed in this and put himself on the line to get it done. Its passage marked a historic promise kept to millions of needy people. I believe the president was both smart and courageous to do so.
I’m not convinced that his political fortunes would be brighter had he postponed the health care issue to attack some ostensibly more feasible alternative political agenda. The economic and fiscal crisis would have been just as bewilderingly complex. Republicans would have been just as implacable, just as resolute in opposing the centerpiece efforts of an Obama presidency. The administration’s political strategies and private negotiating posture would have the same characteristic difficulties. The president’s difficulties with his own political base would have been rightly magnified by his failure to follow through on a matter of central concern to so many people.
I am convinced that the moment to address the central gap in American social insurance could easily have been lost. Some of the same people who now lament the president’s decision to focus on health reform might instead be lamenting the president’s lack of boldness in missing the once-in-a-generation opportunity to assist tens of millions who are now uninsured.
President Obama must raise his game to win reelection, and to make his presidency as worthy and effective as it can be. His committed pursuit of health reform was not the problem. We’ll see soon enough whether health reform helps him win a second term. It certainly made him more deserving of one.
20 comments
To me, it wasn't putting HCR on top of the agenda that caused Obama's political problems, it was the emphasis on universal coverage. Sure, universal coverage may be a necessary condition for ending insurer abuses, but the public doesn't understand that. And doesn't need to understand it to appreciate the more appealing case for ending insurer abuses. In the public's mind, universal coverage is just another give away by Democrats to folks who don't carry their own wait. This is an example of a false assumption: Democrats just assumed that the public understood that HCR was about ending insurer abuses. The public didn't understand in 2009 and don't understand in 2011.
- rayward
June 24, 2011 at 4:28pm
He could have spent his time talking to the public about insurance company abuse and then put whatever they hell he wanted in the bill claiming that it was all to end insurance company abuse -- but he needed a short bill, not a monstrosity that includes much that should have been done by regulation, and a much shorter time to bring it to conclusion, without the enormous waste of time negotiating with implacable Republicans. Above all, when the Republicans started their lying campaign, he needed to respond. The failure is a political failure, not a policy failure. And yes, that political failure has cost us heavily.
- roidubouloi
June 24, 2011 at 5:56pm
More to the point, if private insurance is the best model for funding health care, then why not let the private insurers figure out how to deal with the death spiral rather than imposing the cost of universal coverage on taxpayers. To many Americans, the Democrats were carrying water for the insurers in HCR. And, of course, they were. Sometimes the truth hurts.
- rayward
June 24, 2011 at 6:34pm
As I think back upon and recall the long, tortured process of adopting the ACA, the single thing that as most galling is that Obama and the Dems agreed to a multitude of Republican proposals without extracting any Republican votes in exchange. That was really idiotic. The Dems should have written a bill they could pass, as fast as possible, and then offered to consider Republican proposals, but only in exchange for Republican votes. That would have been bipartisanship aplenty, and the Republicans would have had to sign on in order to get a bill more to their liking. At least if the Dems had to pass a bill on strict party lines, they should have passed the best bill that they wanted. This alone was political malpractice of the highest order. Really incompetent on the part of the administration.
- roidubouloi
June 24, 2011 at 7:54pm
The mistakes of 2009; not challenging the death panel hysteria and the Tea Party, translated in terrible defeats in 2010. 2010 is the gift that keeps on giving in reverse.Following what is going on in the states, the anti labor anti woman agenda is wrecking the country. Abortion is practically illegal in 9 states and they're going after contraception. With safe bases in so many states Republicans will have a good chance at consolidating their gains even with overreach. Scott Walker still garners in the 40's in popularity. Yes HCR was too costly.
- rigos4
June 25, 2011 at 12:22pm
On the other hand if it wasn't ACA it probably would have been something else - perhaps the simple fact that Obama, personally, is President is too much for some folks? And, the anti-woman hysteria has been there for decades, this along with racism, fear of immigrants, hatred of gays, and a growing and to me rather frightening elevation of religious fundamentalism - combined with the bad economy and xenophobia due to 9/11. Meanwhile Obama has struggled mightily his whole career to try and forestall what increasingly appears to be a kind of civil war. So he's always trying to mend fence, be reasonable, deal with "both sides," but what if one side is just flat beyond reason? This goes for journalists too and TV in particular: what if being "fair and balanced" means you are being fair and balanced to an unreasonable, maybe insane faction of the American body politic, which has truly obnoxious ideas? I think we Democrats may have underestimated the "culture wars," partly because the hysteria on the other side seems so bizarre and even silly - for example, claims that the earth was created in six days - six literal, 24 hour days - and that this should be taught in school - who can take this seriously? But - we should I think. I think we have to - because it's resulting in attacks on people, real people - Medicaid for example won't pay for Planned Parenthood visits now in Indiana, for example, because the state has defunded it - thus, poor people won't be able to get pap tests and contraceptives. IMO this is a form of bigotry and should be roundly condemned but - they're getting away with it. And, the "culture war" is being used by the big bucks corporations and rich, powerful cynics to start fights between Americans of lesser means and power - they're using religion and other cultural notions to contest environmental protection - union and workers' rights; and they have a very effective, 24/7 propaganda machine as well, which the *real* media isn't taken seriously enough at all. Worse, very few MSM journalists are openly saying, you know, these guys are nuts and pose a serious threat to the nation. But they do - my very old dad took one look at the McCain/Palin campaign and said, those guys scare me, especially that woman - look what she is stirring up out there. And things have only gotten worse, much worse since then.
- Sophia
June 25, 2011 at 2:35pm
The ACA effort was crippled by Obama's (and Pelosi's, and Reid's) reluctance to act as the Republicans had acted under Bush. Namely, ram through whatever policy they thought was appropriate, over the opposition's objections, and game the system as necessary to get that done. That's how we got the Bush Tax-Cuts over Democratic objections in the first place. But no, Obama, Pelosi, and Reid were better than that. They wanted the Congress to work the way the Congress was SUPPOSED to run. They did not realize, with the rise of Fox News and the Tea-Party and the neo-Cons, there was now a group of Republicans who had redefined "compromise". They'd redefined it to mean "everything we want". So any gesture toward the Republicans were accepted as their due, but also accepted as "not enough" no matter what they were. So sure, the Democrats negotiated compromises, changed the bill, delayed provisions, and at the end of the day the Republicans didn't get "everything we want", and so they walked. Meanwhile demonizing the Democrats every step of the way. The Republicans then lied about the ACA, mischaracterized it, and that's what 2010 was run on. But hopefully, we'll have had almost 2 years of observing Republican insanity in the House in 2012. They passed a Ryan Care bill. They revoked ACA. They held America hostage to keep the Bush Tax-Cuts another two years. They held America hostage to get an ADDITIONAL 34 billion cut that's paralyzed the recovery. They're holding America hostage NOW to get another bite at the budget apple or they won't pass the Debt-Limit. And with all this, you think they'll STILL point back to the ACA (which will have had SOME positive effect by fall 2012). I think there's a whole lot of crap the Republicans have done since then to now that should make a huge difference in what America thinks about the Republicans, apart from the ACA.
- AllanL5
June 25, 2011 at 4:32pm
Some of you give the Republicans so much credit, you've even revised history to fit that narrative. Can anyone please show me any data that suggests Republican demagoguery led to ACA unpopularity, hence 2010 defeat at the polls? Do you think that voters are so naive as to not understand that each party exaggerates? Democrats had a majority to pass anything they want, yes, but that doesn't mean they agreed on policy. Ya think what it would have taken was Obama just making the case to the public, and some Blue Dog senator would suddenly get swayed? Obama looked at the team he had and adopted the strategy that best fit the situation. This is not just a matter of making lemonade out of lemons. It is more like making lemon meringue pie out of apples and oranges. As I read these comments across all the topics under discussion, I get the impression that some presume a better outcome had just Obama advocated more strongly for his policies. Others seem to think that Republicans "insanity" has created a toxic political environment that makes it almost impossible to get anything done. Valid as they may, it still misses the point. Here's an open question to all of you... Why didn't FDR, Johnson, or Clinton, pass single-payer healthcare? Surely the political environment under each of these Presidents was more conducive to compromise, and from commenters have said, it would seem FDR, Johnson, and Clinton strongly advocated their policy positions better than the "naive" Obama, not to mention Republicans were less crazy back then as well. So what prevented those Presidents from taking full advantage to enact single-payer, or get a better deals than whatever they were able to accomplish? This columnist nails it (and articulates my point that I've struggled to get across so many times) when he says... "I’m not convinced that his political fortunes would be brighter had he postponed the health care issue to attack some ostensibly more feasible alternative political agenda. The economic and fiscal crisis would have been just as bewilderingly complex. Republicans would have been just as implacable, just as resolute in opposing the centerpiece efforts of an Obama presidency. The administration’s political strategies and private negotiating posture would have the same characteristic difficulties. The president’s difficulties with his own political base would have been rightly magnified by his failure to follow through on a matter of central concern to so many people. I am convinced that the moment to address the central gap in American social insurance could easily have been lost. Some of the same people who now lament the president’s decision to focus on health reform might instead be lamenting the president’s lack of boldness in missing the once-in-a-generation opportunity to assist tens of millions who are now uninsured." The point is, as with FDR, Johnson, and Clinton, this President is working with the hands he has been dealt, crafting his own strategy that works best for him (I don't know whether it's the wisest strategy, only time will tell), and has more than enough to show for it. The strategy may not be sexy, flashy, or shock and awe people, but it seems to be getting us forward. It may come across as a failure of leadership to some, an adhoc strategy to others, but it may also be a well crafted and deliberate strategic calculation by Obama. This is not to say he cannot or ought not be criticized. Just that the criticism must be supported by facts on the ground.
- wkwami
June 25, 2011 at 5:22pm
If this double posts, please forgive me, I seem to be having difficulty posting... ******* Some of you give the Republicans so much credit, you've even revised history to fit that narrative. Can anyone please show me any data that suggests Republican demagoguery led to ACA unpopularity, hence 2010 defeat at the polls? Do you think that voters are so naive as to not understand that each party exaggerates? Democrats had a majority to pass anything they want, yes, but that doesn't mean they agreed on policy. Ya think what it would have taken was Obama just making the case to the public, and some Blue Dog senator would suddenly get swayed? Obama looked at the team he had and adopted the strategy that best fit the situation. This is not just a matter of making lemonade out of lemons. It is more like making lemon meringue pie out of apples and oranges. As I read these comments across all the topics under discussion, I get the impression that some presume a better outcome had just Obama advocated more strongly for his policies. Others seem to think that Republicans "insanity" has created a toxic political environment that makes it almost impossible to get anything done. Valid as they may, it still misses the point. Here's an open question to all of you... Why didn't FDR, Johnson, or Clinton, pass single-payer healthcare? Surely the political environment under each of these Presidents was more conducive to compromise, and from commenters have said, it would seem FDR, Johnson, and Clinton strongly advocated their policy positions better than the "naive" Obama, not to mention Republicans were less crazy back then as well. So what prevented those Presidents from taking full advantage to enact single-payer, or get a better deals than whatever they were able to accomplish? This columnist nails it (and articulates my point that I've struggled to get across so many times) when he says... "I’m not convinced that his political fortunes would be brighter had he postponed the health care issue to attack some ostensibly more feasible alternative political agenda. The economic and fiscal crisis would have been just as bewilderingly complex. Republicans would have been just as implacable, just as resolute in opposing the centerpiece efforts of an Obama presidency. The administration’s political strategies and private negotiating posture would have the same characteristic difficulties. The president’s difficulties with his own political base would have been rightly magnified by his failure to follow through on a matter of central concern to so many people. I am convinced that the moment to address the central gap in American social insurance could easily have been lost. Some of the same people who now lament the president’s decision to focus on health reform might instead be lamenting the president’s lack of boldness in missing the once-in-a-generation opportunity to assist tens of millions who are now uninsured." The point is, as with FDR, Johnson, and Clinton, this President is working with the hands he has been dealt, crafting his own strategy that works best for him (I don't know whether it's the wisest strategy, only time will tell), and has more than enough to show for it. The Obama strategy may not be sexy, flashy, or shock and awe people, but it seems to be getting us forward. It may come across as a failure of leadership to some, an adhoc strategy to others, but it may also be a well crafted and deliberate strategic calculation by Obama. This is not to say he cannot or ought not be criticized. Just that the criticism must be supported by facts on the ground.
- wkwami
June 25, 2011 at 5:27pm
wkwami, I think something has shifted on the Right. Don't you?
- Sophia
June 25, 2011 at 9:49pm
As for single payer: is the insurance industry so powerful that no president or group of politicians can challenge it effectively? I think that's indeed the case. Money from insurance company coffers is invested in many other businesses, so you're not *just* dealing with Prudential; it's the hotel industry, the oil industry, real estate - you name it. "The people" don't really have a chance up against all those bucks. See the article on Sudan.
- Sophia
June 25, 2011 at 9:52pm
Recall that Obama boxed himself in by campaigning that "you'll be able to keep your own insurance". He would not go against such a major plank, especially so early on. ACA was prob next best available choice, without public option which would likely have eviscerated most private insurance. So, Sophia, you are right, even Obama protected insurer interests in order to get elected, tho he sold it as individual choice. Insurer interests are not only private, but also include the Blues and other not-for-profits (eg, Kaiser).
- ds111
June 26, 2011 at 9:08am
"Health care reform was a central issue in the 2008 presidential campaign." I remember Health care INSURANCE reform was a very major issue in the Hillary v Obama primary slugfest for the Democratic nomination. By the time the actual 2008 election was in full swing, it was all about the economic meltdown and Sarah Palin. Perhaps Pelosi really should have used her fleeting majority to actually reform health care delivery, instead of health insurance coverage. Ironically, the ongoing jobs deficit will ultimately end employer-provided health insurance and ACA, if not repealed in 2013, will be a sauasge laced with salmonella....
- K2K
June 26, 2011 at 9:32am
"With beautiful exceptions, the president has struggled to present a broad progressive message that extends beyond his personal appeal and political fortunes." It isn't that he has struggled, it's that he hasn't even tried.
- AaronW
June 26, 2011 at 9:36pm
"Some of the same people who now lament the president’s decision to focus on health reform might instead be lamenting the president’s lack of boldness in missing the once-in-a-generation opportunity to assist tens of millions who are now uninsured." Isn't this a bit of a straw man? Who is lamenting the president's decision to focus on health reform? Most of the lamentations I hear viz a vie Obama and the ACA are to the effect not that he made health insurance reform his target but that he was feckless in the execution of his health reform strategy.
- AaronW
June 26, 2011 at 10:42pm
The President and the Democrats fought the last war on Health Care. So obsessed with not failing like the Clintons they cobbled together the complicated and ultimately useless ACA. A huge gift to the Republicans that ulitmately cost so many Democrats their seats. Rep Stupak will always be remembered as the Member who traded his vote for an Airport. Ted Kennedy's Seat going to a Republican. Pelosi relegated to the sidelines and still screeching. I think the President will be fine in 2012, he is very popular and the Republicans are just another Tax & Spend alternative that really is not that appealing. But lower down the ticket the American Voter will not put thier trust in to the Democrats. Senate and House Seats will go Republican. And with Obama in the White house, (I really think the Republican Party wants his re-election to boost their numbers in the House & Senate.), and as the ACA takes effect, you will see more confusion and consternation in 2014. So Obama wins in 2012, but the Republicans take control of both houses of Congress in 2014.
- CRS9TNR
June 27, 2011 at 7:13am
Really, wkwami? "Death Panels", "ObamaCare", "Throwing Grandma out of the Nursing Home", "Government Takeover of Health Care", "Rationing"? Shoot, a recent Jon Stewart bit pointed out that "Death Panels" was Politifacts "Biggest Lie" of 2010, while "Government Takeover Of Health Care" was their "Biggest Lie" of 2009. And you completely ignore these terms? You completely ignore the Republican Propaganda? You take an interesting approach, but I don't think it's very accurate or helpful.
- AllanL5
June 27, 2011 at 9:18am
FDR was blocked from passing Single-Payer, he got enough resistance for his OTHER New Deal social programs. Johnson got a LOT of static for passing the limited Medicare of his day. Clinton raised taxes to pay for his health-care plan, then was blocked from implementing his plan by the Newt Gingrich Republicans. Resulting in a budget surplus for the first time since 1963. You really ignore all this history so you can cling to your point of view? That's actually sad.
- AllanL5
June 27, 2011 at 9:21am
AllanL5 writes: "Shoot, a recent Jon Stewart bit pointed out that "Death Panels" was Politifacts "Biggest Lie" of 2010" Heheh, it was VOTED the biggest lie. By online readers. And only 5000 people at that. Be careful using John Stewart references in debates. You'll look like a jackass every time. Do you agree that the UK has "death panels?"It's called QALY. The government says simply "If this treatment that costs Y doesn't extend your life by X months, then we won't pay for it" Isn't that, by definition, a death panel? Yes, private insurers do to, but I can always pay more to get a more generous policy. An advisor on all this was Rahm Emmanual's brother, Zeke. He is a HUGE supporter of something similar to QALY, which puts on emphasis on spending more on the young over the old. In other words, you spend a lot to cure a 35 year old mom with cancer, but you spend nothing to cure a 75 year old retiree of cancer. There's nothing sinister here. A plan for allocating fixed resources is always needed. But what Palin said "Seniors and the disabled "will have to stand in front of Obama's 'death panel' so his bureaucrats can decide, based on a subjective judgment of their 'level of productivity in society,' whether they are worthy of health care." she was correct. This isn't anything new. A host of systems have been put into place for dealing with this issues: Lottery, first come first served, sickest first, youngest first, QALY, etc. Calling it a lie is ridiculous especially when so many that have consulted on ACA have indeed published at length on ways to ration care.
- seattleeng
June 27, 2011 at 12:57pm
Oh, you "can always pay more" can you? When Insurance companies didn't HAVE to accept anyone with a "pre-existing" condition (before the ACA). When Insurance Companies were dropping people (legally, before the ACA) when they got sick. When Insurance Companies were placing a "life-time cap" on the benefits you could get -- difficult when a person got a serious cancer, or diabetes, or some long-term medical condition. Not to mention, perhaps YOU can "always pay more" NOW, before you're retired. But what about when you are retired, on a fixed income, and you've spent $100K on your wife's cancer, and now YOU get cancer? And the "death panels" called out by Palin was simply a panel trying to promote effective and cost saving procedures across medical plans. They weren't deciding who gets care and who doesn't -- that's what Insurance companies are doing today. So it IS a lie. That you insist it's true is what's ridiculous.
- AllanL5
June 27, 2011 at 4:23pm