Kim Strassel once again outshines the crowd in today’s must-read Wall Street Journal column, “How Obama Stumbled on Health Care.”
All Democrats have to do is agree on something. That they can’t is testimony to Team Obama’s mismanagement of its first big legislative project. The president is a skilled politician and orator, but the real test of a new administration is whether it can shepherd a high-stakes bill through Congress.
Kim brilliantly identifies four key mistakes made by the President and his team in their health care legislative effort. I suggest you read her analysis, then return here for my supplement. Go. Read it now. I’ll wait here until you return.
After six months the Administration is one for three on major domestic legislative initiatives. They had a quick legislative win with stimulus, but despite all their work to manage macroeconomic expectations, they are fighting a rearguard action against a growing perception that the stimulus has failed. They rammed a carbon cap bill through the House at some political cost, which now languishes and will likely die a quiet death in the Senate. And Thursday could not possibly have gone worse for the White House. The day after the President tried to restore forward momentum with his health care press conference, the press chattered instead about the Cambridge police while Speaker Pelosi and Leader Reid explicitly acknowledged what everyone in Washington already knew:Â both legislative bodies may miss the President’s health care deadline. Nobody expected the Senate to pass a bill before the August recess, but if the House fails as well, then the President faces not just a loss of momentum, but momentum in reverse. That is why I anticipate a few more twists and turns in the House before the recess. Who knows – maybe the Speaker can pull things together.
Here are six additional health care stumbles by Team Obama, rounding out Kim’s list to an even ten.
- They still have not chosen a strategy:Does the President want a Democrat-only bill that pleases the Left and passes the Senate with at most one or two Republican votes? Or does he want a bipartisan bill at the expense of the Left’s policy priorities? A bipartisan strategy can work only if the President is willing to negotiate directly with Republicans like Senators Grassley and Enzi, who are not so naive as to think that Senate Finance Committee Chairman Baucus has authority to negotiate for House Democrats or the President. Senators Grassley and Enzi are experienced enough to know that an early deal with just Chairman Baucus would unravel later in the legislative process when Republicans have less procedural leverage.Only an up-front negotiation between Republicans and the President can produce a deliverable bipartisan deal, but such a negotiation likely means no public option, no individual or employer mandate, no tax increases except for taxing health benefits (infuriating organized labor), much lower spending and real scorable long-term deficit reduction, and addressing social policy issues that anger some on the Left. It would be extremely painful for the President to break with his own party on these issues at the front end of the process.
Without Presidential strategic guidance, House Democrats are running hard-left with the Tri-Committee bill as you would expect, while Senate Democrats tug between Senators Baucus and Conrad trying to create a centrist alliance without authority, and Senators Dodd, Rockefeller, and Schumer trying to keep the Senate bill from straying too far to the center. The result is chaos, confusion, and Democrat vs Democrat battles.
- They appear to think they control the agenda during a recession:Six months ago a surge of national optimism and stratospheric poll numbers convinced Team Obama that the President would set the policy agenda for 2009. He has more agenda-setting power than all other American politicians combined, but less agenda-setting power than an economy in severe recession. Sometimes unwanted external events drive the policy agenda for you (think 9/11, pirates, a financial crisis, Iran and North Korea). 2009 American domestic policy is not about health care reform or climate change. It’s still about returning the economy to a healthy growing state, and will be until the unemployment rate begins to decline. For the next several months, the President has less domestic agenda-setting power than the monthly employment report from the Bureau of Labor Statistics.By claiming that the stimulus is working (you just can’t tell yet) and things will eventually get better (just be patient until next year) while 2.6 million jobs have been lost since January and the unemployment rate continues to climb, the President risks seeming out of touch on the most important domestic policy issue. Team Obama wants to derive legislative advantage from a serious crisis for long-standing liberal policy priorities. They need to focus on selling their macroeconomic strategy to avoid losing even more ground. This is beginning to undermine the President’s ability to convince members of his own party to take tough votes. It is easy to imagine Members of Congress going home in August to talk about health care reform, only to hear their constituents demand to talk about jobs and the still-weak economy.
This relates directly to one of the “perils of spin” identified by Kim:
Selling a huge expansion of government health care in the middle of a recession was never going to be easy. The Obama team hit on the argument that by adding to the government rolls, it would in fact save money and boost the economy. Bizarre as this claim was, it became the administration’s prime rationale for “reform.”
- They ignore the negative economic consequences of health care reform done wrong: In Washington the people who work on health care legislation are usually health policy experts. Team Obama forgot what Kim points out: health care reform is as much an economic issue as it is a health policy issue. While the debate first focused on the health policy question of the public option, it has now expanded to include broader economic policy questions. The Speaker wants Members to vote on a bill that would result in bigger budget deficits, higher taxes (on small businesses and eight million uninsured people), higher premiums that mean lower wages, a burdensome employer mandate leading to a less flexible workforce, and clunky new government bureaucracies to run it all. How can Speaker Pelosi expect House Democrats to vote for a bill that hurts the economy when the economy is weak? They already took one tough economic vote for climate change legislation only to see the Senate apparently ignore it. Neither the bill’s authors nor the Administration have satisfactory answers to the economic downsides of the specific policies in these bills, and they are losing the policy debate because of it. In the Bush White House we spent hundreds of man-hours anticipating policy attacks and preparing our responses in advance. The Obama Team seemed caught off guard when CBO Director Elmendorf said the bills move the deficit in the wrong direction.
- They are trying to finesse fundamental policy inconsistencies: The President still has not satisfactorily resolved at least three core policy inconsistencies. Large partisan Congressional majorities do not relieve you of the burden of making a coherent and internally consistent argument for your desired policy change, and the Administration has failed to do so. The President’s core problem definition is spot-on, but until he addresses these questions he will be unable to close the sale.
- If cost growth is the problem, why begin by expanding gross federal health spending by 16% and creating insurance mandates that will raise premiums? CBO said the former was a problem last December.
- Why did Team Obama predicate both their health and budget strategies on bending the long-term health cost curve down, and then knowingly propose policies that CBO says will instead only raise the cost curve? What made them think Congress would ignore CBO? The President correctly defined the underlying problem, but still has not offered a specific and credible solution to long-term private health care cost growth.
- The President campaigned against an individual mandate and against taxing employer-provided health benefits. The Left wants to do the former; moderate Democrats need the latter for a bipartisan deal. Few know where the President stands today on either policy. Team Obama cannot finesse these core policy choices and expect legislative progress.
- They are trying to do it all at once:Team Obama began this process with a surprising inside-the-Beltway tactic, I think to avoid a danger learned during the Clinton Health Plan battles. They encouraged Chairman Baucus to negotiate deals with insurers, drug companies, and health care providers, then triumphantly announced the support of these special interests at various Presidential events. It is unclear whether they thought interest group support would help enact a bill, or merely weaken the organized interest group opposition that helped kill the Clinton Health Plan in 1994. It’s an incredibly cynical tactic, given the President’s campaign against Washington special interests.But they are repeating one of the Clinton Administration’s core mistakes by trying to do massive health care reform in one big bite. For 15 years since the failure of the Clinton Health Plan, Democrats pursued an incremental approach. They gradually expanded Medicaid and created S-CHIP, putting conservatives on the defensive as they argued against incremental expansions of taxpayer-financed coverage to politically sympathetic populations. Team Obama instead reverted to the all-at-once approach of 1994, and they face some of the same challenges as Team Clinton did then.
Shuffling $1 to $1.5 trillion (that’s 1,000 to 1,500 billion dollars) and creating new individual and employer mandates are massive policy proposals that would fundamentally reorder one-sixth of the U.S. economy. Redistributing this many resources creates big winners and losers, and those losers will fight legislatively. We can see this as Democrats argue about how to pay for such an enormous entitlement expansion. Having locked themselves into budget cutting agreements with various health care interest groups, Team Obama overestimated their ability to sell tax increases to their own caucus.
They must now choose among breaking with organized labor, dialing back their spending desires, reopening these agreements with health care providers, and budget gimmicks. Congress usually looks first to gimmicks, but the President’s unintentional elevation of the actually honest CBO Director makes that harder than usual. Anyone who thinks they have a deal should be careful. If these bills implode, all bets are off, and the probability escalates that prior promises are re-opened or ignored. (Hospitals: You’re the deep pockets. Insurers, Business and Pharma: They can make you villains again if they need to cut you more to make the budget numbers work.)
- Speed can kill:They tried to jam it through Congress quickly and failed. Their strategy was to take advantage of a huge Democratic margin in the House to pass whatever the committee chairs could agree upon, and then either cut a deal in Senate Finance, or rally their new 60-vote Senate supermajority to power through a filibuster with the August recess as a hard backstop. The strategy was predicated on the President’s tremendous popularity, first year momentum, political muscle, large partisan Congressional majorities, and speed. The goal was to rush a bill through before anyone had time to analyze it and question the policy choices within.For two months Washington has assumed that Chairman Baucus would close a back-room deal either with Senator Grassley or his own Democrats on the Finance Committee, and announce the deal the morning of the Senate Finance Committee markup to deny the economic losers time to organize opposition. This speed-based strategy presumed that partisan loyalty to a popular President would trump serious policy concerns, and it appears to have been a miscalculation. Congressional Democrats will stretch hard to help a new Democratic President succeed, but they won’t vote aye on any bill just because the White House asks them to, and certainly not when their confidence is rattled by bad employment numbers, an apparently ineffective stimulus, and for some a tough climate change vote.
If the House fails to pass the Tri-Committee bill before the August recess, I think that bill is dead. The loss of momentum would mean that the safe move for a nervous House Democrat in August would be to tell his constituents, “Don’t worry about me. I would not have voted for that bill. I will insist on changes when I go back in September.” Having heard from his constituents about their concerns, he may then return to Washington in September with a list of changes that must be made to secure his aye vote.
It would be a mistake to predict that the President will fail on health care reform. He still has enormous resources that he and his team can bring to bear. He is the most powerful and popular person in Washington. The country wants to succeed, and most of them want him to succeed. Many in the press want him to struggle, then succeed. The policy flexibility that has undermined Congressional efforts so far allows him to cut almost any deal needed to get the political victory of a signed law. He has a deep support network ready to help him sell his message to an increasingly skeptical public, and as Congress scatters for recess he will soon have the public stage to himself for a month if he so chooses. He has policy and political goodies to distribute to convince wavering Congressional allies to side with him. And he has huge partisan Congressional majorities who know their long-term political fate is tied to his. With all of this at the President’s disposal, it is amazing that his top agenda item is in such trouble.
Don’t believe anyone’s prediction about how this will turn out. What happens when Congress returns in September is for the moment unknowable.
(photo credit: whitehouse.gov)
Just to let you know if you’re interested CNBC’s Original “Meeting of the Minds: The Future of Health Care,” will premiere on Monday, July 27th at 9pm ET. CNBC’s Maria Bartiromo brings together some of the biggest names in the industry and government to advance the conversation and propose solutions to America’s health care crisis. Click here to watch more: http://bit.ly/s25bW
Thank you!
“In the Bush White House we spent hundreds of man-hours anticipating policy attacks and preparing our responses in advance. The Obama Team seemed caught off guard when CBO Director Elmendorf said the bills move the deficit in the wrong direction.”
The reason is bcs they are far left liberals who ALWAYS think they know better. That is pure intellectual arrogance. It is also why academics tend to be so left. They have high IQs and are “expert” in a certain field, therefore, they feel they know better policy prescriptions that others.It is also why they fail to have a comprehension of and appreciation for markets.
Need proof? Look at Larry Summers – acknowledged to be brilliant, but, extremely diffiicult to work with and even falls asleep in meetings when others speak. Why? Intellectual arrogance and that is why ultimately Team Obama will fail (particularly in foreign policy but elsewhere as well).
“The country wants to succeed, and most of them want [Obama] to succeed.”
Methinks not so much anymore.
http://www.rasmussenreports.com/public_content/politics/obama_administration/obama_approval_index_history
If anyone can think of another President whose approval numbers have lost altitude so rapidly in the first six months of his term, let me know. None of us can truly predict the future but, at the rate things are going, Obama could easily be in the low 40′s, or even 30′s, by the end of the year. Not good for “Hope & Change.” Indeed, given the rotten, byzantine healthcare bill he’s trying to ram through Congress in spite of increasing public opposition, Obama isn’t looking at another “Waterloo”–he’s facing his very own “Vietnam.”
Being a fine student of the Hennessey school, I chose this article for review on my blog today. Though I wish I had read this analysis and included points here, I thought it was important that Obama’s approval is in a pretty sharp decline. Yes, he is probably still the most popular politician in Washington, that’s not exactly saying much if his popularity is on the decline. I also posted my thoughts before Rasmussen updated the daily tracking poll showing his numbers dipping below 50% for the first time.
I could be wrong but I think the industry representatives made deals because the overwhelming majorities and the Presidents popularity, made reform seem inevitable. Deals were made to avoid running ads and acceptance of funding cuts in order to get a seat at the table and have some say in the reforms. While it is far too early to decide reform legislation is dead in the water, it is also looking far less inevitable than it once was. Popularity and approval can change with the weather, but driving these numbers down is the economy and unemployment which is not looking to let up unfortunately. Speeding the legislation through seemed to give the Administration leverage that if deals were broken it would be too late to run ads to influence public opinion. It’s just a hunch but I would bet those who made the deals are also reconsidering whether these deals are in their best interest as well.
I completely agree though, nothing is certain here and those who are opposed to a public option as well as many of the proposals we have seen thus far need to keep pressing, this is far from over.
This is Hillary Care part 2. Hillary is a dreamer. Obama is a dreamer. Dreams are good but reality is better!!!!!!
Obama just doesn’t get it. As with most liberals, he ignores the financial implications of this wild spending, as attested by the ‘stimulus’ bill. In reality it was nothing more than a liberal spending orgy and it did nothing for the economy except run up the deficit. This is not the hope and change the majority of his supporters thought they would see under the almighty smooth talker. As with most people like him, all mouth and no principles and even less of economic realities. As the economy continues to slide Obama will become less and less popular, already below 50% approval. His only hope is to get some new advisors in the White House who have an understanding of markets and who can guide him as he tries to lead the economy out of this recession. If he continues on the same course, he’s Jimmy Carter II. And, as a Georgian, I have to admit that I take some form of delight in his missteps. After his first and only term Georgia will no longer have the unenviable distinction of having produced the worst President in American history; that ‘honor’ will now go to Illinois.
The overall dominating attitude of this White House is that they are impressed with their own image of intelligence. In fact, they are so much enamored with their own ideas, their own opinions and their own thoughts that they assume nobody else has anything to add. Part of this is because President Obama larded his cabinet with a selection of people that reflect his own image rather than filling in the gaps. Consequently you end up with legislation that is big on theory and short on delivery.
It is also telling that though Gibbs, the Administration mouthpiece, proclaimed that President Obama was “unaware” of the Tea Party events that have been ongoing since April 15th, they have had to reel in their expectations due to elected officials whose futures hinge on appealing to the group. The Tea Party phenomenon has been grossly underrated by this Administration. But the local nature of their protests has made congressmen and senators VERY AWARE. The results have been mixed, but the final word is that there are some angry people out here in the “flyover states” and we feel that instead of working with Americans, this adminstration has decided to tell us what is good for us. That doesn’t work when we are the people who put them in office.
The result of this misfire has yet to be determined. I do predict a shakeup in the House leadership with both Pelosi and Boxer taking dives due to their heavily partisan manipulations. I also think that other committee chairs will be quietly shifted to reflect a committee where all sides will be heard. Until this adminstration realizes that all the solutions cannot emanate from government, but that tort reform and other efforts must be employed to create a less intrusive and more efficient medical insurance system. In the end, rather than scuttling everyone’s coverage to create some sort of illusion of collectivism, what should happen is a fusing and streamlining of existing programs to provide services for those who cannot otherwise find coverage. This full scale shake up of insurance along with hospitals, doctors, medical care, social services and all the other nuanced mechanisms that were to be installed with this bill needs to be scrapped. Start again…..
It is a mistake to think that “reforming” health care is a fix to Medicare spending, when it is really the other way around. Medicare is another social entitlement financed by a Ponzi scheme. As it relates to health care spending it is responsible for the growing size of the health care industry and the growing debt of the federal government. The increased demand for Medicare services leads to higher prices in health care and in private insurance premiums. It is a simple case of supply and demand.
To reduce costs of health care services, the government needs to reform Medicare; that is the only program that the govt should be looking at right now in its attempt to reform the industry. It is the source of the larger problems we experience right now and it is the only program that the Govt has a right to meddle with.
Refrom Medicare first.
@Evinx – this is actually an accurate analysis; I am an academic myself and deal with this crowd on a daily basis – they are all engaged in a Hayek’s “fatal conceit”
How about if President Obama deliberatelly got involved into the Cop gate to distract the media focus from the failing approach of his
health care reform?
“With all of this at the President’s disposal, it is amazing that his top agenda item is in such trouble.” I don’t think it’s amazing at all. Obama is a weak leader yet his arrogance blinds him from this. His poll numbers are starting to drop and he appears tired of giving speeches. What’s amazing is how the MSM continues to ignore how the emperor has no clothes.
I have now read through the entire health bill HR3200. 1st problem) In it’s current form American taxpayers will be paying for health care of child born in the United States. Has anyone thought about Admendent 14 – any child born on American soil is an American citizen. Ths is way we will be paying out for several million people’s health care even through they may live in a foreign country. 2nd problem) In it’s current form in five (5) years time there will be only government health care and this also will effect the unions who think they are exempt. How, the government sets the rules and regulations, not the insurance companies, so in effect the insurance companies would not have room to create a profit on invest so they will close shop forcing everyone into the government only health care program. 3rd problem) In it’s current form we will have bureaucrats sitting in regional offices making the decisions of what operations, what medicines, and what hospital we can use. 4th problem) In it’s current form only hospitals that accept the mandate of the federal government can accept people for surgery or delivery of babies, etc. So hospitals that depend on profit to enlarge or purchase new equipment will go out of business leaving less hospitals to provide service. 5th problem) Obama nominated a man to the Science Czar that has written books and supports the Forced Sterialization of Undesirables (no describtion of who these are) and the forced death of anyone who they decide has received enough medical treatment. 6th problem) In the current form we are to throw $2 trillion into a fund and then as people pay preimums this will go up and down according to payouts. Where does the first $2 trillion come from except from borrowed money from China, Russia, EU countries, ME countries who for the past two months have almost refused to purchase more American debt. This will result in much higher taxes close to 10% per person in the first five years.
So Americans have to ask themselves: 1. Do we pay for health care for children born in America that live in a foreign country, 2. Do we want rationing of health care, 3. Do we want doctors and hospitals close by to us to be closed. 4. Do we want to be paying higher taxes so that we can have rationed care and medicine? Simple questions!
@Evinx – As an academic myself, I think you have their number. Their intellectual arrogance stands at the foundation of their dreamy leftist inclinations. These are the people who have never bothered to learn how wealth is actually made. They just think it’s a lot easier to claim the moral high ground and focus on the redistribution part of it.
Is anyone aware of any “tea party” approaches to this debate? I’ve been writing letters, sending emails, calling representatives but it seems something public would be more effective. Especially considering that Obama “will soon have the public stage to himself for a month [in august].”
Another item: Malpractice insurance plays a large part in the cost of health care, yet the administration and congress do not appear to address it at all. Why don’t they get a photo-op with the ABA to commit to a percentage reduction in profits, as they have with other groups? This is an elephant in the room, in my view. I will not support any bill which gets between my doctor and me, purports to keep private insurers “honest” with a public option as if the public option is de facto “honest”, and does not call for tort reform in this area. Just how is the bill going to address defensive medicine?
Side note – This blog is so informative — thank you so much for educating us on the details and the process of these very important issues….
I must comment on this new Obama maniac health plan. The Elderly and the handicapped will expect the death sentence designed by Pelosi, Reid and approved by Obama. This is a letter I wrote to the democrat congress in Ct. 09/23
Please return this plea for help. I may be forced to send this to every editor in America. Face Book My Space, U Tube, Twitter . Sorry I will not die alone.
Hi Chris, There are more important things that We must talk about. I am finding out more daily that the democratic death sentence is a reality. The $500,000,000 stolen from Medicare by Obama and the Democrats was just the start of it all. I am a terminal cancer patient undergoing constant surgery. In the past four years I had two open heart surgeries and need another, I had severe spinal surgery that was the results of a botched spinal epidural. This forced me into a wheel chair until I had the spinal surgery but there was severe nerve damage and I have severe pain while walking. I also suffered severe spinal infections followed by continued brain infections. I filed a suit against the hospital that caused the tragedy and lost. They had a multi-million dollar attorney and I had a five hundred dollar attorney. So I am suffering the rest of my life due to the health regulations, set forth by the new administration. I was forced to delay cancer surgeries because of the steady misdiagnosis preformed by some doctors. And I believe were faultily fabricated to aid the State and hospitals. In other words direct lies.
Now I find that my Social Security is being attached by the fed Government to pay for doctor bills because my Medicaid was suspended without notice. I was threatened that $105.00 a month will be subtracted from my Social Security starting 09/10.
Sue to the severe pain I was forced to resume with the cancer surgery and went to the hospital. During the Cystoscopy my prostate was punctured and I did not realize it or was I told but I was discharged. I felt alright because the Novocain relieved the pain. But on my way home, Forty Five miles, I encountered severe Lower Abdomen pain and ask my ride to hurry home. I did not know what it was but it was very painful. I returned home late that afternoon and sat on the toilet. It was pure blood that I was passing. I waited until the next day and it was still bleeding so I called the hospital. A nurse returned the call and told me that my prostate was punctured an this was when I discovered it. I was told to stay home and have no activities at all just total rest.
Now while I am home I found that my Medicaid was totally suspended and I am just left to die as reported this past spring. If you are old or handicapped then we will force you to decay and die. Thank you Obama and the Brainless Democrats.
Al Duhan
New Milford Ct.
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