Saturday, August 01, 2009

Has Obama lost healthcare reform?

Way back, on February 1st--yes, six months ago it was--I blogged about the Tom Daschle nomination fiasco as a major blow for healthcare reform. Not because I cared for Daschle. But because he would have been an influential cabinet secretary with extensive legislative connections--the kind of combination needed for all the political stuff that needed to happen. Further, the fiasco meant that Team Obama was back sorting through the list of qualified people, and more time was therefore going to be lost in the process.

Through all this, Obama played healthcare over-carefully. He tried to stay only at the big picture level and succeeded. And, at the same time, he did not seem to come across as eagerly and loudly a supporter of "his" healthcare proposals as he did when it came to the stimulus bill. In fact, one might want to refresh memories on how he went aroudn trumpeting the stimulus bill, bank rescue operations and, of course, the auto industry bailout where he even came across as the country's car dealer-in-chief.

Clive Crook has written more about this aloofness of Obama's when it comes to healthcare, and why reform is stalling:

This failure has three separate aspects. First, though politicians and commentators talk about the president’s plan, he does not have one. Learning the lessons of “Hillarycare” far too well, Mr Obama has set out broad goals for reform and some principles to guide the design, but no more. This self-imposed distance is bad both substantively and politically. It is substantively bad because left to its own devices an unguided, disputatious, difference-splitting Congress was bound to make a hash of it. And it is politically bad because the public understands this.

Opinion is turning against health reform partly because watching this initiative lurch to and fro on Capitol Hill without adult supervision is scary. Anything could happen, thinks the median voter, and probably will. Note too that when the president decided to glide above it all and take credit for whatever emerged, he squandered his political capital. He is still expending his popularity on making the case for reform in the abstract, not on advancing a specific blueprint. That was all right at the outset, but no longer. The debate has moved on to specifics, leaving the president behind.

Mr Obama’s second failure is even more surprising: one of salesmanship. He still pitches for comprehensive reform, but with apparently weakening conviction. In his televised talk on the subject last week, he seemed almost bored.

Worse, the president’s message is at odds with the product taking shape in Congress. This is all about controlling costs, he says: without reform, healthcare will bankrupt the country. That would be an excellent line if Congress was seriously trying to build control of costs into its bills, but it is not. Widening coverage is the priority. So it should be, you might argue – but in that case the president has to sell access and health security as things worth paying for, an entirely different proposition.

Every measure on the table would increase costs. The administration, despite all it says about “bending the curve”, is demanding only deficit-neutrality over 10 years. Every time Mr Obama stresses cost control, he diminishes his credibility.

The third failure goes beyond healthcare. Elected as a moderate, a centrist and a pragmatist, Mr Obama has repeatedly sided with the liberal left of his party on economic policy. The design of the fiscal stimulus, the shape of the budget, and Mr Obama’s willingness at every turn to support higher spending and higher taxes on the better-off – to pay for health reform, social security reform, infrastructure investment, expanded educational opportunities, wage subsidies for the poor, you name it – has delighted the party’s left and alarmed its centrists. The related charge of fiscal indiscipline is starting to stick, and it colours the health debate.

If health reform does go down to defeat, it will not be because of Republican opposition, but because of dissenting conservative Democrats and disaffected moderates in the country at large. In disappointing these people, Mr Obama has badly miscalculated. His political power depends on them. He must take the lead in devising a health reform capable of appealing to the centre. For his own good and the country’s, he needs to be the president the US thought it was electing.

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