The Real Missteps

Source: Uwe Reinhardt

This morning Howard Fineman, writing in the New York Times, chronicles what he characterizes as President Obama’s mistakes in pursuing healthcare reform:

Health care is one-seventh of the economy. You can’t expect to rewire it easily. There are going to be losers, and they are not going to go quietly.

Also, there are no moderates left in the GOP. Only conservatives who want to deny Obama success or legitimacy. They’ll oppose anything he proposes and call it principle.

Together, Big Money and Big Mouths will say anything to scare folks: death panels, government abortion, socialism — you name it.

That said, Obama and his team share the blame for the slow but steady shriveling of his claim to be the agent of “change you can believe in” on health care.

It’s time to ask what they did wrong.

His list includes:

• Murky campaign promises
• Orszag’s fantasy (that you can economize and expand coverage at the same time)
• Bipartisan naivete
• Too many 1,000-page bills
• Cap and trade
• Focusing on the have-nots
• Wrong lesson from the Clintons

I’m amazed that Mr. Fineman doesn’t include in his list what I see as the two biggest miscalculations in the attempt to enact healthcare reform.

The first is inadequate leadership. When a president with an 80% approval rating delegates the writing of the plan and, largely, stumping for it to a Congress that’s struggling for a 20% approval rating it may well be politically cautious but it suggests that re-election holds a higher position in the hierarchy of goods than healthcare reform. That’s the act of a bureaucrat, not a leader.

The second is a misreading of the electorate. Consider the chart above. The elderly, those 65 and over, constitute the largest proportion of the total population that they have in American history, that proportion will rise through 2025, and will remain high for the foreseeable future. And elders constitute an even higher proportion of likely voters than the do of the general population.

The purpose of Medicare is not to preserve the health of the elderly. It is to preserve the independence of the elderly and the loss of independence is one of the greatest concerns of aging. The great sad milestones in aging include increasing dependence on children or third parties, the loss of one’s drivers license, hospitalization or living in a nursing home. These are all marks of the progressive loss of independence.

The emphasis on those without insurance in the reforms making their way through the Congress, intimations of cost savings through cuts in Medicare, compensating physicians for end-of-life counseling all feed into the concerns, the reactions of the foolish Congressmen and others attempting to carry on Potemkin townhall meetings to the constituents attending the meetings, many of whom are seniors, and their disdainful treatment in the media all feed into the insecurity of the elderly over the loss of independence.

It’s harsh to say it but many of the elderly vote and many of the uninsured don’t. There was an alternative strategy available. The reform bills could have been advertised as moves to preserve Medicare. They weren’t and, absurdly as many have pointed out that it was, Republicans have seized upon their opposition to the reforms as a defense of Medicare. Democrats failing to stake out that ground was an error.