President Obama As Calculating Pragmatist

Norman Ornstein of the AEI, writing in the Washington Post, explains President Obama’s strategy on a healthcare reform bill as the savvy strategy of a calculating pragmatist:

The Obama strategy since his election has been based on a gimlet-eyed and pragmatic assessment of the prospects and limits afforded by public opinion and the political process. A naive president would have assumed that, after a landslide victory, huge coattails, swollen partisan majorities and a high approval rating, he could have it all — and pushed hard and early for a far-reaching, soup-to-nuts upheaval of the health-care system. Obama and his strategists understood that would not work.

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How to prevail under these difficult circumstances? The only realistic way was to avoid a bill of particulars, to stay flexible, and to rely on congressional party and committee leaders in both houses to find the sweet spots to get bills through individual House and Senate obstacle courses. Under these circumstances, the best intervention from the White House is to help break impasses when they arise and, toward the end, the presidential bully pulpit and the president’s political capital can help to seal the deal.

No health reform bill can be enacted unless the House and Senate each pass a version, and that has been the single-minded goal of the White House. If the Senate has to resort to reconciliation, it can only work if more than 50 Democrats are convinced that it is the last resort — that every effort was made to compromise to include significant Republican support. Thus, the White House signal on the public option. Once both houses pass versions, no matter how disparate, a conference committee can find a way to meld the bills — no doubt with heavy White House input — into one plan that goes back to each house for up or down votes. There, the pressure on lawmakers to support health reform will be much greater, as will the ability to break filibusters by urging all Democrats, even if they can’t support a bill, to vote for cloture as a procedural issue.

This may well be right but I find it troubling. The underlying assumption of such an approach is either that some healthcare reform, even healthcare reform that does not address the manifest problems with our system, is better than no healthcare reform at all. And it flies in the face of President Obama’s repeated statements about cost control in healthcare.

Alternatively, it suggests that President Obama believes he will get another bite at the healthcare reform apple, possibly through the “Medpac on steroids” review committee that’s been mentioned from time to time. Such an approach is contradicted by the experience of history which tells us that on average healthcare reform comes about no more frequently than about once per decade and we don’t have a decade to wait for the reforms that will effect cost control. It also risks furthering an atmosphere of uncertainty which will tend to undermine economic growth.

13 comments… add one
  • steve Link

    I have never thought that Obama was committed to much other than providing a near-universal system. Bringing out a specific plan would have meant spending too much political capital. Congress has to approve it anyway. He and his advisers have talked a lot about costs, but I still dont know their plan. AS I have said before, I just dont see a first term president doing much about costs.

    Steve

  • Once again, I thought everyone knew this was the game. I was surprised when people on my side started taking the Public Option so seriously because I assumed it was trade goods. Obviously for the bluff to work we had to look as if we took it seriously, but I think many on the Left started believing their own bluff.

    In any event, I’ve always thought, always believed, that Obama was neither naive nor ideological. He is a motivated, disciplined, ruthless pragmatist. The only people who are surprised by this are those on the Right and Left who sampled their own brands of Kool Aid.

    The great strength Obama has is that he plays a very long game. So yes, I think he sees this as the opening act. I think he’ll get most of what he wants now, and more later.

  • ….but I think many on the Left started believing their own bluff.

    Or it was never a bluff to them.

    The great strength Obama has is that he plays a very long game. So yes, I think he sees this as the opening act. I think he’ll get most of what he wants now, and more later.

    Not so sure about that, he is taking a beating right now. His approval rating is very low. He has to be watching that and thinking about the rest of his agenda. Which makes things dangerous, because he might just go for universal coverage and forget the cost cutting aspects of health care reform and thus end up making things worse.

  • Cost control was never the core objective. Universality is the core objective. Universality morphs health care into a right rather than a privilege. Just as Medicare turned health care for old people into a “right.” Just as the VA made health care for vets a “right.”

    Once it is seen as a right for everyone, it will get paid for. And then we’ll be dealing more directly with cost containment.

  • Michael, I think you’ve laid out a scenario of tactical success and strategic failure. The history of healthcare over the period of the last 80 years is one of expanding coverage. During the same period there have been repeated attempts at cost control, all ineffective. Expanding coverage isn’t the hard part, it’s the easy part.

    There are three distinct things: coverage, availability, and cost. With reduced cost it’s relatively easy to expand coverage and availability. Increased coverage doesn’t increase either availability or reduce cost. Increased coverage almost certainly means decreased availability, at the very least in the near term and increased costs.

  • PD Shaw Link

    Michael, your “side” is upset because they felt that the public option was a compromise between a single payer system and the private insurance system. I’m sympathetic to the problem of negotiating against oneself in a public debate.

    I think Obama would have been better off following the Hillary Clinton model, except bringing in key legislators, perhaps even some Republicans, to draft the presumptive bill. Since a lot of this discussions would be behind closed doors (thought not necessarily private), they should have committed to not seeking a cloture vote for some extremely long period (1,000 hours of debate) with the implied threat of nuking any filibuster. At the end of the debate, the improved bill will be voted on, along with all the proposed amendments. If we don’t have healthcare reform, we’re campaigning against the do-nothing members of Congress and we’ll be back in 18 months.

  • Cost control was never the core objective. Universality is the core objective. Universality morphs health care into a right rather than a privilege. Just as Medicare turned health care for old people into a “right.” Just as the VA made health care for vets a “right.”

    Yes, and look how well that worked out. Medicare is projected to cost tens of trillions of (today’s) dollars. Tens of trillions we obviously don’t have.

    Dave is abosutely right. You might win the battle, but you’ll lose the war as costs continue to balloon out of control, possibly even faster. Then cuts will be forced upon us whether you like it or not and whether you consider health care you’re right.

    Once it is seen as a right for everyone, it will get paid for. And then we’ll be dealing more directly with cost containment.

    To be sure, but what you seem to be completely unable to grasp is how much you’ll get for what you are paying. Not many people dispute that Medicare is in serious problems. Go ahead and give it to everyone and we’ll watch the situation deteriorate all that much faster.

  • Yes, of course it’s a stupid way to address the problem. But the “smart” way was never really on the table.

    Look, we don’t fix problems until they blow up in our faces. We have a population that is profoundly ignorant on issues. It elects partisan ignoramuses who mirror and indeed magnify the ignorance of the electorate. Those partisan ignoramuses (ignorami?) then respond to whoever pads their PAC and whoever screams the loudest.

    In this debate the health insurers passed out the bribes and the GOP decided on a strategy of nihilism. (If it had been a GOP proposal you could just reverse polarities.) And of course it was easy enough for the GOP to terrify the doddering, frothing, panicky nitwits who showed up to howl like monkeys at townhalls.

    We’re a country of distracted, easily-frightened, and basically rather stupid people trying to micromanage a government in the 21st century. What did you guys think would happen? Did any of you honestly think we were going to rationally address the pluses and minuses and attempt to find the optimum solution? When in any of our lifetimes have we done that?

    We lurch from crisis to crisis. We don’t plan, we improvise and then only when the fecal product has made its final approach to the fan.

    A half-assed plan that makes some marginal improvements in some areas? I’m thrilled with that. It was all we were ever going to get. In a year or so we’ll see some staggering cost increases and then we’ll patch things up a bit. But not until it costs twice what it would cost to fix it now.

  • Look, we don’t fix problems until they blow up in our faces.

    When it blows up it will likely be too late. Reform will be forced on us and not the good kind. Just to recap:

    U.S. GDP as of last Quarter: $14.143 billion
    Medicare Imbalance: $45,000 billion give or take

    But lets expand the problem. $45 trillion is too little apparently. Lets make it a “right” and then well see what happens. Keep in mind that since both dollar amounts above are in today’s terms we need 3x our current GDP just to cover Medicare.

  • Steve:

    Yes, it’s a shame we can’t have an intelligent national conversation about big issues like this and take rational measures.

    Unfortunately we are best my ideologues of all stripes. All stripes: liberal, conservative and libertarian.

  • best my = beset by

    Very tired. Plus no oxygen left here in SoCal.

  • Unfortunately we are beset by ideologues of all stripes. All stripes: liberal, conservative and libertarian.

    I don’t think it is just that. If we had a liberal, a conservative and libertarian sit down I think they could come to some sort of compromise. But we also have feckless politicians who are all to willing to cater to the “have your cake and eat it too” mentality. Yes we can cover everyone and yes we can give them the most state of the art health care in the world and leave medicare unchanged. The reality is no, we can’t and anyone who says otherwise is either stupendously ignorant or an outright liar and knave. Given the large staffs of bright people most of our politicians have I’m going to default to the latter.

  • Paul Link

    “And it flies in the face of President Obama’s repeated statements about cost control in healthcare.”

    He doesn’t care about cost control. He only cares about CONTROL. Just like any good Marxist.

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