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.
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.