a curious Yankee in Europe's court

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Today’s opinion pick: A Contrarian Musing on health care reform

Posted on the January 22nd, 2010

In a recent e-mail exchange with a friend in the U.S., who is a political science scholar, we discussed the stunning Democratic Party loss in Massachusetts on Tuesday, and the crisis it has created for the proposed health reform process. I asked for some guesstimating, looking backward, on these questions:

Why is it that Obama approached health care from the perspective of a grand overhaul? Why didn’t the White House look at the problems, and choose one or two immediately effective things to change — openly speaking of it as the beginning of a complex process? For example, had they just gone for a limited public option — limited in that it would be a prototype program in one state or another, or with a certain selected group — they could have passed it with a little horse trading, and it would have been a great warning shot across the bow of the private insurers. Once this program was shown to be working well, it could have been used as evidence in proposing further legislation. Why not?

I suspect that Harry and Nancy initially told the President that if he would sit tight they would bring him a comprehensive health reform bill, take all the heat, and let him take the bows, and he consented to that.  In addition, I suspect they told him that it would be quick, and done in the background in a low profile process until ready for a vote and signing, and he liked that idea, as well.  He liked that, since he could then focus on the rest of the big agenda and make those actions high profile until the health bill was ready.

Instead what happened is that the health reform bill writing process became the fight that drew the crowds, drew the media, and made the most thunder, and took over the Administration’s image, leaving all hands on deck explaining, explaining, explaining instead of doing, doing, doing.  The jobs issue looked like it was and is being sacrificed, even willingly put last in line, in the whole agenda.

And keep in mind that the bill did three hugely hazardous things. It proposed financing much of the costs on the backs of those who, as with many labor contracts, have the best employer insurance coverage, and it touched the third rail by implicating Medicare and Social Security issues in the mix. In addition to all of this, the bill quickly became such a catch all of complexity that it confused and puzzled and permitted imaginations negative and positive to go wild.

As to why not a piecemeal bill instead of an omnibus, comprehensive bill?  Well, this was Harry and Nancy’s one big thing in life, and they wanted it big while the getting looked gettable.  I wonder if the two of them are not in a frame of mind that this administration, probably this Presidency, is not their career cap, and they are willing to go down and out with that legacy?

As for why the decision to do health bill during the President’s first year, one has to see that the economic crash, especially the financial system crisis, was not anticipated. So the Administration and congregation found themselves on too short notice with too many imponderables to come up with a new plan, so they just tinkered with the old plan, and still are doing so.

In addition, there is that idea of not taking the eye-off-of-the-prize thing about their plans, which means not changing priorities even though jobs are the priority for the public, and the immediate priority on top of that.  So, what they have done is rationalize their old plans, and actually in an underlying way, as jobs programs — you know, health care reform as a jobs program, as an economic recovery program, as an economic growth program, as a re-industrial program.  There is an ideologue-like attitude about the old plan, I suspect.

I think the Obama Administration, partly by their righteous good nature about rationality and non-partisanship, and partly because they assumed their majorities made it less relevant, forgot that the Presidency, when successful, is no less a political campaign than was the election campaign. Governance is a campaign thing at the governors’ and at the Presidential level.

I learned a hard lesson myself (when I worked for a while in a state job)  — it was that the other political party is always the opposition, always, always; so to be the big spirited guy and assume there is a spirit of common team goodwill and attitude in any project is to let one’s guard down and to get skewered for sure. That’s what the founders wanted, and that is what we got: competing interests, balances of power (read that as opposing forces), and loyal opposition all around.

The best we can hope for in this system is common civility and some measure of public courtesy in the eternal punching match of the process, in the eternal one-upmanship of it all.

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