Saturday, January 30, 2010

A health care strategy in Obama's pregnant pause?

Two days ago, I started a post in which I was planning to contrast this intrepid declaration by Nancy Pelosi with what I viewed as mixed messages from Obama:
"You go through the gate. If the gate's closed, you go over the fence. If the fence is too high, we'll pole-vault in. If that doesn't work, we'll parachute in. But we're going to get health care reform passed for the American people."
Paraphrasing Steve Benen, I wrote, "Compare Pelosi's strength and determination with the ambiguity emanating from Barack "identify those core elements of this package" Obama" (Benen's comparison was with Mary Landrieu).  The epithet came from Obama's Jan. 20 interview with George Stephanopoulos, in which the President had seemed to me to be pulling in two directions -- first suggesting that a health care bill might have to be stripped down to win some Republican support, and then explaining why the core elements of the bill could not be pulled apart.

But a funny thing happened on the way to "publish post."  I reread the interview, searching for the wording for my epithet, and began to think I had misread it the first time.  That's partly Obama's fault; his language was unclear.  But his thinking at that point was, I think, completely consistent with his presentation of the health care reform task in the State of the Union address a week later. In both cases, he studiously avoiding speaking as a tactical party leader. He gestured toward one more reach-out to Republicans.  He left the door open to picking up a Senate Republican vote or two and therefore going back to negotiating a merged Senate-House bill, rather than trying to navigate the much messier process of the House passing the Senate bill and negotiating fixes to be achieved through reconciliation.

But also in both, he asserted that the HCR bill had been misrepresented, that its key parts were interdependent,  and that a full-scale bill must be passed. In the interview, when he said, " I would advise that we try to move quickly to coalesce around those elements of the package that people agree on," he was not talking about a scaled-down package. "People" may have nominally included Republicans (or not nominally, if he thinks that his own advocacy may pull in a Republican or two). But essentially, Obama meant that Democrats need to recognize that the core elements in both bills cannot be pulled apart, and that they therefore need to find a way to negotiate or live with whatever parts of the bill they find objectionable and get the core elements -- i.e., in all likelihood, the Senate bill -- passed.

Below is the by-now-somewhat-infamous "core elements" statement in the ABC interview. Look at the passage in light of the SOTU address and Obama's re-presentation of the bill to House Repulbicans yesterday: is very important to look at the substance of this package and for the American people to understand that a lot of the fear mongering around this bill isn't true. I would advise that we try to move quickly to coalesce around those elements of the package that people agree on. We know that we need insurance reform, that the health insurance companies are taking advantage of people. We know that we have to have some form of cost containment because if we don't, then our budgets are going to blow up and we know that small businesses are going to need help so that they can provide health insurance to their families. Those are the core, some of the core elements of, to this bill. Now I think there's some things in there that people don't like and legitimately don't like. If they think for example that there's a carve out for just one or two particular groups or interests, I think some of that, clearing out some of that under brush, moving rapidly..
 I originally thought that that statement was at odds with this one:
If you ask the American people about health care, one of the things that drives them crazy is insurance companies denying people coverage because of preexisting conditions. Well, it turns out that if you don't -- if you don't make sure that everybody has health insurance, then you can't eliminate insurance companies -- you can't stop insurance companies from discriminating against people because of preexisting conditions. Well, if you're going to give everybody health insurance, you've got to make sure it's affordable. So it turns out that a lot of these things are interconnected.

Now, I could have said, well, we'll just do what's safe. We'll just take on those things that are completely noncontroversial. The problem is the things that are noncontroversial end up being the things that don't solve the problem.
But in fact they're complementary. The only pull-back that Obama is really suggesting in the first package is in the carve-outs for Nebraska and Louisiana.

The weakness in that interview lay not only in the charged ambiguity of the injunction to "coalesce around the core elements of the package that people agree on" but in a weak response to Stephanopoulos' misinterpretation of the passage in which that phrase appeared:
STEPHANOPOULOS: So start again with a smaller core package.

OBAMA: Well, look, I'm not going to get into the legislative strategy. First of all, my job is to as president, is to send a message in terms of where we need to go. It's not to navigate how Congress...

STEPHANOPOULOS: It's to set direction.
OBAMA: It's to set direction and the direction I think that has to be set is to identify those core elements of this package and to get that done.
That would be fine, if Obama made it clearer that the "core elements of this package" are essentially the whole shebang -- exchanges, subsidies, individual mandates, employer mandates, coverage rules, cuts to Medicare Advantage. He didn't, when asked directly, though he did suggest as much later. Was it ambivalence? Deliberate ambiguity, designed to give an appearance of being open to 'new ideas'?  Just a failure of clarity? Who knows?

I'm convinced, however, that "core elements" meant "full package" because of the internal consistency in the strategy that Obama laid out and has begun to execute in the interview, the SOTU, and the meeting with the Republican caucus. Here are the steps, reiterated in all three forums:
  • Re-present the bill, explain what it does
  • Explain why its "core elements" cannot be pulled apart
  • "Reach out" to Republicans, which means expose the bankruptcy of their "ideas"
  • Find a way to get the Senate bill -- or, if things go optimally, a properly merged Senate-House bill, passed.
The bad news this week is that Rahm Emanuel is making noises about putting health care on a back burner -- coming back to it after accomplishing various other Herculean tasks. The good news is that Obama has taken a couple of master-strokes at doing what he says he's so far failed to do: re-present the bill to the American people and counter egregious misrepresentations of what's in it.   He did that poorly in the Stephanopolous interview. He did it well, if briefly, in the SOTU. And he did it masterfully in his 90-minute tussle with the House Republican caucus last night.

In executing this strategy, Obama is trying to thread a rhetorical needle. He wants to appear as President of all the people rather than as a partisan Democrat. He presents the bill, as he said to the Republican caucus last night, as "pretty centrist."  In the SOTU, he challenged and called out Congress as a body, rather than Republicans per se.  And rather than advocate for or insist on a particular strategy (in public), he is trying, rhetorically, to close off all alternatives but one: passing a bill that's got the basic architecture of the Senate and House bills.  That's the import of his "let me know" challenge both to Republicans and cut-and-run Democrats:
As temperatures cool, I want everyone to take another look at the plan we’ve proposed. There’s a reason why many doctors, nurses, and health care experts who know our system best consider this approach a vast improvement over the status quo. But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know. Here’s what I ask of Congress, though: Do not walk away from reform. Not now. Not when we are so close. Let us find a way to come together and finish the job for the American people.
The meeting with the House Republicans was a masterstroke, because he was able to call Republicans out directly for their egregious misrepresentations and intellectual bankruptcy without seeming petty, since they had the opportunity to respond.  His complaint that they were denouncing a centrist plan as a "Bolshevik plot" was the signature sound bite, and rightly so -- it's pitch perfect, it's short, and it was backed by citing Bob Dole and Howard Baker's endorsement of the basic plan architecture.   Equally valuable, though, was his engagement with specific nostrums that his interlocutors were pushing:
PRICE: But what should we tell our constituents, who know that we've offered these solutions, and yet hear from the administration that -- that we have offered nothing?

OBAMA: Let me -- I'm using this as a specific example, so let me answer your question. You asked a question, I want to answer it.

OBAMA: It's not enough, if you say, for example, that we've offered a health care plan and I look up -- this is just under the section that you've just provided me -- or the book that you've just provided me, "Summary of GOP Health Care Reform Bill."

"The GOP plan will lower health care premiums for American families and small businesses, addressing America's number one priority for health reform."

I mean, that's an idea that we all embrace. But specifically it's got to work. I mean, there's got to be a mechanism in these plans that I can go to an independent health care expert and say, "Is this something that will actually work or is it boilerplate?"

You know, if I'm told, for example, that the solution to dealing with health care costs is tort reform, something that I've said I am willing to work with you on, but the CBO or other experts say to me, you know, "At best, this could reduce health care costs relative to where they're growing by a couple of percentage points or save $5 billion a year, that's what we can score it at, and it will not bend the cost curve long term or reduce premiums significantly," then you can't make the claim that that's the only thing that we have to do.

If we're going to do multi-state insurance so that people can go across state lines, I've got to be able to go to an independent health care expert, Republican or Democrat, who can tell me that this won't result in cherry-picking of the healthiest going to some and the least healthy being worse off.

So I am absolutely committed to working with you on these issues. But it can't just be political assertions that aren't substantiated when it comes to the actual details of policy, because otherwise we're going to be selling the American people a bill of goods.

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