Three Things to Remember About The Prez’s Role in Healthcare

Ezra Klein writes:

What’s been striking, however, is the implicit argument that this is somehow a simple failure of liberal will. Rachel Maddow called it “a collapse of political ambition.”…The unifying idea here is that someone can just go into a back room and torture Max Baucus and Kent Conrad. But how? Rahm Emanuel isn’t a shrinking violet. Neither was Clinton or Carter or Nixon or Truman or FDR. But none of them managed to get health-care reform past the Congress. There’s not really a record of presidents being able to bend committee chairmen and wavering centrists to their will. Even LBJ, the master of this stuff, decided to go for Medicare rather than full reform. He thought the latter too ambitious. The history of health-care reform is the history of health-care reform failing. If there was some workable presidential strategy, or foolproof negotiating lever, presumably someone would have used it by now, or at least mentioned it in public.

This is exactly right.

I think there’s at least three major mistakes being made relative to Obama and the push for healthcare.

1. There’s this little thing called the constitution.  Since we live in the postWWII era where the Executive, under both Republican and Democratic administrations, has massively increased its power through extra (or un depending on pov) constitutional means, mostly through the creation of agencies (e.g. EPA, NSA, etc.) people think the President is basically all-powerful.  In foreign affairs this has indeed become the case with repeated flagrant violations (again both parties) of the War Powers Act as well as the Congressional mandate to declare war.

In domestic affairs however this is not the case.  And since Congress has been on holiday for at least a decade and half, major domestic reform rarely comes up.  When it does it generally fails:  Bill Clinton with his healthcare initiative, George W. Bush with aborted immigration and Social Security Reform. The Constitution was written for the Legislative branch to be the dominant branch.  You may think that a design flaw, but that’s how it is.  A strong executive the US Constitution does not (on paper anyway) make.

[Sidenote: I think the primary way to fix this is not to give domestic power over to the Executive but to massively expand the membership of The US Congress.  But that’s another day and another fight.]

For our purposes here all that matters is that the President doesn’t really do all that much until there is legislation on his desk that he either signs into law or vetoes.  Other than that he can do some backroom wheeling and dealing, go on TV and try to get people behind him.  But at the end of the day he is not constitutionally mandated nor democratically elected to be handling this thing.  That’s why we have Senators and Representatives.  If you’re someone whose pissed about how this is going call and yell at them.

2. People are also forgetting (or don’t know I guess) what they should remember which is that Obama has clearly laid out what his plan is.  Again, given what small role he does have, he has a plan for how to maximize it.  Another excellent Ezra post on the subject.  The Team Obama plan is to push hard in conference committee for the kind of plan it wants.  It said so specifically:

Conference is where these differences will get ironed out. And that’s where my bottom lines will remain: Does this bill cover all Americans? Does it drive down costs both in the public sector and the private sector over the long term? Does it improve quality? Does it emphasize prevention and wellness? Does it have a serious package of insurance reforms so people aren’t losing health care over a preexisting condition? Does it have a serious public option in place? Those are the kind of benchmarks I’ll be using. But I’m not assuming either the House and Senate bills will match up perfectly with where I want to end up.

So while I agree with Br. Jamelle that attempting to do this through reconciliation would be perilous indeed, I don’t think it will come to that measure.  Or at least that is not the plan from the administration.  But even there, as Ezra’s post helpfully points out, if the Senate passes a bill without a public option (while the House has), the only way for it to get back in via conference would be if Harry Reid stacked the conference committee membership with more liberal (pro-public option) members.  The Republicans would whine and cry foul and play the victim card all over TV and Harry will probably fold for all I know.

But stranger things have happened. 

Normally news that the other side is going to stand against whatever bill you put up there–even one with co-op and not public option–would embolden one’s team to finally go at it knowing there’s no need to try to placate the other side.  Particularly given that the opponent’s base is so adamantly opposed to any legislation, plus the fact that it’s good politics from the Republican point of view to try to kill this thing.

Of course normally does not usually apply to the Democrats.  We’re always on the precipice of the Democrats standing down the Republicans and sending the GOP into permanent exile.  But the Dems always freeze at the last moment.  They never take the plunge.  You’ll often hear that the Republicans are insane and fight every fight like it’s the last stand at the OK carrol.  But actually given the demographics moving away from them, the shift of the country leftward, every fight sort of is their last stand.  Republicans are really inches away from serious long term minority status and near total obscurity.

If the Dems achieve a major domestic achievement like health care reform, if they realize that they can get that monkey-bully of the GOP off their back, then the ball could really start rolling.

But like I said, normal doesn’t apply to the Democrats, so I wouldn’t be placing my bets just yet.

3. Last one.  Obama is yet again simply doing his community organizing thing.  He is letting the other side (the anti-health care reform crowd) have their time and look to a degree powerful so that it becomes clear to those in favor (on Obama’s left) that they need to do something.  When the “regular” Americans stand up for him, then it neutralizes these radical socialist charges.  If the liberal constituency comes in big force, then in theory that puts pressure where it actually matters–not on Obama–but on Harry Reid and Nancy Pelosi to get public option in via conference.

It then also puts pressure (as Ezra points out), one assumes, on the Kent Conrads and Ben Nelsons of the world to vote to end the inevitably coming Republican filibuster on the final bill.  Again that’s pressure where it really matters.  The Centrist Dems could still vote No on a bill with a public option in it but would they want to be party to preventing such a (hypothetically speaking) out of conference bill with public option from ever coming to the floor for a vote?  Though Yglesias points out we just don’t know what they want.  They are the unknown quantity.  How they go pretty much determines how this will unfold.

Postlude:  As a total out there what if—What if Obama had selected Evan Bayh as his Veep?  Would Bayh have had pull with the Centrist Dems to get Obama over the hump?

Update I:

Relative to point #2, all this yammering (mostly from the left) about how the Obama Team can’ t get its story straight on public option (see John Stewart, Rachel Maddow, and/or Jason Linkins) strikes me as really dumb.  If we assume point #2 (Obama’s conference plan), then why wouldn’t the President both continue to say that he wants a public option and yet is open to other ideas that meet his larger frame goals?   The latter opening is would then work to allow passage through the Senate so he can try to work public option back in via conference, right?  I’m mean it’s not exactly Machiavellian in its devious brilliance, but it’s not totally dumb either.  It makes a certain amount of sense at this point to give up on trying to get the public option in the Senate bill.   I mean Obama can easily say both things he’s said and it not be inconsistent or off message or whatever.  Why is this so hard to grasp?  Speaking to different interest groups is not the same as speaking out of both sides of your mouth.

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10 thoughts on “Three Things to Remember About The Prez’s Role in Healthcare

  1. I wouldn’t be all that surprised if Obama takes this opportunity to prove to Blue Dogs et al that Republicans outside of Snowe and Collins simply won’t vote for cloture let alone any bill no matter what the compromise. He could announce how disappointed he is that no one is willing to compromise (and damn Democrats as well in the process), specifically highlighting that the bills passed out of committee so far don’t reduce our future deficit, insure enough people, or provide enough assistance for people in a rough patch to insure their families. Then propose a completed bill a la Hillarycare and demand that it be voted on ASAP — that he’s open to a bill with any changes that don’t cost more, insure fewer people, or raise taxes, but will veto any bill that isn’t better than the one he’s proposing. This is essentially what he did with the stimulus and I think it’s a much better tactic. You don’t demand an up or down vote right away w/out change, but you get an Obama-branded package out there as the standard against which all other bills will be judged. The only legit argument against any package Obama would come up with is that it’s unfair to the insurance and drug companies and he can go all populist on that.

    Also, this is more than a little morbid, but it’s worth considering that Ted Kennedy could die any day and that this would probably grease the skids for the passage of any bill that comes out of the HELP committee.

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      • What I’m proposing is not to wed himself to one section or other of his proposal, but to come out with a specific proposal; one w/ at least as much specificity as the budget (ie not really a bill that’s ready to go into law, but something with all the pieces, cost estimates, benefits projections, etc). Announce it along with a panel of bipartisan, independent health experts who will score the bill in terms of projected increase in the number of insured, quality of care, and premiums for an average family in the individual market over the next 10 or 20 years. Also have the CBO score it and declare that it’s deficit neutral and does something to lower long term deficits.

        Then give it to Congress and say that they’re free to make any changes that don’t make the bill worse, and define worse as: taxes for people <$250,000/yr, fewer people insured, higher insurance costs for individuals, worse quality of care, increase in the deficit, decreases in Medicare/Medicaid benefits. Say that if Democrats or Republicans have ideas that make the bill better, you'll sign it. If they come up with a whole new bill that's better on this score, you'll sign it.

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      • I wrote a long response to this that got lost in the ether earlier today. What I’m talking about isn’t what I think will happen, but what Obama could *do* if he wanted to take some risk in the hope of a more progressive bill. I think it could work if he were to roll out all on one day a complete proposal (a la the President’s budget) that’s scored by the CBO as being deficit neutral over 10 years and bending the curve over the next 50, and scored by an independent, bipartisan panel of health experts as lowering individual costs, increasing quality of care, and increasing the ranks of the insured. He should tell Congress that they’re free to come up with an entirely new bill or take his proposal and run with it as long as they get something to his desk within two months. If the bill he gets is worse on any of those scores, or if it raises taxes on people <$250k or cuts Medicare benefits, he'll promise to veto it. The key is to absolutely force Republicans to oppose the bill on an "it's unfair to insurers, providers, and pharam" basis. Obama's already shown he can win the tax debate, and he just passed one of the biggest tax cuts in history; he's got some leeway when it comes to generating revenue.

        What I actually think will happen is this: House passes a bill w/ a public option that's scored neutral by the CBO. Senate passes a bill w/ a ridiculously neutered co-op sort of thing b/c Dems compromise with thin air. The plan in the conference bill is called a co-op but run by executive branch appointees and funded at the same levels as the House public option. No way anyone supports a filibuster of the conference report… Obama's team will generate an astounding amount of momentum between the time it passes the House and Senate and when they vote on the bill out of conference. No one wants to be labeled as voting for it before they voted against it. Recall that this is exactly what happened with the stimulus. Essentially all of the spending in the House bill ended up in the final bill. The making-work-pay credit was cut by 25% to make the conference bill cheaper and satisfy moderates (appeasing blue dogs by getting rid of tax cuts… wild) and make room for the AMT patch that was inevitably going to be passed sometime this year anyway.

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  2. “The Constitution was written for the Legislative branch to be the dominant branch. You may think that a design flaw, but that’s how it is. A strong executive the US Constitution does not (on paper anyway) make.”

    Well, if they’d really wanted a weak executive they’d have kept that grand olde document, The Articles of Confederation. Why do you suppose the Constitutional Convention was a closed door, no public, no journalists affair? A little paranoia anyone?
    The only thing that gummint run health care will benefit is funeral homes and apparatchiks.

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