What Went Wrong on Health Care?

By Thomas Schaller, Salon - August 24, 2009

Barring a major public groundswell or miraculous reversal in Congress, Barack Obama's healthcare reform package will not include the provision that matters most to the Democratic base, the so-called public option. Why has a president who entered the White House with the second-biggest winning margin of any Democratic president since the New Deal, and who is blessed with solid Capitol Hill majorities in both chambers of Congress, struggled to save this key agenda item?

Was the White House's public relations rollout insufficient to counter the stronger-than-anticipated resistance from healthcare opponents? Was the public option always just a bargaining chip to give away in exchange for what the president really wants? What happened to the vaunted Obama campaign apparatus, which was supposed to morph into a machine delivering support for Obama's agenda? Did Obama simply lack the political will or political capital? Or should he have been less of a consensus seeker and more of a Rove-ian steamroller?

Maybe there's some truth to all those scenarios. Call it the public option's "imperfect storm." Yet the policy stumble by a president who demonstrated so much political skill over the past two years merits further inquiry into what went wrong, and why. Here are four possible explanations:

1. Despite solid Democratic majorities on Capitol Hill, Obama was never going to get his public option provision through Congress – and certainly not through the Senate – because the votes just aren't there.

Earlier this week, during an interview with CNN's Wolf Blitzer, Sen. Kent Conrad said flatly that there "was never enough support" in his chamber for the public option. As Salon's Mike Madden reports, Conrad and two fellow Democratic senators at the center of the negotiations who might have made a difference, Montana's Max Baucus and New Mexico's Jeff Bingaman, never committed their full resources to the battle. "Bingaman may be the prime example of the way some Senate Democrats seem to have approached the healthcare debate this summer: count votes first, figure out what should be in the bill later," writes Madden. "And while you're counting, take the most pessimistic view possible."

And thus, all the Democratic Snoopy dancing following Pennsylvania Sen. Arlen Specter's party switch and the long-overdue seating of Minnesota's Al Franken was premature. Sixty senators are better than 59, and certainly the mere 45 that Democrats claimed just four years ago. But a majority that is filibuster-proofed against the minority's obfuscation still remains susceptible to majority-party defections – or, to be precise, just one such defection. Given the business-friendly profile of Baucus and others, and the pending 2010 reelection challenges facing the likes of Nebraska's Ben Nelson, it's no wonder Harry Reid couldn't keep those 60 Dems toeing the line. To put it as politely as possible, Reid is no Lyndon Johnson.

Apparently, Obama is no LBJ (presidential version), either. Given the reflexive Republican biting of Obama's extended hand, perhaps the president should have dispensed from the start with any serious effort to find accommodation with the GOP. The White House could have spoken otherwise for public consumption, but it should have assumed all along that this would be a Democratic-led proposal. Instead of wasting energy on trying to persuade Republicans, it could have worked over dissenting Democrats in the Senate, and had a better shot at jamming the public option through.

Now the Obama administration seems to get it. At long last, on Tuesday, the New York Times reported that the White House and its Democratic allies on Capitol Hill are now prepared to push through healthcare alone, without help or bipartisan cooperation from congressional Republicans. "The Republican leadership has made a strategic decision that defeating President Obama's healthcare proposal is more important for their political goals than solving the health insurance problems that Americans face every day," grumbled White House chief of staff Rahm Emanuel. But if anybody should have anticipated that scenario, it was the guy Obama hired as his right-hand man. Emanuel still bears both the scars and lessons from a similar confrontation over healthcare 15 years ago. Why did it take him till August to experience this epiphany?

2. Obama misplayed his hand by failing to properly explain what the public option is, how it works, who will have to pay for it – and, most of all, to show that he's prepared to fight for it.

A president has to be educator in chief as well as commander in chief. But the White House lost control of the public option narrative very early on because, as Salon's own Joan Walsh wrote on July 21, Obama hesitated from the start to lay down clear markers and defend them publicly. "I'm clear about why this is a tough fight for Obama. But I think he may be making it harder than it needs to be. I realize it's difficult to define when still playing politics – necessarily – but I really want to know his bottom line," Walsh pleaded, noting that on a range of disputed elements, including the public option, Obama was curiously vague and uncommitted about his intentions. That he has been only slightly more clear and committed in the ensuing month hasn't helped.

It wasn’t until after weeks of being eclipsed by noisy, half-crazy protesters that the White House finally went on the offensive. Obama flew into New Hampshire to conduct his own, nationally televised town hall. It was not an unalloyed triumph. Asked by one questioner to defend the public option, the president offered what had the potential to be a powerful analogy, if executed correctly, when he compared the competition the public option would introduce to the insurance system to that which the U.S. Postal Service creates in the market for package delivery. So far, so good – until the president denigrated the USPS. "I mean, if you think about it, UPS and FedEx are doing just fine, right? No, they are. It's the post office that's always having problems."

For starters, Americans actually have a pretty high regard for the Postal Service. And of course, the price one pays at the counter for postage to mail stuff is subsidized by taxpayer dollars, because the USPS is part of the federal budget. The Postal Service delivers letters and packages pretty darn effectively and often at far lower cost than private carriers – and thus, helps keep market prices in check. But it was easy for opponents to pounce on the long-standing, if wrong, public perception that the Postal Service is somehow just another slow, costly and bumbling bureaucracy.

Barney Frank -- at the town hall meeting where he famously asked one heckler "On what planet do you spend most of your time?" -- also asked the rhetorical question the president should be asking of those claiming that the market is more efficient and the public option too expensive: If the government is such an inefficient, expensive provider of insurance compared to the private sector, why are critics so worried that rational consumers will choose the public option?

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