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Lessons for the White House from the Doctor Fix Debacle

Lessons for the White House from the Doctor Fix Debacle

By Sen. Tom Coburn - October 27, 2009

The day after White House Chief of Staff Rahm Emanuel's Clintonesque plan to triangulate and divide Republicans and doctors failed a major newspaper published this headline: "Democrats Lose Big Test Vote on Health Legislation." The title was so fair and balanced many media obsessed White House advisers could have attributed it to Fox News. Yet, it was the New York Times that captured in a well-written, fair and subtle story the depth of the challenge the White House faces in its push to enact major health care reform legislation.

As the Times reported, "[Majority Leader Reid] needed 60 votes to proceed. He won only 47. And he could not blame Republicans. A dozen Democrats and one independent crossed party lines and voted with Republicans ..."

The first lesson for the White House in this defeat is that public concern about the deficit is real, not manufactured. Twelve Democrats opposed the Emanuel strategy not just on principle but sound political judgment. Senate Democrats understand that voters, by a two to one margin, want Congress to address the deficit first, then health care. They knew that the effort to spend a quarter of a trillion dollar outside of the reform process was shameless and fiscally irresponsible. As Ron Wyden (D-WA), one of the "no" votes, said in the Times article, "On the eve of a historic debate on health care, it's essential to show a commitment to real reform," which includes fiscal responsibility.

The Washington Post - not Fox News - went farther and blasted the Emanuel/Reid triangulation strategy, calling it "nonsensical" and "sleight of hand." As the Post wrote: "The political imperative is twofold: to make certain that Republicans don't use the physician payment issue to bring down the larger bill and to placate the American Medical Association ... A president who says that he is serious about dealing with the dire fiscal picture cannot credibly begin by charging this one to the national credit card, with no concern for the later generations who will have to pay the bill."

The nation's doctors also understood the strategy and weren't impressed by Emanuel and Reid's plan to manipulate them into backing off of their support for tort reform. A poll on Sermo.com - a Facebook-like site which represents 110,000 real world physicians who sacrifice their own time to participate in a serious public debate about health care (in contrast to the American Medical Association, which represents itself and its Washington lobbying shop) included troubling results for the Democrats negotiating in secret. Sixty-five percent of nearly 1,000 respondents said they were "very concerned" about the Senate passing a fix for their own profession that was not offset, and 77 percent said they were "very unsatisfied" or "unsatisfied" with the substance of the so-called fix.

If the first lesson is to get serious about the deficit, the second lesson for the White House is to go back to first principles and conduct this effort with more maturity and less partisanship.

When Barack Obama launched his campaign in 2007 he said, "... it's not the magnitude of our problems that concerns me the most. It's the smallness of our politics ... We have to change our politics, and come together around our common interests and concerns as Americans."

Why then, on the eve of the most important domestic policy debate in a generation, are the President's advisers talking about Glenn Beck, Rush Limbaugh and Fox News? Is this really a common interest and concern among Americans? Would the average voter consider this form of politics to be big or small?

By spending time on juvenile and crass partisan strategies the President's advisers triangulated the wrong target - their own allies. Their tone and tactics united Republicans (all 40 voted against the doctor fix) and caused 12 key allies to fall away.

The Barack Obama I know and worked with in the Senate (through his initiation) is capable of so much more. America needs that Barack Obama to change the tone and go back to attacking problems rather than personalities.

If he does, he'll find plenty of friends ready to work with him - old and new. Every Republican wants to enact comprehensive health care reform that lowers costs, improves quality and increases choice. No matter how often our motives are questioned we will be ready to discuss plans like the Patients' Choice Act, which I'm sponsoring with Senator Burr (R-NC) and Representatives Paul Ryan (R-WI) and Devin Nunes (R-CA), that cover more people than the Democrat plans without pushing our economy off a cliff.

Yes, elections have consequences. The White House certainly has the right to continue its clever partisan strategy. Yet, history shows this process will succeed only if it is truly bipartisan. The doctor fix debate showed that partisanship is the far riskier road.

Tom Coburn is a U.S. Senator from Oklahoma.

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Sen. Tom Coburn

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