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By Jay Cost

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Health Care: Five Political Blunders

As Congress heads into recess, it is a good time to evaluate its efforts in enacting health care reform. My opinion is that the leadership and the President have committed some significant blunders. While a bill is still quite possible, they have to stop making unforced errors. Here are five big mistakes they have made.

No Consistent Message. Will there be a public option, or health care cooperatives? Will there be a tax on gold-plated insurance policies, or the companies that offer them? Will there be a tax just on millionaires, or the middle class? Will there be an employer mandate, an individual mandate, both, or neither? This is just a sampling of the questions people are asking about health care reform. There are not yet any answers because no final bills have been produced - and will not be for some time.

This makes it quite easy to attack reform efforts. All the opponents have to do is pick the most unpalatable of all the options on the table, and go after them. But what about defending them? That's a lot trickier because you have to parse: "Well...I favor this item but not that one," and so on. Ultimately, your defense of the bill has to be contingent upon what's eventually included. That's a weaker rhetorical position.

Divided Messengers. Who said this: "[W]hen you have a Senator like Max Baucus helping us make the decisions on a reform health care bill, you're in trouble." It wasn't Jim DeMint. It wasn't John Boehner. It was...John Conyers, chairman of the House Judiciary Committee!

Ideally speaking, a political party wants to push an issue that unites its side and divides the other side. For some reason, after fifteen years out of power, the Democrats have chosen as their first major legislative push an issue that does exactly the opposite. So it is that the leader of a prominent House committee criticizes the leader of a prominent Senate committee. So it is that liberal groups attack Ben Nelson, who might ultimately be the pivotal vote in the Senate. So it is that after weeks of arm-twisting and deal-making on Energy and Commerce, Henry Waxman still lost five Democrats on his committee (and not all of them were Blue Dogs). The latter implies a not insubstantial number of defections on the House floor. Some of them will be moderate - but there may be liberals voting nay as well. Late last week 57 progressives signed a tartly worded letter to Nancy Pelosi, Henry Waxman, Charlie Rangel and George Miller protesting the deal with the Blue Dogs and concluding: "We simply cannot vote for such a proposal." And this is just in the House.

As if the dry economics of public plans and surtaxes were not enough to divide members - there now is a question over whether the House bill subsidizes abortion. Good - as we all know, no issue bridges the political divide quite like abortion!

We'll see if the Dems' foray into the abortion controversy winds up any better than Jerry's.

Bad Timing. The timing of this push is horrible - of all the unforced errors on the part of Obama and the congressional leadership, this one is the worst. They are debating health care at a time when people are cheering that the economy is only shrinking by 1%, so relieved they are that the "free fall" is over! This Congress and President are simply not focusing on what is worrying the voters. Instead, they're too busy chasing FDR's ghost. Every Democratic leader wants to be the one to expand the New Deal/Great Society social welfare state - and Barack Obama, Nancy Pelosi, and Harry Reid plan to be the ones to do it.

The political problem with this is twofold. First, the electoral risks associated with not staying focused on job one - fixing the economy - are too obvious to bother enumerating. Second, the government has already emptied the Treasury with TARP, the auto bailout, and the stimulus bill. The country is now feeling particularly averse to deficit spending, which makes the current political environment quite different from 1964/65, the last time such an expansion of social welfare was achieved. Back then, the country had been enjoying a five-year economic boom, and times were so good that LBJ could offer Kennedy's tax cut, the Great Society, and an amping up of the U.S. presence in Vietnam. That's not the way it is now. As the AP reports, tax receipts have declined 18% this year - the worst drop since the Great Depression - and President Obama's second choice for Commerce Secretary can now suggest on national television that we're on our way to being a Banana Republic...without anybody laughing him off the tube.

No Clear Legislative Strategy. What's the game plan to get a bill through the whole Congress? I'm not sure anybody has one. I once thought the President did - but after the legislature blew past his deadlines, I'm now quite skeptical. I do not think those deadlines were realistic, which makes me wonder what other unrealistic expectations his team has.

Here is the trillion-dollar question: can the legislature produce a bill that picks up enough moderates without alienating the left flank? I do not know the answer to this question - and frankly I don't think the Democratic leadership in Congress knows, either. I do not think they were even taking the question seriously until recently. How else to explain the pressure that has been exerted on Max Baucus, whose committee remains the best chance for a passable compromise? How else to explain why House Democratic leaders would think they could unveil a bill that made 40+ Blue Dogs choke? How about the objections by the progressives after the deal was reached? The compromise in Energy and Commerce was not so much a solution to the larger problem, but a way to kick the can down the road.

Charles Krauthammer suggested recently that the Democrats would pass something this year, though it would be much less than what has been offered to date. Maybe so - but is that realistic? Keith Hennessey doesn't seem to think so:

Some in Washington think the White House/Pelosi messaging shift is a strategic retreat, laying the groundwork for a fallback position in which the President could declare victory by enacting just the insurance reforms. As a matter of abstract legislative strategy this is a reasonable supposition. The health care reform legislative effort is going poorly for the President, and now is a logical time to make an initial shift to position for a partial win later.

But I don't see it. The health insurance reforms cannot be separated from the rest of the bill for substantive and procedural reasons. While the spending numbers could obviously be dialed way down, I don't see how one would substantively separate the health insurance reforms from the rest of the bill and have it still work. Even if you could, I don't see how you could procedurally get this done given the likely vote situation. Even if the abstract legislative strategy is correct that it's time for the Administration to cut their losses and prepare for a partial victory, I cannot figure out how they could execute such a strategic shift and deliver the desired result. They may be stuck with something close to an all-or-nothing choice.

Too Much At Once? The scope of this bill might simply be too great. Congress is not well-suited for tackling omnibus issues such as "health care reform." The larger the issue a bill deals with, the more likely a member will find some provision in it that he or she just cannot stomach, and the less likely the bill will pass. Congress is much better at passing bills whose scope is more narrow. In the sixteen years since Bill Clinton's efforts for a major overhaul crashed and burned, Congress has not been inactive on the health care front. Far from it. It passed and expanded SCHIP. It also approved a Medicare prescription drug bill. Those are the sorts of bills that, because their scope is more narrow, have an easier time getting to the President's desk.

When you aim for an omnibus health care overhaul, the potential payoffs are greater: you add yourself to the pantheon of great Democratic presidents if you succeed. But the risks are greater still: you increase your odds that something, somewhere in your 1,000+ page bill pisses off the pivotal legislator. To put it simply, there is a reason why no President since Harry Truman has succeeded at what Barack Obama intends here.

-Jay Cost