Tuesday, February 23, 2010

More on Health Care Choices

Nate Silver has a very reasonable take today on the Charlie Cook thesis that health care was (1) a choice for Obama and (2) a bad choice, following up on my argument that it really wasn't a choice, after all (for why it wasn't necessary bad for him and the Democrats anyway, see Seth Masket and Jonathan Chait).  I had said that Obama had no choice about adopting a strong health care platform in order to win the nomination; Silver makes the point that health care apparently helped Obama in November, as well. 

Silver (along with a commenter on my post) says that while I might be right that Obama had to move ahead with health care, he could have delayed for a while, in light of the bad economic news.  I think that's correct, to a point.  Two problems, however.  First, as it turns out he was probably correct about the timing if his goal included passing health care reform; starting, say, in November would have been a disaster.  Second, as Chait says:
[Y]ou have to compare pursuing health care with an alternate strategy. What else could Obama have done? Cook says they should have focused more on jobs. But he offers no suggestion of what meaningful legislation could have passed after the stimulus, which exhausted Congress's willingness to spend any money on job creation. The current fiasco of a jobs bill, with the two parties bickering over symbolic legislation, suggests how little substantive progress was there for the taking.
The stimulus passed in February, and at that point Obama had presumably squeezed every penny that Congress was willing to spend on stimulus.  The main thrust of the Tea Party and other protests over the summer was against spending (stimulus plus bailouts) at least as much as it was against health care.  Is it even remotely realistic that Congress would have passed an unfunded jobs bill big enough to make any difference in March, April, May, or June?  I sure don't think so.  Perhaps, in mid-summer, Obama could have introduced  such a bill, but not much earlier.  But by then the damage was done to his approval ratings, which fell in the spring and early summer until basically going flat from mid-August on.  Of course, Obama could have pushed a jobs bill knowing that it was doomed in the Senate.  But I'm not sure how moving health care prevented him from doing that.  I think a much better case could be made against the climate/energy bill...I could definitely see an argument that had the House voted for a jobs bill just before August recess instead of climate/energy that it might have given Members of Congress a better counterattacking talking point during that recess.  But I also don't think it would have mattered very much to where Obama and the Dems sit today.  So while I'll grant that Obama did have some choice about timing, I don't really see that his actual choice was a mistake.  Especially, of course, if he wanted a bill.

I guess the truth is that I don't see health care reform, to date, as a significant loser for Obama and the Democrats.  Unemployment is at just under 10%, and most everyone thinks the economy is lousy.  Those facts, which have essentially nothing to do with Obama's strategy on health care, do all the work needed to explain Obama's current approval rating.  Improving those numbers would have meant substantive, not rhetorical, changes, and I just don't think Congress was about to throw another $300B or so at the economy, and I don't think anything much less would have made a significant difference.

At any rate, I do have to take issue with one point that Silver makes:
The bigger mistake -- and I've been saying this since at least last June -- may have been in giving the Congress so much latitude to craft its policy, which resulted in an extremely protracted process and news cycle after news cycle in which the lead story was Democrats yelling at one another.
This, again, isn't a choice that Obama had.  He certainly could have dropped a fully-formed bill on Congress...after which they would then begin an extremely protracted process with news cycle after news cycle about Democratic squabbling.  Nothing any president can do about that.  He didn't "give" Congress latitude; Congress has such latitude, whatever a president thinks.  


  1. "I guess the truth is that I don't see health care reform, to date, as a significant loser for Obama and the Democrats."

    Absolutely. It is only a loser if it loses, and whether it wins or loses is up to Democrats, not Republicans.

    About all that can be said is that if the Democrats were more united it would be a bigger winner. It also would also have already passed.

  2. Jon,
    I agree with Nate on this one. Yes, technically, on paper, Congress can debate and vote on whatever they want on whatever timescale they choose. However, that's the textbook Congress. The real Congress has leaders that have significant agenda control powers, and they have partisans that have a significant incentive to allow themselves to be led.

    I think Obama learned only one of two major lessons to be learned from the Hillarycare debacle. The lesson he learned was that you had to get the interest groups involved early and give them a stake in the outcome; in other words, you have to avoid Harry and Louise. Granted, Obama had an easier path there than Clinton faced (in that business was much more in favor of health care reform in 2009 than in 1994 AND that health care reform looked more inevitable in 2009 than in 1994, so they had more incentive to sign on), but he learned that lesson well: the chances of getting something looked much better when the insurers and pharma and doctors were all signing on.

    However, he didn't learn the second lesson. In 1994, Foley asked Clinton if he wanted his plan "protected," and Clinton decided that he was facing the textbook Congress and didn't want to make enemies of the committee chairs or the caucuses, so he told Foley to let a thousand flowers bloom. You ended up with 7 major proposals,, none of which could pass because with 7 proposals, you get something akin to Arrow cycling, except that everything fails because a majority always prefer "something else" to the proposal at hand, even if those "something elses" differ. Now, Obama didn't make the mistake of letting there be multiple legislative vehicles, but neither was this done by "task force" or any of the other ways a Speaker can firmly structure the outcome. It's not like health care is a new issue. This could have been done on an accelerated time schedule over the summer, but neither Reid nor Pelosi did so. And I think Obama could have "made" them do so. So, in the end, I think Obama screwed up, by trying to undo the Bush legacy of making decisions first, telling Congress eventually. The problem is that Congress has ceased to be a transformative legislature and is really just a representative one.

  3. Matt,

    Well, I really don't think that you're right about that last bit, but more generally...I don't think I agree. Yes, it's possible that Pelosi could have done it by task force, but do you really think that the House was the problem? I don't. And I don't think the Senate problem was that Obama didn't dictate; it was that marginal Dems wanted the cover of the Gang of Six thing.

    I do think that there was an extra six weeks or so that could have been squeezed out between the end of the Gang of Six (end of August recess) and bill passage on Christmas Eve Day. And as it turned out, that mattered a lot. If Reid had appointed an ad hoc select committee in the first place, and it was that select committee that acted in the fall and sent that result to the floor without the intervening stages, then there would have been a signing ceremony by now, probably (although there still would have been at least one more round of negotiations, perhaps when the bill was on the floor). And, while it would have annoyed a lot of Senators to do that, I think it's a reasonable criticism, even though way back when there was no way of knowing that six weeks would matter. But that still leaves lots of ugly process stories in the summer and fall, and again that's not where Obama lost his approval ratings, anyway.

    As far doing more...I don't think it's even remotely possible to pre-negotiate everything out before going to the Hill. Bush didn't do that either -- the tax cuts, Medicare expansion, and NCLB all had plenty of ugly negotiations on the Hill, no?

  4. Yes, those three Bush policy wins all were negotiated on the Hill, but the big difference is that the White House was a major player in each of those negotiations.
    Some lib blogs are trotting out the notion that Emmanuel has been doing a poor job as that player; that's possible, but I think it unlikely. I suspect Emmanuel or whoever was in the room for the White House in these negotiations wasn't doing much productive, but I don't know why not...whether that came from ability or orders to let Congress be Congress.

    The alternative, as I see it, is that Obama and Emmanuel have been calling Reid, Pelosi, and moderate senators daily and just launching into them, to no avail. I don't think they have been. I just haven't seen any time pressure put on Congress. I could be totally wrong, but I suspect a lack of prodding from 1600 Penn.

  5. I think the White House (Rahm, etc.) were major players, but undervalued the importance of hurrying up. Which, remember, would have been OK if the Democratic candidate for Senator of Massachusetts had bothered running a campaign. And avoided slurring the voters and the Red Sox. And took down her campaign website with the "Bobby Orr Is The Devil" banner, and its "Parquet Floors are For Wusses" feature, and her blog dedicated to asking whether Jeter or Peyton Manning is the dreamiest man out there, and her campaign to keep the Pixies out of the R&RHOF, and (just for Diane Chambers) the whole Allan Ginsburg is way better than Robert Lowell thing. Also, I hear that she's never seen a single episode of either Spenser or Banacek. And that she doesn't even like driving past the Stop 'n' Shop with the radio on.

    I'm sorry...I guess I got a bit lost there.

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