Health Care Reform: Do We Need a Dictator or a Democrat?

ONLY A FEW MONTHS AGO, the political commentators were telling us that if President Obama hoped to pass comprehensive health care reform, he would do well to avoid the sin Bill and Hillary Clinton committed when they tried to do the same in the early '90s. The Clintons' mistake, the Conventional Wisdom goes, was that they tried to bake the entire package on their own before committing it to debate in public and in Congress.

Whether or not Obama and his team were consciously avoiding such an approach, I can't know; but theirs was to turn much of the crafting of the plan to the hugger-mugger of the Congressional legislative process. Rather than push a strong, centrally controlled process, this White House submitted to what we might call "free-market forces" -- insofar as you can call Congressional policy making free market. (And who says Obama is a socialist?)

The Conventional Wisdom now is that Obama's efforts were fatally flawed. The analysts, who often claim to be more omniscient than those who are actually charged with the hard work of making the policy, now say he should have been more dictator than democrat when it came to health care policy reform. (Now they tell him.)

So now he's giving a major address this coming week that many expect will offer more specifics. Of course, as soon as he does, we'll hear complaints from those who feel their ox will be gored, that he's being unfair, etc. 

It seems President Obama can't win respect on this no matter what he does. That's what comes with trying to do something hard. Sure, maybe he went too far in the opposite direction of the Clintons'. As Jackie Calmes wrote in yesterday's New York Times, "Mr. Obama got a faster start than Mr. Clinton by not repeating his mistake of trying to write the law for the lawmakers. The Clintons’ secretive labors on a 1,342-page bill cost nine months and stoked resentment among Congress’s proud Democratic committee barons, who felt left out.Mr. Obama went to the other extreme. He produced no plan, only fairly specific directives. He said he wanted to create 'exchanges' offering private insurance plans and a public option. He called for insurance subsidies for individuals and small businesses. And he advocated changes in Medicare and Medicaid payments to give the health industry incentives to control costs and improve care."

Okay, maybe. But as Calmes also notes, "[E]ven if the administration did everything right, drafting legislation this complicated is never going to be easy."

Especially when, it seems, Congressional Republicans are (as in 1993 and '94) intent on opposing anything the Democrats in the White House and Congress can take credit for. To my lights, they (or at least most) appear to have little interest in moving the country's dysfunctional health care system to a new and better place. They seem to be banking politically on a strategy of "don't just do something, sit there." Given the depth and breadth of frustration Americans have about our health care, that seems like a dangerous kamikaze strategy for the Republicans. But they may be right, too, that, with control of both Congress and the White House, Democrats can ill afford to come back to the people with nothing. Republicans seem to want that result, not a policy that's good for the people -- thus, many of the nasty distortions we've seen from their camp about this reform.

And then we have a public that is so confused about the stakes and what's what. We've heard over and over about how many Americans who love Medicare are also dead-set against a publicly operated health insurance program. We've heard the silliness about the alleged requirement of "death panels" in the legislation. And we know that many of us, even as as despair over the state of our health care, are afraid to make any big changes.

That last point suggests to some that what we need is not a big, holistic, sudden change but a longer-term series of incremental ones, so we, the people, don't feel the shock. And you can bet that, should this legislation pass, there will be screaming about even the incremental changes.

Whether or not Obama has hit the right point on the continuum between imposing his will and leaving the hard decision making up to others, don't we all agree with his overall premise, that doing nothing is not an option? As he said at a speech in July, "We have talked and talked and talked about fixing health care for decades.  And we have finally reached a point where inaction is no longer an option -- where the choice to defer reform is nothing more than a decision to defend the status quo.  And I will not defend the status quo.  We are going to change health care reform."

Saying that is not sufficient, of course. It will take a whole lot more work, and he and his team seem to have expended a lot of sweat and political capital that end so far. But are we just waiting for the President not only to set the perfect mood music but also to play the music and cook the meal, too? To mix the metaphor, are we just waiting for him to wave his wand and make it all better?

Jeff

Comments

[Joyce Lyon]

Couldn't agree with you more on the Obama health issues. I'm afraid anything he attempts will be and has been attacked by the Republicans. I'm not convinced that the color of his skin hasn't played into this too.

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"There is a principle which is a bar against all information, which is proof against all arguments and which cannot fail to keep a man in everlasting ignorance-that principle is contempt prior to investigation."

-Herbert Spencer

This principle is part of entirely too many people's political and social mindset, particularly in today's polarized climate. With regards to health care reform, and the Gates/Crowley blog as well, in the face of an overwhelmingly complex issue, or even a not so complex incident, people go to their default settings, which all too often is the principle cited above. This is how people make a complicated world simple.

Look at Obama's skin and the debate is settled. Look at Pelosi's demeanor and the argument settles itself. Look at Rush Limbaugh, and all Republicans are evil. Look at the idiots at any number of town hall meetings, and one might ascertain for himself that puppetmasters are at work.

How then does one decipher a 1,200 page piece of legislation? How do you trust government to oversee, much less overhaul or actually run such a gargantuan piece of the economy? Well, we count on the fourth estate and well reasoned arguments coming from blogs such as yours Jeff.

This debate concerning health care must go on. Recently I had kind of a heated argument with a friend who contends that yes, health care is a "right". I said I didn't know the Constitution had been amended. This infuriated him, and I apologized. Health care, whatever its true place in the fabric of our lives as Americans, is important. Important enough to have warranted the birth of Medicare, Medicaid, and hundreds of billions of dollars, neigh trillions spent on research, development, and delivery.

Let's not jump the gun. Let's help people who need help. Let's not send people to "debtors prison". Let's do the next right thing, to borrow from a philosophy I try to employ each day. At the same time, we can't throw the baby out with the bath water. The United States is the leader in developing medical breakthroughs. It is most certainly not the leader in delivery of health care, by any stretch of the imagination. Let's work to bridge this disconnect. As an old carpenter friend of mine once said, you're judged by how you treat the least among you.

Chris McGrath

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But I digress... To answer the question posed in the headline, we need an LBJ. Was he a benevolent dictator or merely a skilled wrestler like Lincoln? I know one thing for certain: he could twist the arm off of anyone in the House or the Senate.

[Rinky]

Can all of us who have been helped and taken for granted the use of Medicare and Medicaid speak up? Many would not be alive today if it were not for the availability of expensive procedures.
So what can be so bad about allowing others to have the chance that we over 65 have.