Obama Health Care Reform Strategy Sidesteps Clinton’s Missteps

The number of mistakes made by the Clinton Administration in pushing for health care reform in 1993 are embarrassingly numerous.  One of the most damning was their heavy handed approach with Congress. Instead of engaging with lawmakers from the beginning, the task force led by then First Lady Hillary Clinton worked behind closed doors. Democratic Congressional Members were pushed out of the loop and expected, I assume, to fall in line with their Democratic President because, well, he was their Democratic President. Oh, and of course because the health care reform package developed by the task force was so obviously wonderful.

Leaving aside the lack of wonderfulness in the plan they developed, this approach was nothing short of political malpractice. The president may propose, but it’s Congress that enacts legislation. Any effort to dramatically change something as expensive and personal as health care will generate opposition. Some of that opposition is based on sincere differences of opinion concerning public policy. Some emerges from economic or political agendas threatened by the changes. In either event, it’s important to have a strong base with a unified message to withstand the inevitable attacks. The Clinton Administration’s approach — imposing their viewpoint on Congress — meant they had few supporters when and where they needed them most. The result was a political rout that helped open the way to a Republican takeover of Congress in 1994.

Whether based on temperament or wisdom earned at the Clinton presidency’s expense, President Barack Obama and his team are approaching health care reform in a far different manner. Their outreach to Congress has been extraordinary. They are not only working with Congressional leaders to design the plan, but are helping to create a unified message as well.

The Associated Press reported on a meeting today between several Democratic Senators and White House political advisor David Axelrod. Their goal, according to Senator Dick Durbin, was to “coordinate our messaging so we present a health care reform effort that the American people trust.”

The meeting was, in part, a response to advice circulated among Republicans by Dr. Frank Luntz outlining ways to attack the Democratic proposal. Dr. Luntz is a highly regarded GOP consultant and an expert on political messaging, the author of Words That Work: It’s Not What You Say, It’s What People Hear. He urged Republicans to be “on the side of reform.” while attacking the Administration’s proposal as leading “to the government setting standards of care, instead of doctors” and “to the government rationing care.”

The 26-page report has caused quite a stir on Capital Hill. Democrats in Congress wanted to make sure they were prepared to withstand the suggested assault. The meeting today with Senators and with House Leaders yesterday were designed to do just that. It was reinforced by a message to the grass roots following President Obama developed during the campaign that now operates as Organizing for America.

What was agreed to was a three-pronged message: medical costs must be lowered, people must have choice in their health care coverage, and care must be affordable for everyone. How these principles are put into action has yet to be determined. No legislation has yet emerged from the numerous Congressional hearings underway.

It’s the lack of explicit information that makes framing the reform effort so important. Until there’s actual legislation to read, all the public has to go on is the general policy positions pronounced by various parties. Eventually, we’ll see a bill, but how the public reacts to it will be influenced to some degree by the spinning that occurs before its release.

By involving Democrats in Congress early in the process of developing the legislative language and working with them to shape a unified message, the Obama Administration is sidestepping one of the most damaging missteps of the Clinton Administration. Ultimately what will matter is the legislation itself. But the mere fact that President Obama and his team are avoiding the mistakes made 16 years ago, is an indication of how different the battle will be this time.

Public Health Plan – Tea Leaves

President Barack Obama’s stated goal is to pass comprehensive health care reform by the end of this year. With a Democratic Congress and muted opposition (relative to those that opposed President Bill Clinton’s similar effort) President Obama has a good chance of succeeding. It won’t be easy, especially given the cost and the state of the economy, but the stars seem to be aligning.

Consider: Health care costs are a huge burden on America’s struggling manufacturing base. Health care reform would ease this burden. The public supports substantive change. Previous opponents to reform (doctors, hospitals, drug companies, insurance plans and the like) have lined up to promise to reduce health care costs by $2 trillion dollars by 2019. Voluntarily. Harry and Louise would be so proud. And President Obama has perhaps the most potent grass roots political organization ever assembled.

Hold that last thought.

One of the most controversial elements of the President’s health care reform package is the creation of a government-run health plan to compete with private carriers in the traditional market place. I’ve written on the controversy several times, so to oversimplify: liberals tend to think a public plan is essential to assure fair competition in the marketplace. Conservatives see it as the first step toward a single payer system. Many moderates, including centrist Democrats who appear to hold the balance of power on health care reform plan, seem skeptical about the idea.

Then candidate Obama campaigned strongly on the need for a public health plan. While he’s always expressed a willingness to compromise on the issue, in the past it has usually been about how a public plan would operate, not whether there would be one.

Hold this thought, too.

Now, let’s bring those two held thoughts together. Ben Smith over at Politico.com is reporting on an email sent out by President Obama’s grass roots organization, Organizing for America, on the issue.  The letter urges supporters of the President to pledge to support three broad principles for health care reform. These principles are:

  1. reduce costs;
  2. guarantee choice; and
  3. ensure all Americans have quality affordable health care.

That’s it (the full email is printed on Mr. Smith’s blog). No mention of a public health plan. Zip. None.

Organizing for America’s call to action is focused on the right principles, too. Some of commented that the Administration’s emphasis seems to be more focused on health insurance reforms than on containing medical costs. I confess, I write more about the former than the latter, but that’s in part due to the nature of this blog and it’s because market reforms have been more controversial — so far. The reality is that President Obama has consistently worked to emphasize the need to rein in the escalating cost of health care in this country. In many ways he’s been successful in gaining consensus on those aspects of his plan.

Which means the question becomes whether he’ll fight to keep a government-run health plan in the mix even if it means jeopardizing the progress he’s made along other fronts. I don’t want to read too much into one email. But the fact that Organizing for America’s call to arms doesn’t mention public health plans may, just maybe, mean the Administration is willing to deal on the issue — or may be recognizing that the votes for a public plan just aren’t there. It’s too early to tell.

But look at it the other way: if the email had included the creation of a public health plan as a core principle, it would be very hard for the Administration to later back down on the issue. By side-stepping the opportunity to make such a plan a core principle of reform, at the very least President Obama is leaving the door open on whether a public plan needs to be part of the final package.

That’s the kind of flexibility he’ll need to pass comprehensive health care reform. And it’s why I personally believe meaningful reform is indeed likely to pass this year.