Three Things to Remember About The Prez’s Role in Healthcare

Ezra Klein writes:

What’s been striking, however, is the implicit argument that this is somehow a simple failure of liberal will. Rachel Maddow called it “a collapse of political ambition.”…The unifying idea here is that someone can just go into a back room and torture Max Baucus and Kent Conrad. But how? Rahm Emanuel isn’t a shrinking violet. Neither was Clinton or Carter or Nixon or Truman or FDR. But none of them managed to get health-care reform past the Congress. There’s not really a record of presidents being able to bend committee chairmen and wavering centrists to their will. Even LBJ, the master of this stuff, decided to go for Medicare rather than full reform. He thought the latter too ambitious. The history of health-care reform is the history of health-care reform failing. If there was some workable presidential strategy, or foolproof negotiating lever, presumably someone would have used it by now, or at least mentioned it in public.

This is exactly right.

I think there’s at least three major mistakes being made relative to Obama and the push for healthcare.

1. There’s this little thing called the constitution.  Since we live in the postWWII era where the Executive, under both Republican and Democratic administrations, has massively increased its power through extra (or un depending on pov) constitutional means, mostly through the creation of agencies (e.g. EPA, NSA, etc.) people think the President is basically all-powerful.  In foreign affairs this has indeed become the case with repeated flagrant violations (again both parties) of the War Powers Act as well as the Congressional mandate to declare war.

In domestic affairs however this is not the case.  And since Congress has been on holiday for at least a decade and half, major domestic reform rarely comes up.  When it does it generally fails:  Bill Clinton with his healthcare initiative, George W. Bush with aborted immigration and Social Security Reform. The Constitution was written for the Legislative branch to be the dominant branch.  You may think that a design flaw, but that’s how it is.  A strong executive the US Constitution does not (on paper anyway) make.

[Sidenote: I think the primary way to fix this is not to give domestic power over to the Executive but to massively expand the membership of The US Congress.  But that’s another day and another fight.]

For our purposes here all that matters is that the President doesn’t really do all that much until there is legislation on his desk that he either signs into law or vetoes.  Other than that he can do some backroom wheeling and dealing, go on TV and try to get people behind him.  But at the end of the day he is not constitutionally mandated nor democratically elected to be handling this thing.  That’s why we have Senators and Representatives.  If you’re someone whose pissed about how this is going call and yell at them.

2. People are also forgetting (or don’t know I guess) what they should remember which is that Obama has clearly laid out what his plan is.  Again, given what small role he does have, he has a plan for how to maximize it.  Another excellent Ezra post on the subject.  The Team Obama plan is to push hard in conference committee for the kind of plan it wants.  It said so specifically:

Conference is where these differences will get ironed out. And that’s where my bottom lines will remain: Does this bill cover all Americans? Does it drive down costs both in the public sector and the private sector over the long term? Does it improve quality? Does it emphasize prevention and wellness? Does it have a serious package of insurance reforms so people aren’t losing health care over a preexisting condition? Does it have a serious public option in place? Those are the kind of benchmarks I’ll be using. But I’m not assuming either the House and Senate bills will match up perfectly with where I want to end up.

So while I agree with Br. Jamelle that attempting to do this through reconciliation would be perilous indeed, I don’t think it will come to that measure.  Or at least that is not the plan from the administration.  But even there, as Ezra’s post helpfully points out, if the Senate passes a bill without a public option (while the House has), the only way for it to get back in via conference would be if Harry Reid stacked the conference committee membership with more liberal (pro-public option) members.  The Republicans would whine and cry foul and play the victim card all over TV and Harry will probably fold for all I know.

But stranger things have happened. 

Normally news that the other side is going to stand against whatever bill you put up there–even one with co-op and not public option–would embolden one’s team to finally go at it knowing there’s no need to try to placate the other side.  Particularly given that the opponent’s base is so adamantly opposed to any legislation, plus the fact that it’s good politics from the Republican point of view to try to kill this thing.

Of course normally does not usually apply to the Democrats.  We’re always on the precipice of the Democrats standing down the Republicans and sending the GOP into permanent exile.  But the Dems always freeze at the last moment.  They never take the plunge.  You’ll often hear that the Republicans are insane and fight every fight like it’s the last stand at the OK carrol.  But actually given the demographics moving away from them, the shift of the country leftward, every fight sort of is their last stand.  Republicans are really inches away from serious long term minority status and near total obscurity.

If the Dems achieve a major domestic achievement like health care reform, if they realize that they can get that monkey-bully of the GOP off their back, then the ball could really start rolling.

But like I said, normal doesn’t apply to the Democrats, so I wouldn’t be placing my bets just yet.

3. Last one.  Obama is yet again simply doing his community organizing thing.  He is letting the other side (the anti-health care reform crowd) have their time and look to a degree powerful so that it becomes clear to those in favor (on Obama’s left) that they need to do something.  When the “regular” Americans stand up for him, then it neutralizes these radical socialist charges.  If the liberal constituency comes in big force, then in theory that puts pressure where it actually matters–not on Obama–but on Harry Reid and Nancy Pelosi to get public option in via conference.

It then also puts pressure (as Ezra points out), one assumes, on the Kent Conrads and Ben Nelsons of the world to vote to end the inevitably coming Republican filibuster on the final bill.  Again that’s pressure where it really matters.  The Centrist Dems could still vote No on a bill with a public option in it but would they want to be party to preventing such a (hypothetically speaking) out of conference bill with public option from ever coming to the floor for a vote?  Though Yglesias points out we just don’t know what they want.  They are the unknown quantity.  How they go pretty much determines how this will unfold.

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Postlude:  As a total out there what if—What if Obama had selected Evan Bayh as his Veep?  Would Bayh have had pull with the Centrist Dems to get Obama over the hump?

Update I:

Relative to point #2, all this yammering (mostly from the left) about how the Obama Team can’ t get its story straight on public option (see John Stewart, Rachel Maddow, and/or Jason Linkins) strikes me as really dumb.  If we assume point #2 (Obama’s conference plan), then why wouldn’t the President both continue to say that he wants a public option and yet is open to other ideas that meet his larger frame goals?   The latter opening is would then work to allow passage through the Senate so he can try to work public option back in via conference, right?  I’m mean it’s not exactly Machiavellian in its devious brilliance, but it’s not totally dumb either.  It makes a certain amount of sense at this point to give up on trying to get the public option in the Senate bill.   I mean Obama can easily say both things he’s said and it not be inconsistent or off message or whatever.  Why is this so hard to grasp?  Speaking to different interest groups is not the same as speaking out of both sides of your mouth.