The Health Care Follies Continue

Megan McArdle offers good advice to health care reform opponents...

I'm seeing a lot of liberals urging their folks to call their congressmen and create pressure for a "yes" vote on the Senate bill. That's going to be an uphill slog, because of simple math.

...Of course, that calculus may change if progressives are making all the noise while conservatives are still celebrating. If they want to make sure this victory means what they think it means, they'd probably better stop popping champagne corks and start dialing their congressmen.

I suppose the GOP may want the House Dems to pass the Senate bill for tactical political reasons, but that's just stupid. Killing this bill should not be the endpoint for the GOP -- they should and must try to engage the President on a smaller set of solutions.

Tactically, I'm not sure why the Democrats would really want to pass a bill that people on their side aren't happy about, leading to more outrage and galvinazation on the right, and greater unhappiness from independants. But I'm not sure the Democrats, from the top on down, have ever really employed smart tactics in the healthcare debate. Jim Manzi makes an interesting point...

I didn’t believe on his inauguration day that Obama was either a genius or had an FDR-like opportunity, based on objective conditions, to change the public agenda. I don’t believe that he is somehow incompetent now, nor that – holding the presidency and with large Democratic majorities in both houses of congress – he is somehow not in a position to implement policy now. Just like retrospectively analyzing the causes of the outcome of an election, it is easy to talk about what alternatives he might have followed to: (1) his decision to prioritize health care and climate change versus jobs and the economy, and (2) his tactical approach to advancing his policy goals on the topics that he decided to prioritize. But even in retrospect, with the information available to him at the time, his choices seem defensible.

That Senator Kennedy would die, and that Massachusetts would then elect a Republican senator in a special election that happened to occur just as health care reform seemed to be nearing completion, is a true “black swan” event. What is striking to me, however, is that he has allowed himself to get into a position in which the loss of one senate seat threatens his prioritized domestic policy goal.

I have a pretty unromantic view of politicians. I don’t believe that I can see somebody on TV, and understand them very well. I do think, however, that specific previous very large-scale executive experience is the only correlate I could ever find with subsequent Presidential experience . This is correlation, not an empirical demonstration of causality, but strikes me as sensible.

One practical lesson that I believe operational experience teaches people is that you always need a lot more margin for error in any plan than you would rationally believe. In this light, Obama’s decision to push for a health care reform plan that could be threatened by losing one seat in the senate is what is troubling. You couldn’t predict this specific event, but it was always safe to assume that something would go wrong as the legislative process dragged on. It is my theory that his lack of executive experience is showing here, just as it did on cap-and-trade.

If you recall during the campaign, some objections were raised about Obama's lack of executive experience, and the concerns were often addressed by responses referring to how well he managed his campaign for President. And while the campaign did an excellent job (albeit working in pretty favorable conditions most of the time), I think we're seeing that simply running a large political campaign is not enough preparation for being in charge of the biggest executive position around.

There's a good argument to be made that's there no real primer out there for people who want to be President to understand the difficulty of the job (although in an interesting twist, I'm guessing Hillary's experience as the First Lady might give the best firsthand impression), but Obama had none. Not as a Governor, not as a Mayor, not as a businessman, not as a member of the Armed Forces. The lack of experience is not an insurmountable mountain to become a successful chief executive, but the lack of experience becomes a much bigger mountain when the chief executive position in question is POTUS.

Obama's lack of experience as a leader shows in a lot of his decisions, but it shows up even more in terms of the process. Manzi does a good job in outlining the health care process and how thoroughly it's been butchered -- basically, Obama allowed the process to get out of hand and stall his agenda. This tends to happen to all Presidents at some point -- they all get stalled by at least one major problem; I heard Dick Morris, of all people, making a cogent point that it's happened to virtually every POTUS in the last forty-plus years. Johnson had Vietnam, Nixon had Watergate, Carter had the Iran hostage crisis, Reagan had Iran-Contra, Bush 41 had the recession, Clinton had impeachment and Bush 43 had Iraq. But the key here is that many of these guys had other minor crisis that could have also stalled their agenda -- Reagan had the brutal '81-82 recession, Clinton had health care -- yet found ways past those points, or used them to their political advantage because they made leadership decisions that kept those other items from derailing their agenda. Sometimes, that might have involved compromising on policy (look at Clinton on welfare reform), but it had the added benefit of getting a contentious problem resolved and chalking up a tangible result. Obama didn't do enough to sell the health care reform package, and failed to recognize that large portions of the public weren't buying it. He could have cut bait and settled for a smaller package (which might have been better than what the Dems end up getting) in September, but instead doubled down. This made the stakes higher, and led to a long, slow crawl toward passage, which imperiled much of the remaining Obama agenda.

Note that another good example of the President allowing the process to capture his agenda occurred with his final decision on sending more troops to Afghanistan. While many people praised the President for taking his time on making the decision, it was effectively portrayed as dithering by the other side. I understand that this was an important decision, but I'm not sure what factors led to it taking so long, and the President's agenda of other items (including health care) made it appear that he had other items that were more important, which helped contribute to the delay.

Manzi also makes the related point about Obama leaving a lack of room to maneuver if an unforseen event (Kennedy's death and Brown's win) took place. The inability to bring any GOP Senator (and only one GOP House member) on board in the initial votes on the packages led directly to this problem -- you can argue that the GOP is playing obstruction, but a failure to get any one of them on board is striking, especially if you found a way (albeit sometimes a corrupt way) to get votes from independants and moderate Democrats like Lieberman and Nelson. But it's not like Kennedy's death/Brown's election was the only possible way for things to go kablooey. Robert Byrd's not in great health; what would have happened if ill health forced him to leave the Senate? What would happen in Lieberman defected? Or if a Democratic Senator was forced from office for a huge unforseen scandal? Yes, these aren't expected events, but these are all contingencies for which they didn't have room to maneuver -- and leaving that lack of room may be another exhibit for the argument about the lack of experience.

This is not saying that President Obama can't recover from this -- it's a great learning tool, and he's definitely getting a full course in executive leadership now. But the experience of watching him do on-the-job training in executive leadership is unsettling enough that it makes me think the electorate's preference for not electing sitting U.S. Senators during the last century or so (only two got the job) might have been a wise one.

And it doesn't mean Obama will fail to pass a health care reform bill, or even the same one the Senate passed. But passing it at a huge political cost (large portions of the public, and likely a majority, oppose the thing, you've lost high profile elections, and your legislative control is likely to disappear this fall) doesn't really seem like much of a victory.