Healthcare reform is expected to pass later today. After years—nay, decades—of failed attempts by various presidents to restructure our hodgepodge, post-war, employer-based insurance system, President Barack Obama and a Democratic Congress have finally broken through. The legislation is imperfect and will hardly solve all of America’s problems, but it’s a start.
Putting the policy and its implications aside, what political lessons can we takeaway from the past year? Plenty, some of them rather disconcerting.
1. Non-incremental policy change is never easy. Presidents since Harry Truman have been trying to solve our healthcare problems. Following Scott Brown's tectonic election in Massachusetts, President Barack Obama was correct when he reminded the nation how politically risky and damaging it was for him to tackle healthcare reform in the first place. But whatever credit he deserves for taking that risk must be leavened by the fact that the White House at times did not seem ready to prosecute a message and campaign commensurate with such a major policy reform--as both David Axelrod in a fantastic recent New Yorker piece by George Packer and the president himself conceded in his State of the Union speech this year. Non-incremental change, especially on this contentious and complex issue, required a full-on assault by the Administration using every weapon in its arsenal.
2. The presidential pulpit doesn't bully by itself. The Washington Post recently ran a Sunday "Outlook" cover piece about how Obama's cool, dispassionate, intellectual, bridge-building style would be more amenable to service on the Supreme Court than in the White House. I like to think Obama's style is suitably presidential too, but until recently it seemed like the president was unable to get tough--that his conciliatory tone was not helping him or his fellow Democrats that much. If you presume there are votes to be gained across the aisle (or even within your own party) but reaching out a hand, fine. But given that the GOP was clearly signaling its obstinance no matter what--see Senator Jim "Alamo" DeMint; see also #7, below--Obama may as well have thundered away from the start. Say what you want about George W. Bush, but he always "asked for your vote" in campaigns and managed to move the public and the Congress on far less popular and necessary agenda items via stubborn insistence on his position. Obama's belief that his election was somehow a tonic for the type of politics played in Washington was, in the end, a fantasy. He should have asked Americans to rally on behalf of reform--and bullied those in his way.
3. Misinformation is more easily disseminated than debunked. Washington is overtaking 20 percent of the economy! Grandma's survival will be decided by "death panels"! This will end Medicare as we know it! To misinform is to recognize and exploit the asymmetries of political warfare, and reform opponents understood this well. The Administration was not always good at explaining what was in the legislation (see #1, above), especially since there never was a White House bill in the first place (see #4, below). But having to explain what the legislation does not contain only made explaining what it does contain tougher. Misinformation works.
4. Have an Administration bill. Given the respective outcomes for Clintoncare and Obamacare, I'm least certain of this lesson, but it still seems to me that letting the Congress lead the process made it more confusing and delayed the outcome. At one point last summer, it seemed like Max Baucus was running the entire show, rather than the White House. And it was hard for proponents to defend reform because it was impossible to say what exactly the Administration supported. Multiple versions of legislation also invited legitimate complaints from opponents that it was difficult to respond to "healthcare reform" as proposed because it was in fact a moving target of bills and amendments in both chambers. I understand the need to defer and respect Congress. But this is politics in the modern, presidential-centered era, not the 19th century.
5. Proxying process for policy works. You know that old legal maxim about arguing the facts when the law is against you, and arguing the law when the facts are against you? The political equivalent is to focus on process when a policy's popularity works against you. Rather than engage in point-by-point debate about healthcare costs or access, Republicans and conservatives very smartly pointed to congressional deal-making (Cornhusker Kickback!), transparency (televised hearings in Congress), bipartisan inclusion (We want a summit!), and, most galling yet effective, bemoaned that a policy reform which was six decades in the making, discussed for two years during the last presidential campaign, and debated for the past year or so has somehow been "rammed through." I don't remember these arguments, or debt-minded Tea Party "patriots" making these arguments during the debates over Bush tax cuts or Medicare Prescription Part D legislation. But give credit where credit is due: Focusing on process was very, very smart politics by the GOP because it's always easier to sway busy, rationally ignorant voters seeking informational shortcuts for understanding a complex policy proposal by redirecting their attention to an easily-understood deal cut by a Louisiana senator as proof that the policy proposal itself is rotten.
6. It pays to hold out. Ben Nelson, Olympia Snowe, Joe Lieberman, Mary Landrieu, Bart Stupak, Dennis Kucinich, Eric Massa--need I say more? OK, we can scratch Massa, but you get the point: In this town, the squeaky wheels get the political lube jobs.
7. Bipartisanship is a waste of time—except as a tactical feint. After the Scott Brown rebuke, Obama basically said, "Fine, I'll meet publicly with my Republican opponents." He proceeded to spank them pretty solidly. But in the end, as it was from the beginning, he wasn't going to get any support from them. And frankly, as I have long maintained, it didn't make sense for the GOP to sign on to the Administration's efforts anyway, because they would get no credit and stand to benefit considerably from playing the blame game if the public hates reform. However, the recent lip service the Administration paid to bipartisan cooperation, from the meeting in Baltimore to the health care summit, did help because it provided a patina of procedural fairness and gave the media a counter-story that focused on befuddled GOP elites instead of Tea Partiers. But there were never any votes to be mined from reaching out the hand of bipartisanship, and hopefully the Administration will remember that next time.