Monday, May 11, 2009

The Big Picture and the Strike: On Health Care

Earlier today, one of our favorite bloggers, Ezra Klein, wrote an entry that was skeptical of today's health care meeting between various stakeholders at the White House. He thinks that industry leaders are expressing vague support for "cost containment" while being firmly opposed to any actual proposal for cost containment. The Big Picture and I discuss:

The Big Picture: Hmmm very interesting points - exactly why Ezra is my nominee for analyst of the year for 2009. I think though that Obama can do to the medical industry what Ezra fears it will do to him - hold them to account for what they're promising. He can say, IN PUBLIC, which is key: "Great, you stand for cost-saving - well here are our cost-saving proposals, they save a lot, you agree to them, right?" and if they do, obviously that's great, but if they more likely don't, than he can chide them, gently at first and then harder and harder in public, saying that this is how we're going to save money, you said you wanted to save money, WHAT'S THE PROBLEM? And really conduct a full campaign, take this case to the American people, speeches and town halls, show real people, how they'll benefit, pound home the Orszag points about rising health care costs crippling the budget. I think if Obama leaves that up to Congress though, Ezra's point will come true. They are less willing to stand up to the medical industry, they have much less power and and bully pulpit to do so, and they are just not as skilled and credible communicators and will be rolled by the spokesmen and advertising of the medical industry. Only Obama has the credibility and skill and bully pulpit necessary to turn this fascinating and critically important government-industry dynamic to the advantage of true reform.

The Strike: I agree that Obama should hold them to account on what they write in this letter. By accepting this proposal, Obama is giving himself the chance to use THEIR words, however vague and unsubstantiated they are, as justification for bold action. Barack Obama is more popular than the health care industry, that’s clear. It will be far easier for average Americans to agree with a popular President than with representatives of an industry that most likely has made their lives significantly worse. The same can not be said for policy wonk members of Congress, like Max Baucus. I don’t think the American people have much more trust for members of Congress than they do for the insurance industry. In fact, they probably see them as part of a spectrum of corrupt entities that have failed to get enact meaningful health care reform. Barack Obama is not tainted by the debates of the past, and he is not inextricably linked to any one proposal. He should pick out the best work of whatever comes out of the Senate Finance Committee, and convince the American people that such a proposal is the responsible and necessary plan for reform.

The Big Picture: But this logic will only apply if Obama really pushes hard and turns this into a true campaign in the coming months, with the aid of his two advisers we trust the most, David Axelrod on the message and David Plouffe on the campaign management. Obama has demonstrated a remarkable sense of discretion, as in he knows better than anybody else out there how to pick his battles. This has led to frustration for people on the left but on the whole it has been a very effective strategy, where Obama is achieving major accomplishments while accumulating, rather than leaking, political capital. But he will need to stake much of his political capital on the line for health care reform. He has already signaled that he will, with his declaration that he will achieve it this year, coming from a man who has never to date promised to achieve something and then not achieved it. An all-out Obama campaign for health reform will be successful in this political environment. The only thing holding it back will be any squeamishness, any shrinking from the challenge to do easier things and stay popular and not risk his dominant position. This will be the biggest test yet of what kind of President Obama will be. He has said he wants to tackle the tough issues now, that he is willing to be a one-term President if he takes on the important challenges and does not want to slide along on his charm for two terms. I have faith that he means what he says, but now is the time to prove it.

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