It's Time To Lead, Mr. President

[ Posted Wednesday, July 22nd, 2009 – 16:12 UTC ]

In a few hours from now, President Barack Obama will give a live press conference to the nation. This is part of a new and concerted media effort by the White House to make Obama much more visible in the debate on healthcare reform. But being visible is one thing, and showing leadership is another. Because President Obama has so far been unwilling to tackle the tough decisions on healthcare reform, at least not in public. And, as Obama is accusing his detractors of doing, this is nothing more than playing politics with the issue by avoiding personal political risk to himself. Disturbingly, Obama hasn't even been very good at this political cheerleading, although he has gotten better in the past few days.

Obama's legislative style (as evidenced so far, on major bills) has been to vaguely define what he's for, introduce a plan that is quite obviously open to lots and lots of negotiation, and then sit back and let Congress work it out. The White House deploys Obama's chief of staff Rahm Emanuel up to Capitol Hill, who twists a few arms and makes more than a few compromises. At the eleventh hour, Obama appears tough, and says things like "the time for talk is over." So far (see: the stimulus package) this has worked well for him. He has gotten 80 to 90 percent of what he asked for, without too much pushback from his own party. Perhaps he is (or, at least at the beginning, "was") serious about wanting bipartisanship, but in reality it matters little as long as bills get passed that he can sign.

But this may not be enough on healthcare legislation. Obama is facing much stiffer resistance from within his own party, and Congress appears in danger of bogging down over the issue and not moving forward, or sacrificing so much of the core reform that whatever passes will be next to useless.

Now, Obama can help on two fronts tonight, if he has the political willpower. In other words, if he shows the willingness to deploy leadership skills and take a few risks, to draw a bit of heat off his allies in Congress. The first of these fronts is to make some sort of "the time for talk is over" statement. He could actually reject some of the possibilities being discussed on the Hill by some Democrats. Conversely, Obama could draw a few lines in the sand by threatening a veto if he doesn't get this or that program he supports. This would make big news. The other way he could drive the media narration is to loudly reclaim the high moral ground in the debate -- and remind the news media the starkness of the problem he is trying to solve for America. In chilling detail.

In the first instance, Obama needs to realize that when you're "for everything," you are to a large degree, "for nothing." Think about it -- Obama has offered varying degrees of support for just about every idea out there on healthcare reform at one point or another. And he has only denied a "seat at the table" to one very large idea -- single-payer. This is somewhat understandable both politically (Obama shows from the very start he isn't "captive to the far left") and practically (because single-payer is somewhat of an all-or-nothing choice, it leaves very little room for compromise). This also has absolutely enraged the single-payer supporters, as well it should. Because they were publicly and pointedly denied their "seat at the table," they weren't even provided an opportunity to make their case to the public. When Senator Max Baucus had some doctors arrested at a Senate committee hearing, the message could not have been clearer: "We do not even want to hear what you have to say." This was a public-relations mistake. If single-payer advocates had been allowed to make their case, and then had it wistfully rejected by the president, it would have made that bitter pill a lot easier to swallow.

But Obama has so far been reluctant to shoot down any other idea, no matter how unworkable or obstructionist it may be. This is also a mistake, and it is what I meant when I said Obama is playing politics with the issue. Obama appears to be more concerned with his own political capital than he is with solving the problem. This may be a mistaken appearance, but it is nonetheless one that is taking hold, even from the left -- which is dangerous for Obama not just on healthcare reform, but for the entire rest of his term and the rest of his agenda. If Obama is seen as figuring that he can just sit on the sidelines and cheer for every idea out there; because -- no matter what eventually passes -- he comes out of it on the winning side, it will damage his standing with the public in the long run. Alternatively, if he throws his weight behind one idea over another, and if his side loses in the congressional wrangling, then he risks "Obama's Plan Defeated!" headlines -- something he has just not been willing to risk as of yet. If Obama pushes for one idea over others, and doesn't get it, he risks being seen as forced to compromise on the issue. Since there are a number of key issues with healthcare reform (how to tackle it in general, how to pay for it, and how to reduce costs), Obama could wind up winning a few and losing a few. But he would (it seems) rather float above the fray, so that whatever emerges he can then call his own.

This is not leadership, it should be noted. This is political opportunism.

Obama's fans will likely point out at this point that he has indeed been getting a lot more forceful on defending his vague goals and aspirations for healthcare reform. And he has actually drawn one sharp line in the sand in the last few days, with a veto threat for "anything which adds to the national debt," or demanding that any bill be "revenue-neutral." The White House is already doing a bit of fudging with Medicare reimbursements on this issue, but at least Obama's standing up for something in the debate, so he has to be given credit for that.

But on the details, Obama appears much more willing to horse-trade away just about anything so that he can get a bill on his desk that he can sign, and then chalk it up as a significant legislative victory -- even if it is so watered down that it does little to "fix" the healthcare problem. He needs to (and most likely will) show some serious frustration at the way the process seems to be heading right now, and show some backbone towards getting it back on track. In plain language, Obama needs to show a lot better than he has yet that he cares about the actual result more than he cares about an empty political victory on healthcare reform. Sooner or later, he's going to have to say "no" to somebody, because not every Democrat is going to get what they want out of the bill. That's just the way the sausage grinds in Washington. Obama could score enormous political points by saying something along the lines of: "Some Democrats in Congress have taken an awful lot of money from the healthcare industry, and they need to make a decision -- vote with the special interests which funded your past campaigns, or vote for your constituents' needs." He could even back this up (which would also do wonders for him politically) by saying loudly: "Any Democrat who loses campaign donations as a result of voting for their constituents' interests over big donors' interests, I will personally raise money for and campaign for in your next election." This shows both the carrot and the stick at the same time.

Which brings us to the second front he needs to be fighting on. Obama also needs to project a greater sense of urgency about the process itself, to counteract all the "whoa... let's not rush into anything" soft obstructionism we've been hearing of late. In Obama's recent media blitz, he has been doing a fairly good job of this, but he needs to hit it harder. This, in his defense, is an area where Democrats routinely fail to communicate well on -- and fail so prominently that there's a number of excellent books explaining exactly how Democrats fail in this regard, and how they should frame issues better.

To reduce it to its core: you need to tell a story.

People relate to stories. They relate to urgency if it is explained. They relate to politicians who "understand people like them." And if healthcare reform is not achieved this year, it is my firm belief that this will be the reason why -- because Democrats just aren't that good at indignantly taking the moral high road. Obama used to be, back when he was on the campaign trail, but that "fierce urgency of now" has been all but absent in the entire healthcare debate so far.

Where are all the stories, for instance, of the millions of Americans who have gone bankrupt due to medical problems? Where are the stories of the millions who have seen their houses foreclosed upon due to medical problems? Where are the stories of people losing their life's savings to pay for something they thought they were covered for? Where are the stories of people being denied insurance because of pre-existing conditions? Where are the stories of people who have been dropped by insurance companies because they had the effrontery to actually get sick and want care paid for? Where are all these stories in this debate? Why do we not hear at least one of these stories -- a brutal description of what some average American citizen had to go through due to sickness -- each and every time a Democrat appears on the mainstream media? All it would take would be one Republican to scoff at such a sob story, and the framing would be complete: Democrats care, Republicans don't.

Statistics are just not good enough. Sure, it's fine to say: "over sixty percent of personal bankruptcies in America are due to medical problems," but it just doesn't have the same punch as saying: "I was talking to one of my constituents the other day, and she had worked hard all her life and paid medical insurance premiums for decades, but then had to have a hip replacement and was denied by her insurance company. She lost her home to foreclosure, she lost all her retirement money, and she still had to declare bankruptcy -- through no fault of her own other than needing treatment for a medical condition she thought she was insured for, and now she can't even afford the drugs she needs to keep her alive. This has to end! This is what we are trying to fix. This is why we're trying to fix it. And any bill I see which does not directly address her specific problem I can not and will not support."

See how easy that is? This ain't rocket science. All you have to do is tell a story that is similar to the stories we hear from our parents, our friends, or even what we're personally going through ourselves. You can say "sixty-two percent of bankruptcies blah blah blah," or you can tell someone's story -- the content of the argument is exactly the same, but the emotional effect on listeners is vastly different.

And as an added benefit, nobody can argue the other side of this equation, at least without leaving themselves wide open to charges of "defending the status quo." This isn't a debate on something like global warming, where scientists can dither about whether there's even a problem until the public stops listening. This is something that just about every American family either has faced, or is terrified of facing. It's not that hard to connect with the public on the issue, in other words. And it's also easy as pie to take the moral high ground in this case -- all you need to say is: "This must end."

President Obama has been moving in this direction in the past week or so. But he's still not really there yet. He has not adequately shown enough moral indignation at the status quo. He has not projected the image that he is fighting for you in this fight. He has not shown nearly enough dudgeon in denouncing the abuses we currently accept in our system on a daily basis. Tonight's press conference may be his best (or even his last) chance to make this connection with the American public.

Because even if Obama stayed away from the details, and politically rode above the fray in a risk-free manner, he could still "buck up" (as he said last week) the Democrats on the front lines of this fight who are actively fighting for Obama's goals in the congressional committees -- and who also are, at this point, fighting with other Democrats. Obama has shown some real frustration with the deterioration of the schedule he set for Congress, because he knows that the longer this fight drags on, the less chance there is of him signing anything this year. And if it gets pushed into next year, then Congress will start all over again, meaning he will have lost any ground (and any momentum) he now has.

But Obama also has to start to crack the whip a bit. He could do this in a number of ways, both direct and indirect. He has already started running ads which tell a few healthcare horror stories in home districts of wavering Democrats. But he could also let it be known that if Congress takes five weeks off in August without passing anything, that he will personally appear in town hall meetings in each and every home district of Democrats who are blocking legislation -- and explain to that congressman's constituents exactly how many dollars their elected representative has taken from the healthcare industry, and exactly what they are now opposing. If you think this wouldn't motivate a few Democrats, then you don't know Congress very well.

What Obama may be using as his giant lever tonight, though, is an issue that Nancy Pelosi may have just teed up for him, in the absolute guarantee that it would provoke a question for Obama: cancelling (or scaling back) Congress' five-week summer vacation, until they pass a bill. I have been suggesting using this lever for a while now, and will be interested to see if Obama firmly grasps this giant prybar tonight. Pelosi herself has shown (last year, mostly) that she is adept in this maneuver, having pushed through many tough votes and bills on the last days before congressional vacation weeks, and she has now given President Obama the gift of calling for such an action herself right before Obama's nationwide press conference, so I assume Obama's going to follow through on this tonight.

I would love to see tomorrow's headlines scream: "No Vacation For Congress Until They Pass Healthcare Reform!" Or perhaps: "Obama Issues Veto Threats In Support Of..." (just about anything that finished that one up would probably be OK with me at this point). Or even: "Obama Threatens Blue Dogs," again, no matter what the subtitle read. Obama is unlike every other politician in Washington, because he owns the bully pulpit. He can grab an hour of television time, which nobody else can do. But if he refuses to say anything new, if he refuses to strongly support or strongly come out against this idea or that, then he will show he hasn't mastered the power of that bully pulpit. I'd even settle for the headline: "Obama Says 'This Must End!' To Healthcare Woes."

Because each and every one of those headlines says, in essence, the same thing: "Obama Shows Leadership On Healthcare Reform." That is what has been painfully missing in this debate so far, and what is absolutely necessary for success at this point in time. Please, Mr. President, don't disappoint tonight. Show some frustration. Show some empathy for average Americans. Show some impatience. Show some backbone. But most importantly, show some leadership.


[Note: Possibly due to articles of this nature, I was not included in the White House's recent outreach to the liberal blogosphere on the healthcare issue. Just in case anyone was wondering, the opinions expressed in my columns on healthcare reform are my own, and have not been "encouraged" in any way from the current administration, or anyone else for that matter.]


Cross-posted at The Huffington Post


10 Comments on “It's Time To Lead, Mr. President”

  1. [1] 
    nutcase wrote:

    Cross-posted on HuffPo


    Obama's quest for bipartisanship is on a par with chasing rainbows. Whatever he agrees to, the Regressives will move the goalposts. It wastes not just his time, effort and resources it exacts a steep price in each of those factors. He cannot succeed. It will weaken his image and effectiveness.

    I also wonder why progressives are not included in his vision of bipartisanship.

    He has had a few PR "successes." The AHA agreed to take a $150 billion cut. The AHIP agreed to reduce healthcare inflation by 1.5%. al-PhARMA agreed to take a $80 billion hit. This gave each of these groups a chance to be seen as signing on to his reform. He gets to appear to be getting the enemy to change sides. It was all pure BS.

    With almost universal coverage the members of AHA will receive payments for large numbers of patients that have been charity cases. Actually, the government has been largely subsidizing these costs through both direct payments and letting them write it off on their taxes. It's just a matter of them getting the money out of another pocket.

    I feel confident that the AHIP's promise is nothing more than that. Even so, the proposed reforms give them more customers. They will actually make more money, even if they were to keep their promises.

    To get PhARMA to agree, he reversed himself on eliminating the Part D ban on allowing Medicare to negotiate prices. Most of that $80 billion falls into the donut hole. They have agreed to let seniors purchase brand names at 50% while in the donut hole. They expect to take business away from the generics and still make obscene profits, even with that limited 50% discount.

    As bad as the economy is, Eli Lilly just announced a 21% increase in profits for the last quarter. Poor things. Don't you feel sorry for them?

    I want everyone to appreciate one little fact. None of the proposed public option plans that I have seen give everyone an option. If you presently have a plan through your employer, you are not eligible for the public option. Every health insurance company will likely end up with more customers than now.

    Pay attention. These plans are scheduled to begin in 2013. How many people will die or lose coverage during that 4 years? How much will costs increase during that span? It makes one wonder why they need to act before the August recess.

    It is a scam. Obama is giving away the farm. He seems to have no interest in being a leader of the progressives. Although I am on Medicare and have no dog in the main fight, I am disappointed and disheartened by what is happening both on Capitol Hill (perhaps that should be CapitAl Hill) and in the Oval Office.

  2. [2] 
    Chris Weigant wrote:

    Just wanted to reply to something nutcase said over at HuffPost:

    "I do communicate with Chris, probably more frequently than he wishes."

    This is patent nonsense. I love communicating with my readers, and read every single email sent to me. I sometimes don't reply to every one, but I certainly take the time to read them all, as I do with comments. So even though I know you were joking, nutcase, I just wanted to say to everyone: "Email is fine with me! Bring it on!"


    As for Obama's performance tonight, I would give it about a seven out of ten. Some answers were about an 8 or 9, some were about a 5 or 6, so for me it averaged out to 7. He hit some personal stories, he remained positive and upbeat throughout most of the hour, and he made a lot of good points and cut some arguments off at the knees. There were a few shaky moments, but all around I was pleased with his performance. In case anyone was wondering...


  3. [3] 
    Elizabeth Miller wrote:

    This was my favourite part of your essay...

    "Obama could score enormous political points by saying something along the lines of: "Some Democrats in Congress have taken an awful lot of money from the healthcare industry, and they need to make a decision — vote with the special interests which funded your past campaigns, or vote for your constituents' needs." He could even back this up (which would also do wonders for him politically) by saying loudly: "Any Democrat who loses campaign donations as a result of voting for their constituents' interests over big donors' interests, I will personally raise money for and campaign for in your next election." This shows both the carrot and the stick at the same time."

    I was really disappointed that President Obama didn't say something like that - that would have made headlines and had all the talking heads talking for sometime after the headlines. I think that really would have resonated. But, that's just me.

  4. [4] 
    Michale wrote:

    Interesting milestone here..

    This latest public press conference of Obama's is the exact same number that President Bush had.

    In his ENTIRE 8 years of being president. :D

    Now, would someone please explain to me exactly what the "Single Payer" plan is and why it is such a good thing??

    Thanx.. :D


  5. [5] 
    nutcase wrote:


    I have a post on my blog from a couple of weeks ago that, I hope, fully explains the differences between a public option and single payer.

    Why is single-payer such a good thing? For one it eliminates our need to rely on those who created our present mess. It saves about 30 cents on every healthcare dollar just on administrative costs. Government employees don't have to worry about showing a profit so they will have no reason to deny you just to meet a quota or look good. It's the only fiscally viable way to cover everyone.

    With a single payer it is easy to direct efforts at prevention, the single greatest potential savings of money and the largest factor in moving us up from 37th in the world in overall health and 50th in life expectancy.

  6. [6] 
    Michale wrote:

    Thanx Nutcase...

    That was very enlighting.

    A couple points.

    Maybe I missed it in your outstanding commentary, but what are the drawbacks of a single payer system. What I mean is, what are the issues of those who have a problem with the single payer system..

    I noticed that you mentioned the UK.. Do you know the case of Gary Reirbach?

    Finally, in your point about Government Management.
    I asked the question before but no one had any response. Well, CW did, but it was a misunderstanding.

    Is there any instance where the government has entered what is traditionally a private sector enterprise and actually ran it well??

    It seems that there is an issue of credibility here. And let's face it. To be perfectly honest, the government is losing credibility by the day in it's efforts towards the economy... I am reminded when President Obama swore up and down that we MUST pass the second stimulus package or else unemployment will rise above 8%..

    Well, the second stimulus was passed and unemployment STILL rose to 9.4%...

    The government in general and this administration in particular doesn't have a good track record that would allow the politically agnostic person (such as myself) to believe that they (the administration) is truly up to the task..

    As I have said on many occasions... Yes, it IS probable that the status quo is completely unacceptable... But the question here is, "is a bad plan better than the status quo"??....

    I don't think it is...

    Finally, I have to say that I am becoming VERY concerned about Obama's tendencies of late to "shoot from the hip" on issues and coming down TOTALLY and COMPLETELY on the WRONG side of said issues..

    First off, it was Obama siding with the likes of Chavez and Castro and castigating the Honduran government and it's change of said government that was completely in keeping with it's own Constitution.. Obama was, and still IS, completely and unequivocally in the wrong on that issue.

    Then we have Obama spouting off the cuff about Professor Gates and saying that Cambridge cops "acted stupidly"... We come to find out that it was Gates who was the asshole and the Sgt that arrested Gates was a model cop. Hell, that police Sgt even taught about the evils of racial profiling at the Police Academy, for Chreest's sake!

    I am saying this as a person who voted for Obama. He really needs to keep his mouth shut until he has all the facts...


  7. [7] 
    nutcase wrote:

    Okay, Michale.

    I need a few days to come up with a post on addressing the problems claimed by those opposing single-payer.

    I am not familiar with Gary Reirbach.

    Government management varies depending on several factors. I can address those in the post I am contemplating. To keep you from fretting too much in the meantime, I should say that I have a great deal of confidence in the government running healthcare. The main consideration is to keep the opponents from deliberately fouling it up. To heII with bipartisanship.

    The problems with the stimulus are basically it was too small, Obama let the Regressives and Blue Dogs stuff it with nonsense (only 40% of the package can be called stimulus) and most of the stimulus isn't scheduled to begin for another year. Why? Don't ask me.

    Without question the status quo is not acceptable. The healthcare industry, through the politicians that they own, could come up with something worse. I still fear that they will. Single-payer gets them almost completely out of the picture, thereby giving us a head start on something rational.

    I also voted for Obama, a different one than we are presently seeing.

  8. [8] 
    Michale wrote:


    Wow! Yer fast!! :D

    Gary Reirbach died a few days ago. He was a 22 year old that was admitted to a UK hospital for a bad liver brought on by excessive and heavy drinking since the age of 13. It's relevant to note that this was his FIRST hospitalization..

    The UK government bureaucracy determined that Gary wasn't worth having a new liver so they let him die..

    Now, I am a hard-nosed former cop and military officer. I have no time for the Gary Reirbachs of the world who cause their own problems. I know that sounds callous, but it is how I am. I fully understand the decision that lead to Gary's death.

    On the other hand....

    The argument that this was Gary's first hospitalization and that he MIGHT have been rehabilitated, does have merit.

    It is this kind of bureaucracy that makes life and death decisions that I fear from the Democrat's HealthCare plan. Such a plan would have a GOVERNMENT ENTITY deciding who lives and who dies.. And such decisions would be made by a, for all intents and purposes, POLITICAL PARTISAN organization.

    Democrats have shown that they are willing to be as nastily partisan as Republicans were when THEY were in charge... So, what's to stop some Dem oriented board to decide that I am not worth a new heart.. Granted, I have served my country in several conflicts and two different branches of the US Armed Forces.. But I have criticized the Obama administration and Democrats in general. So, no new heart or liver for me, eh??

    The status quo may be unacceptable... But the plan that Democrats have put forth does NOTHING to fix ANY of the myriad of problems facing health care and not only makes matters worse, but actually is going to cost the average American citizen even MORE...

    How can a TRILLION+ program be "revenue neutral"?? It's simply not possible.. It surely won't be "citizen neutral", that much is certain..

    I should say that I have a great deal of confidence in the government running healthcare.

    Then you must surely see something I don't.. A distinct possibility, to be sure. :D

    I see no examples of efficiency within the Obama Administration. Except, of course, for the efficiency of partisanship and political bigotry...

    The problems with the stimulus are basically it was too small, Obama let the Regressives and Blue Dogs stuff it with nonsense (only 40% of the package can be called stimulus) and most of the stimulus isn't scheduled to begin for another year. Why? Don't ask me.

    One reason...


    I voted for Obama The Leader...

    What I got was Obama The Politician...


  9. [9] 
    Michale wrote:

    Here is an animated version of the Democrats HealthCare plan...

    Maybe you can follow it... :D


  10. [10] 
    nutcase wrote:

    As I stated, I am not familiar with that particular case but I am familiar with inaccurate and incomplete reporting. Once upon a time, in an era far, far away, I was a foreign correspondent.

    There are fewer available transplants than needed. Steve Jobs, with all of his money, had to shop around and found a liver here in Tennessee. Not everyone can get one. That means hard decisions must be made. With no more information than we have, it is unfair to characterize the UK decision as heartless. There may have been dozens waiting for just a few livers and his health could have been so bad as to put him too low on the list. The story smells of an anecdote selected and modified for the express purpose of supporting the position of the opponents of reform here. Not everyone here gets a transplant - not by a long shot.

    Would you rather have an insurance employee without medical training deny you service because he was given a quota or because he wants to impress his boss? That is what happens now, right now.

    As I have stated many times, single-payer is the only fiscally viable alternative. With that, there are potential savings unlikely or impossible to implement otherwise. There are tremendous savings possible. I have outlined just a few in another post:

    As for Obama having become a more or less typical politician, I share your disappointment. It is true, however, that people on the outside cannot fully appreciate the pressures on the few politicians that want to serve with integrity. That is one reason I voluntarily refused to run for re-election way back in the 1970s. It is possible to resist but very difficult.

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