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Hindsight Advice For Obama

The conventional wisdom is quickly settling on the view that President Obama miscalculated by pursuing health care reform. "I think choosing to take a Captain Ahab-like approach to health care — I’m going to push for this even in the worst downturn since the Great Depression — is roughly comparable to Bush’s decision to go to war," says Congressional handicapper Charlie Cook. Likewise, my friend Dana Milbank argues:

Obama's greatest mistake was failing to listen to [Rahm] Emanuel on health care. Early on, Emanuel argued for a smaller bill with popular items, such as expanding health coverage for children and young adults, that could win some Republican support. He opposed the public option as a needless distraction.
The president disregarded that strategy and sided with Capitol Hill liberals who hoped to ram a larger, less popular bill through Congress with Democratic votes only. The result was, as the world now knows, disastrous.

Keep in mind that to argue that Obama should not have attempted health care reform at all is different than arguing that Democrats should abandon it now, having already paid nearly all the cost. The latter is like arguing that a homeowner who's hired a contractor to remodel his kitchen, paid out 90% of the sum, and had his old kitchen taken out but the new one not yet installed, should fire the contractor mid-job and just eat the cost and go on without a working kitchen. The former is more like saying that if they had to do it all over again they would have kept the old kitchen. The latter view is simple insane. The former view has at least some plausible logic.

Still, I find it unpersuasive. For one thing, Cook and Milbank simply assume that health care reform is dead. I don't. Democrats may be freaked out and at daggers drawn, but they still have the votes and the incentive to pass a comprehensive bill. I've been holding the odds of passage at just over 50-50 for about a month now and I'm not budging yet. The near-universal assumption in the media that reform is dead is based much more on optics and the general tendency of pundits to project that the most recent trends will continue unabated than any deeper consideration of the fundamentals.

Second, you have to compare pursuing health care with an alternate strategy. What else could Obama have done? Cook says they should have focused more on jobs. But he offers no suggestion of what meaningful legislation could have passed after the stimulus, which exhausted Congress's willingness to spend any money on job creation. The current fiasco of a jobs bill, with the two parties bickering over symbolic legislation, suggests how little substantive progress was there for the taking.

Milbank, meanwhile, suggests a health care bill expanding coverage for kids and young adults. That's something. But it's a mistake to consider that a half-measure on the road to eventual comprehensive reform. The problems of the health insurance system -- spiraling costs and a dysfunctional individual market -- are enormous and interconnected. Children's health insurance is related to that issue in that it pertains to health care, but it represents zero progress toward alleviating the pathologies of the system. It's like saying that, instead of trying to kick the heroin habit that's destroying your life, you'll instead switch from brand-name Tylenol to the generic stuff. They're both a kind of fix to a "drug problem," but that's the extent of the connection.

Third, you have to consider the political cost of inaction. Obama won his election by a wide margin running on a plan to reform the health care system. Simply abandoning that promise at the outset surely would have cost him some support from his allies, both in Congress and among the voters.

Ultimately, I don't think you can answer the question of whether it made sense to undertake health care reform until we know whether or not it passes. If it does pass, it was a good idea. (Obama didn't have any other major realistic uses for his political capital, which was bound to diminish in the face of rising unemployment.) If it fails, it was a bad idea. Still, what strikes me most about the retrospective advice being proffered to Obama is its sheer amorality. Politicians do need to look after their popular standing, but that's not all they need to do. The broken health care system represents a massive economic and moral crisis. It's hard to imagine a Democratic president winning a clear-cut election victory and bringing in the largest Congressional majorities since Lyndon Johnson and not trying to fix the problem. The purpose of winning elections is to solve problems like health care. There's something strange about advice that presumes it's appropriate to value the preservation of popularity above all else.