What If... Obama Had Broken Health Care Into Pieces?

Did President Obama get the politics of health care all wrong? It's not an academic question.

Though the White House has been reluctant to offer too much guidance to Congress about what they should include in a health care bill, they've been clear from day one on strategy: 1) Don't put obstacles between Congress and the White House. 2) Lay out broad principles that everyone can agree on. 3) And try to do everything at once.

At the start of the Congressional recess, hindsight finds flaws with each of these tactics. Turns out that Congress produced too many bills too quickly, making it hard to produce one bill by the start of the recess.


Turns out that some specific guidance from the White House may have helped push things along in the Senate, in particular. And it turns out that if the White House had split the various pieces of its reform into digestible chunks, it might already have a real victory to sell to voters. I think the last criticism has the most merit. It's the one decision of the three that had foreseeable consequences, and it's the decision where those consequences weren't affected by outside factors, like the economic collapse.

As Mr. Obama points out, the House and the Senate have agreed on the backbone of major reforms to the health insurance system. The industry, having been effectively courted by the White House, conceded to these reforms. The White House's above-the-fray sales pitch kept them on board.

A bill could be passed today that includes a variety of new restrictions on insurance companies that will gainfully improve the system. Instead -- and predictably -- Congress is haggling over the hardest part of health care to do quickly, which is how to fund an expansion of coverage for those who don't have it. Blue Dog Democrats might not have revolted had the president assigned this task to a partially-binding Congressional commission at the beginning of the administration.

The "good" stuff in the health care bill is now indelibly linked to the "bad" stuff -- the inevitable rise in short-term costs and the ballooning deficit. Had the White House split up the pie, one can reasonably assume that Mr. Obama might not have had to spend August traveling across the country, using his still considerable but continuously dwindling store of political capital to shore up what should have been an easy bulkhead: the health care status quo is NOT acceptable, and reform will improve the lives of everyone. Mr. Obama is less popular than he was when this debate began. His attempt to link health reform to the economic recovery failed, and voters are anxious about endorsing a huge bill at a time when the government can't yet seem to fix the economy.

Mr. Obama's August strategy is probably the correct one, from the White House's perspective, and given the political landscape he faces. Absent a direct case from the country's most popular politician -- a political who Americans like more than they favor and whose approach to government has won him sympathy from independents and moderates -- anxiety, magnified by conservative interest groups, will predominate at the town hall meetings that are used by members of Congress as a proxy for public opinion.

The White House remains confident that Mr. Obama can rally the Democratic base and snap Americans out of their funk by aggressively selling the quality component to his plan and by demonizing the insurance industry and Republicans as the status who. Behind the scenes, his advisers will work with members of Congress to mitigate differences between the various stakeholders. And in some ways, they are tantalizingly close to a compromise: a majority on the House Energy and Commerce Committee have passed a modified "public plan" that reimburses doctors at Medicare rates plus five percent, doesn't require participation, and puts off the reimbursement mechanism for hospitals until later. From a 30,000 foot perspective, if the White House can contain the panic that members will inevitably feel (and maybe a visit from the president to select cities can help) then its August recess will have been productive. Or at least, as productive as it could have been, given the choices made earlier in the year.