President Obama made a risky wager when he decided to let Congress take the lead on crafting health care legislation, rather than presenting his own reform package. Congress is not known for taking bold, decisive leadership on tough issues. Normally, it reacts and gridlocks; it doesn’t lead.
As Congress takes its usual August recess without acting, it appears that Obama’s strategy has failed. But, has it? Is there a deeper strategy? What’s really at stake here?
Obama reportedly reasoned that Congress will do better in the long-run if it protects its institutional prerogative as law maker and doesn’t take on the appearance of being the President’s rubber stamp. This is a plausible calculation. The last time Congress was asked to respond to a President’s health care reform proposal during the Clinton years it did so by throwing the whole package in the trash can.
It is likely that there is more to Obama’s calculation than meets the eye. He knows that Congress is entangled with the health care industry’s massive lobbying and campaign finance money machine. Republicans and Democrats alike depend on special interest money to finance campaigns.
The only political force strong enough to persuade Congress to transcend the special interests is an outraged public. It’s all about the money to be sure; but even more so, it’s about what members of Congress really care about: votes.
Obama’s immediate problem is that the public is turning on him, not Congress, for failing to provide leadership. But this will be a temporary diversion of public anger if he now steps up with his own specific proposal.
He has placed himself in a position to press for substantive reform, including a measure at its core – the public insurance plan option. The best informed experts agree that a public option will drive down health care and insurance costs, and give virtually every American a chance to have affordable care. It will avoid simply throwing more money at a system that already costs way more than it should.
Throwing good money after bad will happen because the Congressional proposals add to the numbers of people who will be covered by the same insurance companies that offer coverage now. The proposals don’t offer a public option choice, and will increase the customer-base—and stock value—of insurance companies, whose track record on holding down costs isn’t very good. This helps explain why some insurance interests and their allies are now paying for ads in favor of health care reform; their version of it will produce a pretty good return on their political investments.
The proposals don’t hold down health care costs either. A public option will allow competitive and impartial introduction of the tools required to drive these costs down. The public option is the pathway to reversing the perverse incentives of the status quo which push costs of care and its coverage ever upward.
These incentives are driven by deep structural flaws in the current system, including an emphasis on specialty, rather than primary care, the lack of information technology needed to improve quality and ensure science-based decisions about care, and a fee for service system that creates incentives to drive costs upward. The public option plan provides the platform to launch these essential reforms, and to promote public choice among insurance carriers.
If Obama doesn’t aggressively pursue the public option, he will fall short of the character of leadership needed to ensure quality health care for the American people; and the promise of his presidency. His credibility with his supporters will be severely damaged; and his enemies will rejoice.
If he loses the battle of the public plan after fighting hard, at least he will be around to continue the war against “politics as usual.” Leaders and followers alike learn from battles they lose as well as those they win. Conviction and persistence, traits Obama surely possesses, are what matter most. Unless he presents a specific proposal with a public option and fights hard for it, Obama will be seen correctly as a politician, not a statesman.
The question is whether the public will do its part and whether Obama will do his. The public’s outrage is growing by the day as more and more Americans suffer from the increasing costs of health care and loss of coverage. If public reaction is not channeled in a positive direction, everybody in political power loses.
Those who think health care reform is a show down between the President and Congress or Republicans and Democrats miss the point. It’s a show down between government and the citizenry. Powerful special interests are squarely in the middle, trying to control the outcome as they equate the common good with their own.
It’s fair to conclude that the credibility of the entire American political system is on the line. While the battle is about health care, the war is about preserving, protecting and defending the viability of American democracy. The health care battle will demonstrate to the world the character of the American body politic, and the strength of its new president.
Perhaps most important of all, a hard-fought battle against the special interests will demonstrate whether democracy still works in the nation that first introduced it to the modern world.
Larry Arrington is a Florida-based planning and management consultant. With Herb Marlowe, he is co-author of Sustainable Governance: Renewing the Search (Llumina Press). The book is due out in fall, 2009. Watch for it at http://www.arringtonmarlowe.com/; and at http://www.llumina.com/.