The Speech: Could this have been what he planned all along?

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White House Photo

A conventional look at The Speech:
Obama over-learned the lessons of Hillary-care; he gave Congress too long a leash; he lost control of the message; the wacko’s attacked with a barrage of Socialist/Nazi/Plug-Pulling-on-Grandma-isms; not only was health reform on the ropes but the entire Obama Presidency was in danger of imploding (taking the Dems down with him in the mid-terms); Obama had his back against the wall, a make-or-break moment. Then last night, the President gave a great speech that staked out a thoughtful middle ground; Joe Wilson went rogue, horrifying nearly everyone; this led to real sympathy for Obama and the Dems and a shift in the political landscape. In the end, a mild version of health reform – with nearly-universal coverage, some regulatory protections against the most heinous insurance practices, fee hikes to pay for it all, and a little movement toward improving quality and efficiency – passes.

Another look at The Speech: 

Obama, a student of history, realizes that health reform is a near-impossible sell since every special interest will come out swinging; he gives Congress the ball knowing that whatever plan emerges from their sausage factory will simply be red meat for demagoguing Republicans and special interests worried about preserving their Gravy Train; Congress obliges by developing plans that overpromise and under-resource, or that push predictable hot buttons (immigrant coverage, palliative care); the Right and its attack dogs go berserk throughout the Wacko Days of August; the left hunkers down, drawing a line in the sand on the Public Option, kyboshing malpractice reform, and avoiding the hard questions about financing. 

Then last night, Obama gives a superb speech that positions him as the only grown-up in the room, one offering a reasonable, pragmatic, middle-of-the-road solution to some real problems; the Republicans look like sunburned sourpusses (John Boehner), texting teenagers (Eric Cantor), or immature louts (Joe Wilson). The President’s approval ratings skyrocket; he uses this political capital to whip his party in line, finds a couple of centrist Republicans who can read tea leaves, and health reform passes.

Scenario 1, the reactive one, is what you’d go with if you thought the President was a normal politician. Scenario 2 is the one you’d favor if you thought Obama (and Axelrod and Emanuel) were superb chess players, thinking 10 moves ahead. And (to mix sports metaphors), if you believed that they were expert in the art of political jujitsu.

Of course, Obama couldn’t have prepared for his two biggest breaks: Ted Kennedy’s death (sorry if that seems insensitive, but there’s no question that the tragedy enhanced the prospects for reform) and Joe Wilson’s folly. But chance favors the prepared mind, right?

So those are the two scenarios that could explain the painful road to health reform. Which one do you think is right? 

(If you need a hint as to my guess and you’re over 18, click here to see a poster, created during other [similarly] perilous moments during the campaign).

Robert Wachter is widely regarded as a leading figure in the modern patient safety movement. Together with Dr. Lee Goldman, he coined the term "hospitalist" in an influential 1996 essay in The New England Journal of Medicine. His most recent book, Understanding Patient Safety, (McGraw-Hill, 2008) examines the factors that have contributed to what is often described as "an epidemic" facing American hospitals. His posts appear semi-regularly on THCB and on his own blog "Wachter's World," where this post first appeared.