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

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.

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17 replies »

  1. Door No. 2…please!
    The Republicans new love of bi-partisanship after the last 8 years is…interesting. Almost as interesting as their convenient forgetfulness of the MESSES we are simultaneously having to clean up.

  2. I think he started out based on lessons learned from the Clintons and threw the ball to Congress. Unfortunately, the whole thing backfired pretty badly. I don’t believe any politician would knowingly create a bad situation, planning on one golden speech down the line to save the day. This course of action would not qualify as brilliant chess playing, it would qualify as reckless gambling.

  3. Margalit:
    “Option 2 may have come into play originally as Plan B, in case Congress blew it, or may have been proposed during the August craziness in lieu of immediate response to the “death panels\communist take over” crowd.”
    Agreed.
    Gary O.:
    “While it is dangerous to draw conclusions too soon about the precise role President Obama is playing, the authors make some cogent observations from the Medicare legislative process that may apply: the President must have a deep personal commitment, create political momentum that will enable Congress to act speedily, put together an experienced legislative team, delegate details and giveaway credit, and throw caution to the wind (as every other President has for major programs) when your economic advisors tell you can’t afford it. I think President Obama has read the play book.”
    That sounds about right, except for part about throwing caution to the wind on affordability. I take the promise about not increasing the deficit seriously.

  4. We are seeing predictable politics as usual–perhaps with a wind-aided gust from SC. The “public option” never was (especially in the Senate), and only with very skillful camouflage, will be. This whole thing is going to drag out for so long, most of us will forget when and if “reform” actually happened. The President is smart enough to know that the trick is to amend the rules and change the game, even if slightly in the beginning. Once the rules are changed, momentum, and change will build, and reform will be real, if gradual. Anyone expecting the big bang will be sorely disappointed.

  5. Time to re-read Blumenthal and Morone, The Lessons of Success—Revisiting the Medicare Story, N Eng J Med, November 27, 2008, 359:22, pp. 2384-89. In 1964 Medicare passed the Senate but not the House. The conventional story of its becoming law in 1965 (until the recent release of tapes and other archived materials) emphasized Congressional wrangling with minimal Presidential involvement, the latter being LBJ’s advocacy of health care for the elderly in the 1964 campaign and sweeping a big Democratic majority into Congress on his coattails. Even Johnson’s autobiography downplayed his role. History now shows that he deftly managed this historic legislation. While it is dangerous to draw conclusions too soon about the precise role President Obama is playing, the authors make some cogent observations from the Medicare legislative process that may apply: the President must have a deep personal commitment, create political momentum that will enable Congress to act speedily, put together an experienced legislative team, delegate details and giveaway credit, and throw caution to the wind (as every other President has for major programs) when your economic advisors tell you can’t afford it. I think President Obama has read the play book.

  6. Dennis,
    How poorly informed are you? Obama claimed his door was open yet Republicans sent a letter requesting a meeting and he has refused to see them. That was a couple months ago. Do you ever get tired of walking back your comments?
    The facts since you can’t seem to find them without me handing them to you, this is from June, 3 months ago;
    “Last month, Republican leaders in the House asked Obama for a meeting on the issue before Congress embarks on its summer adventure, but in his reply sent on Friday night, Obama makes no mention of their request, according to a copy obtained by POLITICO.”
    “This past week, Obama met with Democrats on two key Senate committees, but not their Republican counterparts. And though his staff is meeting with moderate Republicans in the House, he has not yet met with party leaders to discuss health care reform.”
    “In his letter, Obama thanks the GOP leaders “for letting [him] know that you share my view that we should enact legislation this year that reforms and improves our nation’s health care system.”
    Republicans sent the president a letter laying out some broad priorities for health reform before a scheduled White House meeting in May with congressional leaders from both parties.
    “I especially appreciate your commitment to assuring affordable, quality health care for all Americans,” Obama says in his response. The president goes on to say that Congress has “an extraordinary opportunity to move forward in the months ahead” and reiterates his belief that the House will pass a bill by Aug. 1.
    “I am encouraged by your willingness to work with me in that effort,” Obama wrote. “

  7. If it is such a great thing, then pass it and see if it really is a good thing or not. You don’t need the Republicans, unless some blue dog dems need to vote “no” to get re-elected. The Republicans have been in the minority before. But they will serve their time in the wilderness while the dems implode the country. Someone with a lick of sense will emerge to fix it. We will have hyprinflation to pay the debt followed by a depression. Then it will begin again.

  8. Option 1, with maybe a little bit of 2.
    I think he started out based on lessons learned from the Clintons and threw the ball to Congress. Unfortunately, the whole thing backfired pretty badly. I don’t believe any politician would knowingly create a bad situation, planning on one golden speech down the line to save the day. This course of action would not qualify as brilliant chess playing, it would qualify as reckless gambling.
    Option 2 may have come into play originally as Plan B, in case Congress blew it, or may have been proposed during the August craziness in lieu of immediate response to the “death panels\communist take over” crowd.

  9. RE: Dennis– How can you say the party of No? Republicans have put up a plan with far more signers than the one being espoused in the media? I give you that the current administration has chess players, but i’m taking a different approach: Obama is the one who behind the scenes pulls the strings to create the chaos, then comes in to ‘save the day’.
    I trust that neither party alone has the right mix to work on this issue, instead, it should be a mix of both. But how can bipartisan work take place if only one party is invited to talk???

  10. Obama and his liberal team have locked the republicans out of every bill discussed yet he tries to make it sound like they were unwilling to participate. He hasn’t spoken to a republican about health care since April. Don’t belive what he says, look to what he does. Just another one of his meaningless speeches. Pretty soon he’ll have his own prime time show.
    He’s on video telling the AFl-CIO that his plan was a single payer system back in 2007.

  11. Obama gave the Republicans a chance to join in and they refused. Had they been participants rather than the party of “no,” they might have gotten a more moderate bill (and Obama raised some ire on the left as a result). But instead, Obama decided it was time to take control, be the only adult in the room (although most Democrats had quietly all along been adults), and pull his party together. When the final bill is passed, the some Republicans may have learned the lesson and decide it no longer helps being the party of “no.”

  12. Was Obama an “or immature louts” when he and other Democrats stood and heckled Bush in the State of the Union? Or is this one of those rules that only applies to Republicans when you’re in full on demigodry mode?
    Option 3, we can call it reality, is it was just another speech of hot air and we all know speeches don’t accomplish anything bills do, something he has still not produced despite 8 months of talking about his bill. If he really had any concern at all for the country he would have stood and demanded a bill comprised solely of what we all agree on. By removing such an import issue from the realm of politics he would have transcended politics and secured his place on Mt. Rushmore. A simple bill consisting of;
    1. Tort reform, over 80% of the public wants it.
    2. eliminate all this fraud and abuse in Medicare and Medicaid they claim they can. Why can this only be accomplished when they need the money to spend elsewhere, shouldn’t this have been done on standalone bill since it is so important. What sort of President refuses to stop 70 Billion a year in theft unless we let him spend it elsewhere?
    3. Remove the cost to our systems imposed by illegal aliens, again hugely popular with the public.
    This bill should save 100 billion + per year, not involve any additional taxes or fees from the struggling tax payers and it has huge public support. Pass this bill, show government can actually improve things for once then come back in 2-3 years and address the other supposed problems. For some reason the 3 things the public actually really wants them to do are all excluded from the bills being considered, why is that?

  13. Definitely the second.
    It took the left a while to realize this, but the plan all along had to be to show that Republicans wouldn’t play nice, then pass a partisan bill over the flaming wreckage of the Republican party. That’s why I was criticizing the numerous posts on this blog asking “What are Republicans going to do?” or “Can Republicans save reform?” They’re irrelevant, you fell for Obama’s smoke screen. We’ll have health reform this year.

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