SEPTEMBER 1, 2009
Obama Hurt by Hands-Off Strategy
By GERALD F. SEIB
WSJ
Among the many problems President Barack Obama confronts on the health-care front, one is fairly simple. He is defending a plan that doesn't really exist. It may be time for the White House to change that. As the president and his administration figure out how to hit the reset button on health at the close of a bruising August, one option is to, at last, lay out exactly what Mr. Obama now wants in an overhaul package, and start selling and defending that.
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As a matter of political and legislative strategy, the White House has never actually presented an "Obama health-care bill." As in the earlier quest for an economic-stimulus package, it chose instead to enunciate some general principles and let Congress craft the actual legislation. Four committees have done so, and a fifth is trying. The reasoning was fairly simple: As soon as there is a presidential bill, it becomes the target of all attacks. There also is a historical reason to avoid presenting a specific bill. President Bill Clinton offered an (overly) detailed health plan in 1993, and his critics picked it apart, chart by chart and page by page. That wasn't a path the Obama White House was going to travel. But in recent weeks the downsides of that strategy have become clear. The absence of an actual Obama health plan hasn't stopped Republicans from attacking as if there was one anyway and convincing many Americans they are opposed to it.
And, because he hasn't said precisely what he will and won't accept, Mr. Obama has been in the awkward position of having to defend virtually every idea congressional committees have thrown out -- some of which, one suspects, the president actually doesn't think are all that worthy of defense. He has been out there defending surtaxes on wealthier Americans he never asked for, deeper Medicare spending reductions than he has sought and a government-run insurance option he may or may not be wedded to. That is a tall order. It is likely the administration's original strategy was to stay out of the nitty-gritty until both the House and Senate had passed something, and then move in when those bills hit a conference committee. That hasn't happened, of course, and there is now a need to restart the conversation rather than simply continue the argument.
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There is less and less evidence that any Republicans are prepared to sign on, but the president still might be well served by calling in House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid, laying out for them what the White House wants to support at this point, and using that to rally Democrats. As it happens, two wise observers have just stepped up to offer useful advice on how to do so. Sen. Dole on Monday penned a piece in the Washington Post advising the president to stop acting as "cheerleader in chief" for various Democratic ideas and get "out front with his specific plan." Meanwhile, former Democratic Sen. Bill Bradley, in a New York Times piece on Sunday, harkened back to his own success in helping craft a bipartisan tax-reform plan in the 1980s to urge the president to include in his plan something Republicans can rally around. He suggested a limit on medical malpractice, a perennial Republican goal.
All of that raises the broader question: What kind of new bill might the president, at this point, offer to draw broad support. Mark McClellan, a health adviser to former President George W. Bush, now is part of a bipartisan group trying to address that question. He thinks the answer is some combination of health-insurance reforms that would, among other things, prevent exclusion of people with pre-existing medical problems and create regional insurance "exchanges" to expand insurance options for both consumers and businesses. Those would be linked to a requirement that all Americans carry some type of health insurance, so that healthier and less-healthy Americans share the costs of broader coverage. That, in turn, would require government subsidies to help the poor and working-class afford coverage. Businesses would get tax credits for offering insurance, and pay fees into the national pool if they didn't. More expensive health plans would be taxed to help pay the broader bill.
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http://online.wsj.com/article/SB125174752477973547.html (subscription)
Printed in The Wall Street Journal, page A2
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