Obama health care: What went wrong?

Howard Fineman • E-mail

WASHINGTON - When the history of President Barack Obama’s first year in office is written, scholars will try to answer this puzzling question:

How did a gifted, charismatic young Democrat — who won the White House by a large margin and brought in huge congressional majorities — manage NOT to enact fundamental health care reform, a goal his party has been seeking since Truman?

I still think Obama is going to get a bill, just not one very worthy of the name. Why?

Well, Republicans and their conservative and corporate allies are a big part of the explanation. Health care is one-seventh of the economy. You can’t expect to rewire it easily. There are going to be losers, and they are not going to go quietly.

Also, there are no moderates left in the GOP. Only conservatives who want to deny Obama success or legitimacy. They’ll oppose anything he proposes and call it principle.

Together, Big Money and Big Mouths will say anything to scare folks: death panels, government abortion, socialism — you name it.

That said, Obama and his team share the blame for the slow but steady shriveling of his claim to be the agent of “change you can believe in” on health care.

It’s time to ask what they did wrong. Here’s my list:

Murky campaign promises
Obama’s candidacy was fueled at first by opposition to the war in Iraq, then by his own life story, then by the economy. Yes, health care proposals were always there, but they were less of a central rationale than a policy box to be checked.

His proposals were written in part to draw useful political contrasts, first with Sen. Hillary Clinton and then with Sen. John McCain. As a result, it is hard for Obama to claim a mandate for a single, coherent detailed plan. The president is for “reform,” which says… nothing.

Orszag’s fantasy
Every president wants to reconcile frugality and generosity, and there is always an ambitious and clever aide willing to tell him it can be done. In Obama’s White House it is Budget Director Peter Orszag, who confidently told Obama that carefully administered universal health coverage would save the government money in the long run.

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Perhaps in some decade hence that is possible, but for the foreseeable future the truth is just the opposite, at least according to Douglas Elmendorf, the independent head of the Congressional Budget Office — and a fellow just as credentialed and brilliant as Orszag.

Bipartisan naivete
Obama doesn’t like to make enemies, and he loved the idea — fueled by the likes of Orszag — that he could fight the reform battle on conservative turf: that we need to completely change the system because otherwise we will go bankrupt as a country.

But that was a tactical mistake on two fronts. First, Elmendorf undercut it with three devastating CBO reports.

And even if the proposals did save the government money, Republicans in Congress weren’t going to care!

For two generations, they were on the receiving end of Democratic fear-mongering how the GOP wanted to “throw grandma in the snow.” Now they are relishing the chance to accuse Obama of the same thing. They never had any intention of cooperating on a deal, and Obama should have known that from the start.

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