It has been 16 years since another young, ambitious Democratic president with a Democratic Congress tried to change the way this country deals with health care. That didn't end well for Bill Clinton. In the New York Times Magazine, Matt Bai took a look at the Obama administration's relationship with Congress and how it reflects lessons learned from Clinton:
The first senator elected directly to the Oval Office since 1960, Obama has an entirely different theory of how to exercise presidential power, and he has consciously designed his administration to avoid Clinton’s fate. After winning the office with the same kind of outsider appeal as his predecessors, he has quietly but methodically assembled the most Congress-centric administration in modern history. Obama’s White House is run by Rahm Emanuel, a former House leader who was generally considered to be on a fast track to the speakership before he resigned to become chief of staff, and it is teeming with aides plucked from the senior ranks of both chambers. Obama seems to think that the dysfunction in Washington isn’t only about the heightened enmity between the parties; it’s also about the longstanding mistrust between the two branches of government that stare each other down from twin peaks on either end of Pennsylvania Avenue.
And so, from Obama’s perspective, passing a health care plan this fall isn’t primarily a question of whether to include an “individual mandate” requiring every American to have insurance or how fully to regulate providers or even how to hit back against “Harry and Louise”–type attack ads, although his aides spend time contemplating all of those things. It’s more about navigating the dueling personalities and complex agendas within his own party’s Congress. Rather than laying out an intricate plan and then trying to sell it on the Hill, as Clinton did, Obama’s strategy seems to be exactly the opposite — to sell himself to Congress first and worry about the details later. As Emanuel likes to tell his West Wing staff: “The only nonnegotiable principle here is success. Everything else is negotiable.”
Bai has focused on an important aspect of Obama's administration: he designed it to work well with Congress, starting with his choice of Biden as VP, a point easily over-looked during the campaign while everyone wondered what the immediate political payoff would be. But that last quote from Rahm is lacking. Of course the details matter. If succeeding is nonnegotiable then there has to be a way of quantifying what is and isn't worthy of being deemed a success. And that is the inclusion of a strong public option. Private insurers competing with the government's coverage. The very thought has Republicans hyperventilating with spurious warnings of "socialized medicine." For the record, socialized medicine, like what the British have, would mean everything involved in the health care industry (nurses, doctors, hospitals, insurers) being owned and operated by the government. We're not getting close to that. What we're getting close to is threatening the profit margins of health insurers.
This also couldn't be more different than the way the Bush White House dictate its legislation to the Hill. For this to work, however, Obama will have to win over Blue Dog Dems. Republicans aren't the problem. Progressives would be better served focusing their ire on moderate Dems resisting the public option.
