08.06.09

Stop the Health Care Hysterics

No matter what critics say, health-care reform isn’t in trouble yet. Former Clinton budget official Matt Miller says that after the bill gets through Congress, then Obama’s role and rhetoric must change.

No matter what critics say, health-care reform isn’t in trouble yet. Former Clinton budget official Matt Miller says after the bill gets through Congress, Obama’s role and rhetoric must change.

Business-minded Democrats and Republicans are apoplectic over the emerging House health plan because it funds expanded coverage with stiff new taxes on business, as well as surtaxes that could lift marginal rates on high-earning Americans toward the high 50s. For their part, liberal Democrats are apoplectic that the all-important Senate Finance Committee (fresh from a White House powwow Thursday with the President) is throwing the public option overboard, which they view as the litmus test for serious reform. If I hear anyone else explode over what they see as the fatal flaws of what’s happening on health care, I may go apoplectic myself. Which is why my advice to well-meaning zealots of every stripe is to chill. The truth is that everything that’s taking place right now is irrelevant.

Why do I say this? Whatever your leanings, if (like me) you’re hoping for some kind of major health reform this year, the crucial text at this juncture is from Schoolhouse Rock—where that famous old ditty, “ I’m Just A Bill,” lays out how a bill becomes a law. We’re at the point in the process where this is literally all that matters. For health reform to happen this year, something has to pass the House, and something has to pass the Senate. It doesn’t matter exactly what those somethings are, or how offensive big chunks of those somethings may be to some of us. Never forget that when the Clintons convulsed the country over health care in 1993 and 1994, these simple Schoolhouse Rock steps never came close to happening. For all the drama back then, nothing came to a vote.

Even if his poll numbers are a bit tarnished, does anyone really want to bet against Obama seizing the presidential megaphone and making health care reform compelling?

Only after something passes the House and the Senate will the real work begin. The conference committee to hammer out a final, identical bill will be the mother of all summits. That’s where President Obama must weigh in heavily to shape and then sell the outcome. Contrary to all the carping, what he and the White House do before then on the specifics of the legislation doesn’t much matter. The White House’s only job until we get to conference is to shape the climate of opinion with one simple end in mind. Legislators need to get the message that their constituents want “change” on health care, and will punish them for supporting the status quo. The White House’s mission is to be sure that enough legislators feel they cannot safely oppose Obama’s definition of “change.” That’s it. (It’s also a tall enough order, what with organized conservative protesters having the early edge in disrupting town hall meetings as lawmakers head home for recess).

You can’t channel surf on cable these days without seeing pundits who insist that: 1) Obama has over-learned the lessons of Clintoncare; 2) ceded too much power to Congress; and 3) blown it by not detailing what he wants in a final bill at this point. These folks don’t know what they’re talking about. The nattering nabobs of an earlier era would have likewise slammed Abraham Lincoln when he said, apropos of his general outlook, that “my policy is to have no policy.” But Lincoln knew a thing or two about political leadership. Within general parameters (pro-slavery or anti-slavery, pro-health reform or anti-health reform), a president’s job is to preserve enough flexibility to get the results he seeks while carrying most of the people along with him. A studied ambiguity as events unfold is indispensable to this task, and Obama intuits this just right.

Once we get to conference, however, Obama’s role must change. That will be the moment. That’s when he and his team have to knock heads, crafting a deal that covers everyone, funds this in economically rational ways, and slows system-wide cost growth. As importantly, that’s when Obama must move from Rose Garden jawboning and press conference talking points to a riveting series of speeches on health care that will rival his race speech during the campaign. He needs to take the issue to an entirely new level of adult conversation, frame the case for “change” versus “the status quo” in ways that empathize with the fears and aspirations of all sides, and show why the path he’s forged is good for average Americans and a fit with the journey the country has been on since its founding. Only Obama can provide the macro political framing and cover and energy that at the end of the day (around Thanksgiving) gets a majority of legislators to transcend their own preferred versions of reform and agree to act.

Even if his poll numbers are a bit tarnished, does anyone really want to bet against Obama seizing the presidential megaphone and making this compelling?

Between now and then, everyone should take a deep breath. The talking heads have to fill up air time, but the rest of us should remember: until we get to conference, it’s all prelude.

Matt Miller is a management consultant, a senior fellow at the Center for American Progress, and the host of public radio’s popular political week-in-review, Left, Right & Center. His new book is The Tyranny of Dead Ideas.