02.24.10

10 Biggest Health-Care Mistakes

As the bipartisan reform summit gets underway, The Daily Beast breaks down the strategic missteps that drained Obama’s political capital—and left him empty-handed on his top domestic priority.

The Daily Beast breaks down the strategic missteps that drained Obama’s political capital—and left him empty-handed on his top domestic priority.

In his first speech to Congress, on Feb. 24, 2009, President Obama swore, “Health-care reform cannot wait, it must not wait, and it will not wait another year.”

Well, here we are a year to the date of that speech, and after pushing the deadline back again and again—to Congress’ August recess, then to Thanksgiving, and then to the New Year—there is still no health-reform legislation for Obama to sign. Instead, we’re gearing up for a televised health-care summit that will provide a forum for more “bipartisan” posturing, while behind the scenes, Harry Reid and the White House consider passing elements of the reform plan through reconciliation—a parliamentary maneuver that would require no Republican support, and that has been an option open to Democrats since the beginning of this long, long process. Meanwhile, the prospect of a majority vote has put pressure on lawmakers again to include a public-insurance option in the deal, an issue of bitter contention within the Democratic caucus that the White House remains loath to take on.

No one ever said a health-care overhaul would be easy. The issue tripped up presidents from Truman to Nixon to Clinton. And sure, hindsight is 20/20. But since a year ago, everyone who is anyone in Washington was predicting a historic health-care bill by the end of 2009, The Daily Beast decided to compile a list of the mistakes, mishaps, and miscreants that brought the White House and congressional Democrats to their current predicament: Despite spending a ton of political capital, they’re still empty-handed on the president’s signature domestic policy priority.

1. Putting Too Much Faith in the Gang of Six

Peter Beinart: Ram Health Care Through!

John Avlon: Washington’s 20 Saboteurs
For all the complaints from GOP leaders that the White House won’t negotiate in good faith at its summit this week, health care might have been finished long ago if Democrats hadn’t become bogged down in unproductive talks with Republicans. For months, a bipartisan group of senators labeled the “Gang of Six” delayed a vote on health care in order to pursue an agreement that would satisfy all sides. But as the Republican base began mobilizing against wavering members, it quickly became clear the talks were a joke. Sen. Chuck Grassley (R-IA), who helped lead the negotiations, returned to his state only to spread phony “death panel” rumors popularized by Sarah Palin’s Facebook page. And Sen. Mike Enzi (R-WY) went on to brag to local business leaders in his state about how he killed health care by stringing along Democratic negotiators until it was too late.

2. A Muddled Sales Pitch

Are we reforming the health system because we need to tackle the budget deficit, or because providing high quality health care is simply the right thing for an affluent, modern nation to do? Seemingly terrified of being labeled a spendthrift liberal, President Obama constantly touted how much money Democrats’ health-care reform plans would save taxpayers. “Put simply, our health-care problem is our deficit problem. Nothing else even comes close. Nothing else,” Obama intoned in his big September health-care speech—after Congress had already missed several deadlines for delivering him a bill.

The problem was that by promising to provide Americans access to affordable health insurance while erasing the budget deficit—all in one fell swoop—Obama confined Congress to spending about $950 billion. That arbitrary number limited the policy options for addressing the health-care crisis, and created a Beltway obsession around the proclamations of the Congressional Budget Office, whose job is to “score” proposed legislation on how cost effective it would be, a fraught process that can never fully capture a bill’s potential upsides or downsides. Meanwhile, the heartbreaking stories of families forced to choose between their mortgage payments and cancer drugs got lost in the shuffle. Whatever happened to calling for a more moral America?

3. The Wrong Senate Captain

There are rational reasons why Sen. Max Baucus, the Montana Democrat and Gang of Six leader, sat smack at the center of the health-care reform process. He chairs the Senate Finance Committee, which is responsible for paying for the damn thing. He’s a legislative veteran, having served in Congress for 35 years. And he has powerful allies in the West Wing, most notably his former chief of staff, Jim Messina, who now serves as the deputy to White House Chief of Staff Rahm Emanuel.

Baucus, though, has never been known as one of the Senate’s truly passionate wonks on health-care reform. People who fit that description—like Ron Wyden (D-OR), Bob Bennett (R-UT), Jay Rockefeller (D-WV), and Barbara Mikulski (D-MD)—were shunted to the side in the negotiation process, depriving the debate of powerful, informed, bipartisan voices for change. What’s more, from 2003 to 2008, Baucus accepted about $3.4 million in donations from the health-care industry—the very same insurers, drug companies, and hospitals a reform bill would regulate. As Baucus’ repeated watering-down of the bill became an obsession on the left, his relationships with corporate health-care interests became a major embarrassment.

4. Wasting Time on Olympia Snowe

From a Gang of Six to a Gang of One: Olympia Snowe (R-ME) seemed a gettable vote on health care and the White House in particular seemed determined to bring her along. Snowe voted for the Finance Committee’s version of legislation, but with Republicans up in arms and many of her colleagues facing primaries from the right for working with Democrats, she voted against the final bill despite its broad similarities. Her stated reason? That after the better part of a year devoted to bipartisan health-care negotiations, the “process denies us the opportunity to thoroughly and carefully and deliberately evaluate what's at stake." Soon afterward, she joined Republicans in declaring elements of the bill she had championed herself to be unconstitutional. “As I look back, it was a waste of time dealing with her, because she had no intention of ever working anything out,” Harry Reid later told The New York Times Magazine.

5. It Looked Like Vote Buying

Polls show that many components of the Democrats’ health-care plan are popular, but the process that got them to their vote in the Senate has left many Americans frustrated. Deals with Sens. Ben Nelson (D-NE), nicknamed the “Cornhusker Kickback,” and Mary Landrieu (D-LA), derided as “the Louisiana Purchase,” secured extra federal health-care funds for their states in exchange for their vote to break a Republican filibuster. While these kinds of exchanges happen all the time in Congress, opponents of the bill latched on to the deals as evidence that Democrats couldn't muster the votes for health care without buying them. It also fueled popular perception that contrary to Obama's pledge to make negotiations as transparent as possible, backroom deals were still occurring in the Senate. Democrats’ underestimated the public outcry over Nelson and Landrieu, which Time magazine’s Karen Tumulty suggested might have even cost Martha Coakley her race against Scott Brown. The deal wasn’t even popular in Nelson’s Nebraska, and he later praised the White House for ending his state’s special treatment in their recently unveiled health-care plan.

6. Taking 60 Votes for Granted

Achieving a supermajority in the Senate that could overcome filibusters—something not seen since the days of Lyndon Johnson—seemed to herald a new era of Democratic power. But the party took its 60 votes for granted by ignoring warning signs that a motivated conservative grassroots and disillusioned Democratic base threatened its candidates, even in blue-state elections. As a result, Sen. Scott Brown (R-MA) was able to sneak up on Democratic candidate Martha Coakley in the special election to fill Ted Kennedy’s seat. Losing the seat was bad enough, but health care was especially threatened because the White House, according to Obama adviser David Axelrod, had prepared no backup plan for passing the legislation because the "widespread assumption was that that seat was safe."

7. Letting “Death Panels” Live

In 2008, the Obama presidential campaign was successful in pushing back against slanderous chain emails and word-of-mouth rumors about Obama’s nationality, religious beliefs, and issue positions. But despite efforts by the president to address similarly outlandish attacks on his health-care plan, including a false rumor spread by Sarah Palin that it would empower “death panels” to withhold care from elderly and disabled patients, the Democrats failed to prevent some of the lies from taking hold. One poll showed close to half of Americans believed the government would be able to pull the plug on Grandma after health-care reform.

8. The Abortion Distraction

The White House made it known to pro-choice organizations that they should stay relatively quiet during the health-care reform process—not asking, for example, that the bill overturn bans on abortion coverage for women on Medicaid, women in the military, and federal employees. But pro-lifers were quickly organizing to put abortion at the center of the debate. Catholic bishops and evangelical leaders instructed priests and ministers across the country to preach against any health-care plan that included abortion coverage—even though the vast majority of private insurance plans already cover the procedure. Meanwhile, in July, Rep. Bart Stupak, a moderate Democrat and abortion-rights opponent from Michigan, partnered with the religious right to compile a list of 29 Democrats who would refuse to support any legislation that didn’t explicitly ban abortion coverage.

In an aggressive move that shocked liberal Democrats, on Nov. 7, the night of the vote on the House health-care bill, Stupak and his band successfully hijacked the proceedings, refusing to support their party’s signature priority unless the bill barred insurance companies that provide abortions from doing business in the new, federally regulated health-insurance market. The restrictive Stupak language would roll back access to abortion, and gave liberals yet another reason to oppose health-care reform. Now the White House is stuck between a rock and a hard place—worrying that unless the final heath bill contains the Stupak language—which Obama officially opposes—they could lose key votes for passage in the House.

9. Letting the Hill Run Wild

In 1993, Bill Clinton’s detailed and complex health-care reform plan was torn apart by Congress. To avoid the same fate, Obama decided to present only broad ideas—such as banning insurance companies from denying coverage due to preexisting conditions—and let the legislative branch work out the rest. Unfortunately, the devil proved to be in the details, from Medicaid funding for states to whether immigrants should be covered.

Three House committees and two Senate committees wrote health-care reform bills, all of which were supposed to be merged into a coherent plan. It never happened. On Monday, the White House finally released its own version of health-care reform, based largely on the less progressive Senate Finance Committee bill, with no public option. The move was an acknowledgment that without strong executive leadership, House and Senate Democrats would never come to terms. But is it too little, too late?

10. Maybe Rahm Had a Point

White House Chief of Staff Rahm Emanuel believed a massive health-care overhaul was too politically risky, and instead favored passing a series of smaller bills that would guarantee coverage for children, expand Medicare and Medicaid eligibility, and so on. That would have disappointed the liberal base, of course, many of whom see systemic health-care reform as a Holy Grail.

But grassroots liberal Democrats—once Barack Obama’s most loyal followers—became increasingly skeptical of the president anyhow, as they witnessed how each subsequent draft of health-care reform ignored more and more of their priorities: abandoning the idea of a public health-insurance option, allowing Joe Lieberman to nix a plan to expand Medicare to everyone over 55, and not even trying to use health-care reform as an opportunity to address the concerns of key interest groups, such as pro-choicers.

The administration added fuel to liberals’ fire when both Obama and Emanuel made comments over the summer and fall suggesting the public option wasn’t a mandatory part of reform. There were ham-handed attempts to roll back the damage, but liberals got the message that the White House wasn’t pushing hard on these long-term progressive priorities. Deep-seeded disappointment followed, leading many former Obama fans to disengage with the health-care reform process—or, following the lead of Howard Dean and influential Firedoglake founder and blogger Jane Hamsher—conclude that no health-care reform at all would be better than the relatively weak sauce Obama was now content to support.

Adding insult to injury, Obama’s outreach to his much-hyped, gargantuan email list of campaign supporters failed to stem these harsh critiques from the left. The Tea Partiers simply were more enthusiastic about derailing the bill than progressives’ were about supporting it. Given how disappointed the base has become, could Rahm have been right? Maybe Obama’s political capital would be far stronger today had he already successfully passed one or two tightly targeted, high-profile health-care bills.

Dana Goldstein is an associate editor and writer at The Daily Beast. Her work on politics, women's issues, and education has appeared in The American Prospect, Slate, BusinessWeek, The New Republic, and The Nation.

Benjamin Sarlin is a reporter for The Daily Beast. He previously covered New York City politics for The New York Sun and has worked for talkingpointsmemo.com.