Newspaper columns, cable talking-head shows, and blogs are filled with recriminations from the left and a certain amount of gloating from the right: how did Obama manage to lose the health care debate? (That in and of itself isn’t a good thing for Obama while the debate is going on. His effort to achieve a government-run health care plan isn’t dead — not yet.) The arguments fall into two general categories, both of which get it slightly wrong.
From the supporters of ObamaCare, we hear that the cardinal error was getting all concerned about health care costs. John Cohn of the New Republic is typical:
Had he spent more time reminding voters that reform would provide them with the security they now lack — security from financial ruin and medical catastrophe, the type private insurance too rarely provides — he probably would have been better off. …
The trouble for Obama is that, in getting serious about cost, he gave critics lots of fat, juicy targets. Obama proposed to tie payments to quality; Betsy McCaughey said he would be giving doctors money for pulling the plug on grandma. Obama proposed to put a board of experts, using clinical evidence, to set Medicare payment rates; Sarah Palin interpreted that as creating a “death panel” that would declare the sick and disabled unworthy of treatment. The great irony is that by trying earnestly to craft a plan that could control costs, as well as expand coverage, Obama has provoked a political backlash that will make cost control harder in the future. He’s tried to tackle health care like a grown-up and, at the moment, he’s suffering for it politically.
But, as Cohn points out, it’s a little hard to avoid talking about cost when the public sees $9 trillion in debt spanning over the next decade. Perhaps Obama shouldn’t have gone hog wild on the stimulus or should have passed a responsible budget rather than the $3.5 trillion monstrosity, but once he did all that he really didn’t have a choice but to try to address the cost issue.
And there is nothing wrong with talking about cost; it is the type of cost reduction which government-centric health care entails which is the problem. Once Obama decided to go with the standard fare liberal health care model, he was locked into the main cost-saving scheme which just about every other nationalized health care system around the world must employ: rationing. He could have looked to increased private sector competition to lower insurance costs. He could have taken a whack at unnecessary procedures and high medical malpractice costs by working on tort reform. But neither of these holds much interest for Democrats. So he was therefore driven into the sort of cost-saving which has proved to be an anathema to most Americans.
The error therefore was not in talking about cost-cutting. It was in running up the deficit first and hawking a government-run system which necessitates rationing.
The other sort of post-mortem analysis of ObamaCare focuses on process errors made by Obama and the Democrats. Andrea Tantaros lists the mistakes: message schizophrenia, hubris, playground tactics (“The left discounted the initial concern and anger of its constituents and insulted them by calling them ‘angry mobs’ and ‘evil.’”), poor planning (they didn’t anticipate much “pushback”) and ignoring the lessons of HillaryCare.
Ross Douthat takes the same approach:
The White House’s messages have been mixed — fiscal hawkery one day, moralism the next. The administration has allowed distractions like the Skip Gates affair to crowd out his agenda. It has overlearned the lessons of the Clinton-care debacle and given Congress too much leeway. It has underlearned the lessons of the Bush-era Social Security debacle and gone to war before there’s an actual piece of legislation on the table.
These observers are right, insofar as their analysis goes. Obama’s team has been extraordinarily incompetent and Obama himself has not helped his cause by overexposure, lame analogies (e.g., red pill/blue bill, the Post office[!]), and hostility toward dissent from ordinary citizens.
But again, the real issue here is the plan itself and, more importantly, the assumptions underlying it.
Obama simply miscalculated the American electorate’s willingness to throw out a health care system that insures over 80% of us, has led the world in technological innovation, and provides a good measure of autonomy for individuals to choose their doctors and treatment options. He had a terrible time selling ObamaCare because it was a terrible idea. It turns out Americans don’t want to replace an imperfect but very good health care system with a lowest-common denominator, government-run system that has given worse care and led to greater dissatisfaction than private insurance when tried in other countries.
In the end it comes down to the substance of ObamaCare. Liberal pundits would rather talk about tactics because it deflects attention from the failings of their long-cherished dream of nationalized health care. Conservative activists don’t mind talking about the incompetence of The One. But ideas really matter and awful ideas like ObamaCare are, it turns out, quite hard to enact into law once the public wakes up to what is afoot.