Resuscitating The Presidency

Everyone has an opinion on yesterday's marathon White House health care summit, and indeed, details both minute (did Obama wink at McCain?) and monumental (do the Democrats have the chutzpah to go it on their own) were reviewed by every major news outlet.

Here's a local take by Michael Doonan, Ph.D., assistant professor at Brandeis University and Executive Director of the Massachusetts Health Policy Forum, who writes: "I basically think the President is resuscitating his presidency:"

The president was successful in putting health care back on the agenda with his bipartisan summit on health care reform, and this was no small feat. Whether reform can ultimately survive is another question, but for now the patient is off life support systems. After more than a year of debate, health care reform passed both chambers of Congress and was closer to passage than at any point in our history. But the Democrats lost control over this issue.

Tea Party shout downs, special deals for hold out legislators, traditional cries of “socialized medicine,” and finally the election of Senator Scott Brown put reform on ice. More than a few Democrats quivered, reassessing how votes on reform might impact their political futures. President Obama in his state of the union address warned fellow party members not to “run for the hills.” At the Blair House Summit he called them back.

The challenge of passing comprehensive reform is steep with scrap heaps of bills that once burdened landfills that are at least recycled now. Major domestic policy change has generally taken place during profound crisis and/or when the Democrats enjoyed super majorities. We are largely a conservative country favoring incremental change with a political system designed to put the brakes on redistributive policy. James Madison said that the Senate is like a saucer to cool the passions of the people, to slow things down and contemplate them for a while. The system works as designed. An impassioned minority can most often thwart the will of the majority.

It was pretty clear before the summit that a bipartisanship kumbaya was not going to break out. No deal was going to be struck. So why the seven hours? The partisans around the table kept to their scripts. Republicans echoed the refrain, “Mr. President, the American people do not want this bill.” We need to start over, focus on cost containment, take it one step at a time, trust the American people to make their own health care decisions, let the free market work, open cross state insurance options for small business, and above all reduce not expand the role of government.

Cue up the Democrats. “Mr. President, you just won’t believe what happened to a woman/man/family in my district.” Republican ideas have been considered, many are in the bills, but incremental change will cost more, fail to stop insurance companies from discriminating against people with pre-existing conditions, and leave millions uninsured. The public option has been dropped in favor of exchanges the Republicans used to support. We cannot afford to wait.

Great, everyone brilliantly on message, so what? I argue that the point is the process, the theater and the audience. The process showed the President firmly in control of the complex details and nuances of reform. Bringing together both parties but equally important both chambers of Congress under the guise of comity and finding common ground was brilliant. The openness may have mitigated some of the earlier seediness of the legislative process. The use of “C-Span,” cable outlets, and internet streaming created a bully pulpit Teddy Roosevelt could only dream of.

The stage of this theater was set to the advantage of the President. My grandfather said, “if you keep score you should win.” Obama was the score keeper, the arbiter of what was legitimate, who spoke when, the sub-topics and of course he has the last word. While past Presidents sweated out one monthly news conference, this President subjected himself to seven hours of opportunity to screw up on a complex topic that is just part of his day job. A reporter on NPR this morning said that he rewound the tape three times to see if the president at one point winked at someone. This is scrutiny.

The audience here was critical. The idea was for the president to reframe the issue for the public to demonstrate that reform is not a big scary government takeover, but a wise effort to regulate “insurance bullies,” control costs and cover the uninsured. He wanted to show that he was reaching out to Republicans and that they are intransigent on this issue.

However, the bigger audience was all the Democratic members and staff back in their offices still scared about the next election.

Ironically, the best possibility for reform is that this summit further polarize the parties on reform. The scenario is that these House Democrats now coalesced around the President’s bill (The Senate bill dressed up). This is something they would not have done a couple of weeks ago. Liberal representatives wanted their own plan, and moderate Democrats were scared. Now the talk is passage through the budget reconciliation process which requires a simple majority in the Senate. But it all starts in the House.

Will it happen? Don’t know, but the chances are far greater than they were last week and the President can take credit for standing up.