Was it a political mistake to pursue health care reform?

Was it a strategic mistake to pursue health reform?

There’s a meme going around that health reform was a central strategic error of the early Obama presidency. On this view, it was a mistake to spend so long waging trench warfare to pass the Affordable Care Act. For example, Time’s Joe Klein believes that President Obama misread his mandate:

In 2008, Barack Obama wins a smashing electoral victory, largely because the public believes he’s a calm, cool adult who can lead the country out of an economic crisis. But for some crazy reason, he decides to focus much of his attention on passing a universal health care plan that has been the long-term dream of his party. This, despite polls that indicate nearly 80% of the public are satisfied with the health care they already have. The plan passes, but it’s so complicated, the public isn’t sure what’s in it (and is wondering why the President hasn’t focused similar attention on the economy), and Obama’s party is clobbered in the 2010 elections.

Klein personally supported health reform. So this indictment has added sting.

I disagree at TNR.

Although I disagree with Klein and others, I fear that one legacy of the health reform fight will be a certain domestic policy Vietnam syndrome facing any future new president who is contemplating addressing big complicated problems such as immigation or global warming. It’s all too easy to imagine his chief of staff closing the door and saying: “Do you really want to fight Verdun over this, risk possible failure, and sacrifice the best year of your presidency?” Our sclerotic legislative structures are damaging our ability to attack big problems.

Author: Harold Pollack

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has served on three expert committees of the National Academies of Science. His recent research appears in such journals as Addiction, Journal of the American Medical Association, and American Journal of Public Health. He writes regularly on HIV prevention, crime and drug policy, health reform, and disability policy for American Prospect, tnr.com, and other news outlets. His essay, "Lessons from an Emergency Room Nightmare" was selected for the collection The Best American Medical Writing, 2009. He recently participated, with zero critical acclaim, in the University of Chicago's annual Latke-Hamentaschen debate.

12 thoughts on “Was it a political mistake to pursue health care reform?”

  1. That you don’t bother with getting public support for your solutions to big problems before imposing them doesn’t exactly help, either.

  2. The mistake was the 800 billion spent on the stimulus.
    I was against it. All my arguments, and more, have come to pass:

    1) It wasn’t large enough to do the job.
    2) It didn’t build anything macroscopic you could point at with pride (a Hoover damn, huge solar generation farms, Mars in a decade).
    3) It was passed with alacrity…

    I realize there are sound counterarguments:

    1) It was large enough to stop a depression and a bigger bite wasn’t politically feasible.
    2) The stimulus needed to be smeared out over a multitude of small projects for maximun effect.
    3) The country was in dire straights and speed was of the essence.


    1) It helped Fox News zombies claim Keynesian economics is a failure, and has brought us to more tax cuts for the wealthy and no tax increases for anybody.
    2) It as left nothing for Americans to point at with pride, and so has added potency to the zombie lie that the stimulus was all waste and did nothing.
    3) It gave heft to the well-rung argument that Democrats are the party of spend, spend, spend.


    The shrewder plan would have been to wait until the economy was in full shambles, with the full force of depression heaped on Bush and republican policy and people begging for relief in soup lines. In politics, the time to hit the stimulus gas is when you hit the recession bottom. Then all the upside is accredited to your initiatives.

    Instead, the stimulus maximized political failure and minimized economic success. If you say rightly, “But it stopped a lot of suffering.” I would say, “No, it merely deferred it, and has instead, acted as a multiplier to suffering”. Check out where we are now: A Democratic president, looking as dour and ineffectually as Hoover, is negotiating with Medicare terrorists over the simple and necessary act of increasing US sovereign debt! This is pathetic, anemic, and embarrassing lame. Obama is looking like a boy playing Community Organizer in a room full of sharp-toothed and hard-hearted goons.

    It has devolved to this: One can speculate that Obama is starting wars because that is the one thing republicans will let him do (barely)…

  3. Brett – A majority of the public (unless you cherry pick the polls) either supported the ACA as passed or thought it didn’t go far enough. And many of the opponents were carrying signs demanding that the gov’t keep its hands off their Medicare and screaming about death panels – i.e., they were radically un- or misinformed.

    In any case, a reform was and is essential to the future well being of the nation. Whether Obama pays a short term cost or not is irrelevant. What exactly is the Democratic party be for, if not progress . You have only to look at what the GOP stands for (high walls protecting what they’ve grabbed) to see how important it is to seize the moments of opportunity whenever t. Obama had to step up, in a much more fraught environment, and he pulled it off.

    As long as it survives ’til 2014 when the benefits really become apparent, it will be seen in a generation as one of the great Democratic legacies, whatever its imperfections. You’ll get the same response from its beneficiaries that you now get from those of Medicare – “Don’t touch my ACA”. (Then they’ll forget who made it happen and go pull the lever for some right wing moron screaming about sharia, or whatever the next xenophobic flavor du jour is.)

  4. I’m not convinced that his political fortunes would be brighter had he postponed the health care issue to attack some ostensibly more feasible alternative political agenda. The economic and fiscal crisis would have been just as bewilderingly complex. Republicans would have been just as implacable, just as resolute in opposing the centerpiece efforts of an Obama presidency. The administration’s political strategies and private negotiating posture would have the same characteristic difficulties. The president’s difficulties with his own political base would have been rightly magnified by his failure to follow through on a matter of central concern to so many people.

    This sounds correct to me.

    I don’t think ignoring health care would have led to a better economkic program, which I suppose was the alternative doemstic policy issue. The GOP was pretty much going to prevent anything more being doen.

    IMO Obama’a big error was not fighting a (likely losing) battle for a bigger stimulus. That would have given him some grounds to argue from when the actual crippled program was less successful than hoped for.

  5. I feel like Bernard, but with a slight alteration:

    IMO Obama’a big error was not fighting

  6. Human beings are fundamentally conservative. Change is unpopular. Little-understood change about fundamental human needs, like health care, is especially unpopular. And the effect is bipartisan; witness the blowback over the Ryan Medicare plan.

    But politicians who only ever want to do what will keep their numbers high in the next quarter’s opinion poll don’t deserve the authority we give them.

  7. That you don’t bother with getting public support for your solutions to big problems before imposing them doesn’t exactly help, either.

    Do you apply the same logic to the Republican drive for tax cuts for the rich? Their drive to sustain oil subsidies? The drive to destroy Medicare?

  8. Traditionally a president’s strongest year is his first. In many ways Obama wasted it.

    He endlessly preached bipartisanship” while failing to support his own party. He failed to provide much leadership at all during most of the health care debate. Public opinion polls indicated a majority of Americans preferred single payer if it was clearly described. They preferred expanding Medicaid. They prefer nearly all the features in the bill that was finally passed other than its corporatist dimension. Here we have leadership fail on a massive scale. He had a large Democratic majority and with the help of the incompetent Harry Reid, blew it. He exemplifies the bankruptcy of the corporatist Clinton crowd. He does not deserve to win again, but given the depravity of his opposition, his winning is likely preferable to those who will run against him.

  9. Predictably, Brett gets his weasel point wrong. He’s already been rebutted on that, so I am not going to waste the time repeating it.

    But his response encapsulates what happened.

    Klein is flat out wrong. If it were not health care, it would have been the stimulus. If it were not the stimulus, it would have been something else. It’s not the mandate that Obama misread–he misread the degree of callousness and purely political ambitions of Republican “public servants” and the amount of racism still percolating beneath the 2008 vote. Neither of these was really a mistake–Democrats had the largest majority in several generations and they should have exercised it for the benefit of the country. No one could have counted on 1) the entire Republican Party turning to economic terrorism following Rush Limbaugh’s lead, 2) Fox News turning a minor grumbling from the lunatic fringe into an amoeba-like political movement that brought a collection of ignoramuses into the legislature, 3) pathetic sycophancy and cowardice of Blue Dogs that sabotaged both the stimulus and the health reform message (luckily, we won’t see most of them in the legislature any more). The one mistake Obama did make is not learning traditional Middle Eastern haggling techniques. He and the Democrats lost an edge because of negotiating from a position of weakness. This is not merely a misreading of the field–it is a complete miscalculation. No compromises should be offered up front to a desperate negotiator. Offering concessions–such as preemptively removing single-payer from health-care options–up front, not only emboldened the opposition, but it also made the strong look weak. The message was sent early–the first judicial nomination that Obama made by selecting a uncontroversial, conservative justice resulted in an absurd filibuster anyway. After that, no concessions should have been offered upfront–no compromised positions on health care until after negotiations, no reductions in stimulus, no preemptive suspension of the drilling moratorium, etc. All of these should have been negotiated positions. Instead, Obama’s advisors decided that they would look strong by “taking away issues”. This technique could work in a debate club, but not in US politics today. Democrats are like the Middle-Eastern bazaar merchants who sells his widgets as “second-best” because the customer could not afford the “best quality” stuff, while Republicans are the hucksters in the next stall proudly proclaiming “Best Widgets in the World!” while peddling defective junk (and if the customer comes back complaining, they blame the customer for breaking it–or worse yet, with a straight face, they blame the other seller for sabotaging their wares).

  10. Harold:

    Why do you care what that worthless front-runner Joe Klein says anyway?

    There’s no such thing as a mandate, advancing policy is not zero-sum, and if HCR was in the national interest (which it obviously was) then passing it was the right thing regardless of everything else Klein had to say about polls or strategy or imaginary alternatives.

  11. Worrying about the trivia of institutional rules and political tactics misses the fundamental drivers of our politics. The conservative movement moves on relentlessly, because it has cultivated their own fields, and salted the fields of the liberals and progressives.

    Obama’s big “mistake”, from a progressive point-of-view, was appointing Larry Summers and Timothy Geithner, instead of leaning over to the French President at the inaugural, and asking for the loan of some guillotines. If you don’t want the uber-rich and corporate chieftains to dominate your country, you have to take their lives and fortunes from them. Jail them. Tax them. Tear down the sources of their power.

    The defects of the ACA are, foundationally, the same as the defects of financial reform: a fundamental reluctance to destroy. If you want to reduce the cost of health care from 18% of the economy to 12% in any finite period of time, you must be willing to destroy some major institutions, sucking up and channelling that 6%. If you want banking, insurance and finance to be 3% of the economy, instead of 8%, then, a whole bunch of banks have to go out of business tout suite.

    Obama did not want that. And, a majority of voting Democrats didn’t want that. They didn’t want “change”, if it meant destroying a large part of the financial sector, or destroying a large part of the health care sector. But, they should have wanted that. “Should have” in the sense of logical necessity linking ends to entails.

    It seems to me that this post, and much of the comment thread above, remains an exercise in hiding from ourselves the necessity of destroying the increasingly decrepit superstructure of the Imperial American economy.

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