Can Obama Still Get Meaningful Health Care Reform?

Surely, Barack Obama didn't expect to be stuck in such an awful quagmire over health care reform as he heads into Labor Day weekend in his first year as President. He expected a hard battle, but, probably, not this nightmare.

Much of the resistance goes with the territory. There are too many powerful special interests in health care that can block attempted change at every corner. However, Obama and his team have made the prospects for genuine, large-scale reform much less likely than they had to be. For a President who has excelled in communicating with the public, Obama often has appeared vague and indecisive. He has appeared cautious and passive rather than bold and strong.

It has been extremely difficult to follow the story of health care reform. That's partly due to the fact that so much of the "action" of this story goes on behind the scenes, beneath the radar. It involves lobbying and more lobbying. It involves money and influence. It involves political muscling and dealmaking. What information bubbles to the surface is all that we, the citizens, see, and, usually, it's an incredibly incomplete picture. The typically flawed news reporting on this issue has only increased the murkiness.

Despite this incomplete picture and my limited knowledge of health care policy, I'll attempt to list some central factors that have impacted the evolution of this policy drama.

1. Obama's strategic decision to "let the Congress shape the legislation" has backfired quite a bit. On the one hand, it seemed understandable that Obama didn't want to repeat the Clintons' mistake of attempting to develop a reform package from inside the White House. Obama wanted Congress to help shape, and, later, "own" the product of its work. However, Obama has chosen to avoid asserting his own views and priorities on the significant aspects of health care reform for far too long. This has made him appear weak and directionless on an issue that he harped on - with authority and principle - as a candidate in 2008. Plus, Obama's choice to stay above the fray has allowed the debate to be unnecessarily aimless, unfocused, noisy, reckless, distracted, and, often, unpleasant or obnoxious. The Republicans, the Party of "No" have been allowed to create mischief on a near-daily basis -- partly as a result of the White House "letting the Congress shape the legislation." The Republicans' only mission is to defeat Obama.

2. Obama has failed to explain why we have to have health care reform. He has failed to identify his own largest reasons. Is it to help the uninsured - particularly those millions of people of low or moderate income? If so, one cannot easily conclude this from Obama's town hall forums. Yes, he mentions it, but he mentions A LOT of things and that's the problem. He has desparately needed a "mantra" - a rallying cry -- a few top goals to group together in a slogan or argument.

3. Obama has not clearly identified his allies and opponents. Who is he fighting for? Against? I'm sure he'd reply he's helping "the American people," but, again, his rhetoric has not been clear, strong and focused in that regard. Has he been railing (enough) against HMOs or the pharmaceutical industry? I don't think so. He speaks in generalities about the system, but, surely, he knows, as a former community organizer and communicator, his Administration's argument would be more compelling if it were urging us to stop some opposing force or industry. It helps to rally people against a big, bad target or "enemy."

4. Isn't it a sign of trouble that several of Obama's largest informal "allies" for reform are the most "mainstream" health care entities imaginable -- i.e. the pharmaceutical industry, the AMA, (the largest physicians' organization) or, hospitals? Recently, according to an original, thorough article by Matt Taibbi in Rolling Stone on health care reform, the Pharmaceutical Research and Manufacturers of America "...announced that the industry would contribute an estimated $150 million to campaign for Obamacare..." (www.rollingstone.com/issue1086) Taibbi details many troubling aspects of the impact of behind-the-scenes lobbying on the ongoing "debate" in Congress.

5. Obama and his team have done a particularly poor job trying to explain "the public option." In a year when the public has grown wary and hostile toward the idea of additional federal government intervention, it became even more important for the Administration to explain "the public option" very clearly, carefully, and patiently. One priority should've been to emphasize that it will NOT result in a harmful intrusion by the government, but, rather, a way of ensuring people get their choice of coverage. Obama and his team have been far too casual about showing the American people how this reform effort will not bankrupt us by creating tremendous new deficits. They'll have to do this in the weeks ahead if they are to succeed.

6. In a closely related way, the Obama team has never shown a sufficient acknowledgement that, in a year of the economic stimulus package - a measure with results that've been hard to see and measure - of course, the public would be skeptical of the federal government playing a much greater role in the provision of health care.

7. There has been a dramatic shortage of strong "surrogates" speaking in support of the Obama Administration's efforts. This has been a weakness that characterized the period before the vote on the stimulus too. Why do I hear so much about Republicans' reactions to every little development on health care without seeing and hearing showings of strong support and rhetoric from Obama supporters? I'm referring, in particular, to Democratic US senators and Democratic US House members, who have been remarkably silent. I don't think that's a coincidence. Many Congressmen base their behavior solely on protecting their own interests. They are, unfortunately, not generally the least bit courageous or bold. They avoid risks at all costs. Too often, this story has presented Obama on one side -- speaking in generalities -- and a wide array of critics on the other side who are all too willing to spout any reckless, irresponsible criticism, attack or distracting remark at the Obama side. Worsening matters is that the Republican Party has become a tiny group of politicians unwilling to engage in thoughtful debate on anything. They should be irrelevant, but, they've had more success at attracting media coverage than their quiet, passive, unimpressive counterparts -- even though the Democrats outnumber them by a tremendous margin and possess strategic advantages.

8. While I mention the failings of Democrats, I must stress that their collective effort was obviously much more needed given the timing that Obama has chosen for this. Obama, understandably, felt if he had a shot at health care, it probably had to come in his first year - after his historic victory and the peaking of good will from the American people. Yet, after he had to grapple with the economic crisis non-stop in his early months, he lost some key momentum and credibility. He needed - but, received very little - outspoken support from Democratic allies to back him up in the uphill - "against-the-wind" effort to reform health care. I believe that even if Obama gets a watered-down bill in 2009, he deserves at least some credit for choosing to take this issue on in a time of tremendous economic stress for the country.

9. Obama seems to have adopted an approach aimed at alienating as few people as possible. He seems to want it both ways. On occasion, he'll speak of the big changes needed, but, at the same time, he fails to identify - specifically - who and what players and entities within the system must change the way they do business. For a "populist" sort of argument, Obama sure hasn't sounded like a populist. A populist has to rally people against something or someone mistreating or hurting them -- whether it's Big Business or whoever. I have not hear Obama rail against any of the "bad players" in the health care world in a way that's as compelling as it could be. I suspect that's because the Obama team has been "working with" some major players in health care AND Obama has tried to keep too many parties in the arena happy, when, in fact, a leader of a reform effort CANNOT keep pleasing everyone; in fact, if that leader is generating momentum, he or she will probably made some real enemies and created deep anger and tension and conflict. How can a major reform drive amount to much WITHOUT that kind of opposition or side-effects?

10. The Obama team has not presented good, clear arguments even to me - and I'm an enthusiastic Obama supporter. I still receive emails from the Obama grassroots group, "Organizing for America" and what I've noticed is the same general presentation that lacks an edge. (They fail to identify often enough what, specifically, needs to be replaced or changed!) If the Obama people - both in the White House and those leading the Obama grass roots machine - have not shared a clear "rallying cry" that has captured my attention, that's a bad sign.

Don't get me wrong. I support major health care reform and I hope the Obama administration will force through as strong a bill as possible. I just want Obama to stand up and show more leadership on this issue - NOW, before it's too late.