Obama’s New Health Strategy: Leadership

After eight months of letting Nancy Pelosi and Harry Reid try to handle the most important domestic initiative of his administration, President Obama is reluctantly considering providing some leadership, Mike Allen and Jim VandeHei report.

Aides to President Barack Obama are putting the final touches on a new strategy to help Democrats recover from a brutal August recess by specifying what Obama wants to see in a compromise health care deal and directly confronting other trouble spots, West Wing officials tell POLITICO.

Obama is considering detailing his health-care demands in a major speech as soon as next week, when Congress returns from the August recess. And although House leaders have said their members will demand the inclusion of a public insurance option, Obama has no plans to insist on it himself, the officials said.

“We’re entering a new season,” senior adviser David Axelrod said in a telephone interview. “It’s time to synthesize and harmonize these strands and get this done. We’re confident that we can do that. But obviously it is a different phase. We’re going to approach it in a different way. The president is going to be very active.”

Top officials privately concede the past six weeks have taken their toll on Obama’s popularity. But the officials also see the new diminished expectations as an opportunity to prove their critics wrong by signing a health care law, showing progress in Afghanistan, and using this month’s anniversary of the fall of Lehman Brothers to push for a crackdown on Wall Street.

On health care, Obama’s willingness to forgo the public option is sure to anger his party’s liberal base. But some administration officials welcome a showdown with liberal lawmakers if they argue they would rather have no health care law than an incremental one. The confrontation would allow Obama to show he is willing to stare down his own party to get things done.

Certainly, a major speech by the president will capture the nation’s attention. Presidential addresses are rare and therefore auspicious occasions that can change the game.

Oh, wait.  Not anymore.

But at least the president has taken these months to carefully study the problem and gauge what’s politically possible so that we can finally have a single plan to focus on rather than getting wound around the axle on rumors of the numerous plans floating around congressional committees.

Aides have discussed whether to stick to broad principles, or to send specific legislative language to Capitol Hill. Some hybrid is likely, the officials said.

“I’m not going to put a date on any of this,” Axelrod said. “But I think it’s fairly obvious that we’re not in the second inning. We’re not in the fourth inning. We’re in the eighth or ninth inning here, and so there’s not a lot of time to waste.”

Obama’s specifics will include many of the principles he has spelled out before, and aides did not want to telegraph make-or-break demands. But Axelrod and others are making plain that Obama will assert himself more aggressively — a clear sign that the president will start dictating terms to Congress.

“His goal is to create the best possible situation for consumers, create competition and choice,” Axelrod said. “We want to bring a measure of security to people who have health insurance today. We want to help those who don’t have coverage today, because they can’t afford it, get insurance they can afford. And we want to do it in a way that reduces the overall cost of the system as a whole.”

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James Joyner
About James Joyner
James Joyner is Professor and Department Head of Security Studies at Marine Corps University's Command and Staff College and a nonresident senior fellow at the Scowcroft Center for Strategy and Security at the Atlantic Council. He's a former Army officer and Desert Storm vet. Views expressed here are his own. Follow James on Twitter @DrJJoyner.

Comments

  1. Triumph says:

    President Obama is reluctantly considering providing some leadership, Mike Allen and Jim VandeHei report.

    The fact that his health care plan implements sanctioned government killings will make any attempt at leadership a failure.

  2. JKB says:

    Oh no! Obama is going to throw his support behind the healthcare initiative. He is going to imperiously dictate the terms to Congress who will not dare oppose his will.

    Plus, as his senior advisor relates, he wants everything except to deal with reality:

    “His goal is to create the best possible situation for consumers, create competition and choice,” Axelrod said. “We want to bring a measure of security to people who have health insurance today. We want to help those who don’t have coverage today, because they can’t afford it, get insurance they can afford. And we want to do it in a way that reduces the overall cost of the system as a whole.”

    I wonder if his mandarins dare tell Obama what common folk already know: his wants are all good and well, just that they are incompatible with each other and the real world?

  3. Eric Florack says:

    I guess in the word of the leftist, this qualifies as ‘leadership”

    (spit)

  4. I kind of think this was the plan all along. I’m only surprised that people are surprised.

  5. Dave Schuler says:

    As the comments to my recent post suggest, there are two conflicting points of view on the status of healthcare reform. One is that the president and the Democratic leadership have ineptly squandered an opportunity. The other is that everything is proceeding according to President Obama’s shrewd plan.

    If it’s the latter, I think it may fall into the “too clever by half” category, a tactical victory but a strategic failure.

    I think that President Obama learned the wrong lesson from what happened with healthcare reform under President Clinton. It isn’t so much that President Clinton didn’t show the necessary deference to the Congress and tried to impose a plan on them. It’s that healthcare reform is difficult and you shouldn’t entrust constructing a plan to your politically inept wife.

  6. Brett says:

    On health care, Obama’s willingness to forgo the public option is sure to anger his party’s liberal base. But some administration officials welcome a showdown with liberal lawmakers if they argue they would rather have no health care law than an incremental one. The confrontation would allow Obama to show he is willing to stare down his own party to get things done.

    Whatever he does, could he actually just pick something and run with it? What happened to his campaign skills and discipline from 2008?

    Instead, we get public debate between Obama officials with differing stances in press conferences, so nobody has any idea of what Obama is actually going to stand for in a health care bill. There were many things I disliked about Bush Jr., but the ability to keep message consistency among his top people was not one of them.

    I think that President Obama learned the wrong lesson from what happened with healthcare reform under President Clinton. It isn’t so much that President Clinton didn’t show the necessary deference to the Congress and tried to impose a plan on them. It’s that healthcare reform is difficult and you shouldn’t entrust constructing a plan to your politically inept wife.

    And that the HMO system is unpopular on paper and in reality, which is basically what Clinton’s plan centered around.

  7. Dave Schuler says:

    And that the HMO system is unpopular on paper and in reality, which is basically what Clinton’s plan centered around.

    That’s a critical point, Brett. The move to HMO’s was originally conceived as a cost savings measure. Costs would be reduced by a change in incentives which gave an advantage to preventive medicine. At least that’s the theory. It’s been the theory for about 80 years. The practice has been more elusive.

    That’s what concerns me about healthcare reform as it’s currently being conceived. Extending coverage is the easy part. Coverage has gradually been extended over the period of the last 80 years. Cost controls have proven far, far harder to obtain.

  8. Stan says:

    “Coverage has gradually been extended over the period of the last 80 years.”

    Isn’t the percentage of medically insured residents going down?
    And won’t it go down even further as the UAW and other industrial unions lose membership and power?

  9. Dave Schuler says:

    I meant coverage under various government programs.

    It started with the VA healthcare system, then the Indian Health Service in 1921. Healthcare for federal and state employees. Medicare and Medicaid in the 1960’s whose scope has gradually expanded over the years.

    More recently there have been a number of state programs in Tennessee, Maine, Massachusetts, and others expanding state healthcare subsidies.

  10. Dave:

    I don’t think it was a case of Obama being too clever by half. I think it’s just the way he is, his core approach to problems. He operates like a community organizer: let people have their say, let them wear themselves out, then step in and define the consensus.

    That’s a strategic failure only if his strategic goals are the same as yours. I don’t think they are. You’re focused on solutions to rising costs. I think Obama is focused on solutions to the uninsured, cancellations, rejections. As you’ve pointed out many times, insuring more people will cost more, not less, so there was never any politically practicable way to cover more people and cut costs.

    The key is to move health care from “privilege” to “right.” That done, we will figure out how to pay for it. We’ll have to find the cost-cutting, and we’ll no doubt raise taxes. Just as we’ve done to finance Medicare thus far.

    I think for better or worse Obama is a gradualist. This is a surprise to those on Left and Right who projected their own hopes and fears onto him. But he is a fundamentally moderate man, cautious and incrementalist.

    If there’s a problem here it’s the death of Teddy Kennedy and the incapacity of Robert Byrd. Other than that, I think we’re about where we were inevitably going to be.

  11. JT says:

    Nobody is ever going to be completely satisfied with the new health care reforms. Everyone is going to get just a tiny piece of what they initially wanted, but most people will probably look at that as failure or defeat.

  12. Steve Plunk says:

    Lack of leadership is not the problem here. The immensely difficult if not impossible task of a Utopian health care system cannot be had merely through better leadership. As well the approach of a single piece of legislation makes it too difficult.

    Small measured changes to combat rising costs is a better approach. Legislation that requires renewal to ensure bad laws go away. Tort reform would not only be good for health care but for all business except lawyers.

    Break this problem up and deal with it realistically rather than as some grand vision.

  13. Zelsdorf Ragshaft III says:

    I think they should start by being honest. Most know there are not 47 million people who do not have health insurance through no fault of their own. A good portion of that that number make more than enought money to pay for their own insurance. They choose not to. Then they should stop telling the lie people are not able to get health care. All anyone has to do is show up at an emergency room of a hospital and get treatment. People are not dying in the street for wnat of health care. Next. Tell the truth about what is in the bill they are trying to pass. Who wrote the damn thing? If it was the Apollo group, trash it.
    Asking for honesty from this Administration is never going to work. Obama will say anything to get what he wants. Like his buddy, the right reverend Wright said, he is a politician. A very very radical one.

  14. Herb says:

    Cost controls have proven far, far harder to obtain.

    This has been a crucial part of the debate that has been only fleetingly explored.

    Ignoring the leadership quandary for a minute, what kind of cost controls could be implemented that will be both effective and acceptable to the Zelsdorfs of the world?

    (Sorry, Zelsdorf…I called you out, cuz I just can’t let that “People are not dying in the street for wnat of health care. Next.” remark slide.)

  15. Brett says:

    I think they should start by being honest. Most know there are not 47 million people who do not have health insurance through no fault of their own. A good portion of that that number make more than enought money to pay for their own insurance. They choose not to. Then they should stop telling the lie people are not able to get health care.

    How many, then? Moreover, there’s insurance, then there’s insurance. A worthless, light-cover policy will do nothing when you get a major expense, and that’s all many of us so-called “young immortals” can afford.

    All anyone has to do is show up at an emergency room of a hospital and get treatment.

    Which does nothing for someone with a chronic condition, and is much more expensive than simply making it possible for people to see normal clinics earlier. And that’s forgetting that the hospital will usually try to come after you for the bill afterwards.

    People are not dying in the street for wnat of health care.

    They’re dying in their houses.

    Not that I particularly expect someone so pompous as to actually add “III” to his name to understand that.

  16. Tano says:

    Perhaps we have different senses of what leadership is, or should be. This is supposed to be leadership of a democratic nation, of free people. Its not exactly like the leadership style that might be necessary on the battlefield, when the lead is flying (which tends to be the GOP model for the only type of leadership).

    I think Obama was very smart to let everyone involved have their say, after he laid down the essential principles. If the Congress had been able to pick up the ball and move it downfield, and end up with a good bill, so much the better. Reagan used to like to quote the old saying about how its amazing the stuff you can get done once you stop worrying about who gets the credit.

    But if the Congress stumbles, as they seem to have done, then the President steps in, just at the moment that everyone is turning to him for leadership, and offers some clarification and energy.

    I still think it highly likely that there will be a bill that the left can live with (grudgingly), the middle will find quite positive, and the right will be infuriated about – not so much because of its content, but because it wont be a platter full of juicy targets. If thats the way it turns out, Obama will emerge the stronger for the process.

  17. TangoMan says:

    What happened to his campaign skills and discipline from 2008?

    This is like arguing that because someone has good horse riding skills those skills should make them a good race car driver. Campaigning is different from governing. People elected a good campaigner. If they wanted someone with proven successful experience at governing they should have voted for the ticket that had an experienced governor.

  18. mw says:

    I am glad the President is finally going to be speaking out on health care reform. We are well overdue to hear from the President on this issue. It has been quite a while since his major health care reform speeches on June 15, July 17, his major health care reform press conference on July 22, his heath care reform town hall meetings in Wisconsin (June 11), at the White House (June 24), North Carolina and Virginia (July 29) , New Hampshire (Aug 11), Montana (August 14), Colorado (August 15) and maybe a few other major speeches and media events that I might have missed.

    This time the President will be telling us what he wants to see in health care reform now, as opposed to what he wanted to see during the campaign, or David Axelrod’s chain-mail missive of August 13 outlining in detail what the administration expected to see from health care reform then.

    Speaking of which – I am doing my part. I have been diligently forwarding David’s chain-mail to every e-mail address I can find as he requested me to do.