Obama and the Dems Just Sound Too Wonky on Health Care

Barack Obama ran the best-organized and best-framed presidential campaign in history. How is it possible that the same people who did so well in the campaign have done so badly on health care?

And bad it is: The public option may well be gone. Neither Obama himself nor Senior Advisor David Axelrod even mentioned the public option in their pleas to the nation last Sunday (August 16, 2009). Secretary Sibelius even said it was “not essential.” Cass Sunstein’s co-author, Richard Thaler, in the Sunday NY Times (August 16, 2009, p. BU 4) called it “neither necessary nor sufficient.” There has been a major drop in support for the president throughout the country, with angry mobs disrupting town halls and the right wing airing its views with vehemence nonstop on radio and tv all day every day. As the NY Times reports, Organizing for America (the old Obama campaign network) can’t even get its own troops out to work for the President’s proposal.

What has been going wrong?

It’s not too late to turn things around, but we must first understand why the administration is getting beat at the moment.

The answer is simple and unfortunate: The president put both the conceptual framing and the messaging for his health care plan in the hands of policy wonks. This led to twin disasters.

The PolicyList Disaster

The whole is greater than the sum of its parts.

Howard Dean was right when he said that you can’t get health care reform without a public alternative to the insurance companies. Institutions matter. The list of what needs reform makes sense under one conceptual umbrella. It is a public alternative that unifies the long list of needed reforms:  coverage for the uninsured, cost control, no preconditions, no denial of care, keeping care when you change jobs or get sick, equal treatment for women, exorbitant deductibles, no lifetime caps, and on and on. It’s a long list. But one idea, properly articulated, takes care of the list: An American Plan guarantees affordable care for all Americans. Simple. But not for policy wonks.

The policymakers focus on the list, not the unifying idea. So Obama’s and Axelrod’s statements last Sunday were just the lists without the unifying institution. And without a powerful institution, the insurance companies will just whittle away at enforcement of any such list, and a future Republican administration will just get rid of the regulators, reassigning them or eliminating their jobs.

Why do policymakers think this way?

One: The reality of how Congress is lobbied. Legislators are lobbied to be against particular features, depending on their constituencies.  Blue Dogs are pressured by the right’s communication system operating in their districts. Congressional leaders have a challenge: Keep the eye of centrists and Blue Dogs on the central idea, despite the pressures of right-wing communications and lobbyists’ contributions.

Two: In classical logic, Leibniz’ Law takes an entity as being just a collection of properties. As if you were no more than eyes, legs, arms, and so on, taken separately. Without a public institution turning a unifying idea into a powerful reality, health care becomes just a collection of reforms to be attacked, undermined, and gotten around year after year.

Three: Current budget-making assumptions. Health is actually systematic in character. Health is implicated in just about all aspects of our culture: agriculture, the food industry, advertising, education, business, the distribution of wealth, sports, and so on. Keeping it as a line item — what figure do you put down on the following lines — misses the systemic nature of health. The image of Budget Director Peter Orszag running constantly in and out of Senator Max Baucus’ office shows how the systemic nature of health has been turned into a list of items and costs. Without a sense of the whole, and an institution responsible for it, health will be line-itemed to death.