Global Pulse Blog

There is an old saying that is passed down through the generations.  It is typically sung to the effect: everything in moderation.  Various individuals attribute the wisdom to various past figures, but no matter the source, the saying has some bite.

In a recent Economist article, the clever authors offered cogent commentary related to the fiery health care debates taking place within the US and what the Obama administration will have to do to navigate the storm and unfavorable winds.  For the most part, the authors diagram where and when Mr. Obama begins to vacillate and also recommend how he should proceed with a promising give-and-take strategy.  Although this literary dialogue devoted to policy compromise (aimed to directly please the centrists, while indirectly enraging the head and tail of the political spectrum) is certainly relevant to the title of this piece, I do not intend to dwell on it.  Frankly, others have done it well enough.

However, I believe another, and equally important, lesson in moderation  is encapsulated by the US health care debates of the past 15 years.  This lesson has to do with the process of bill creation rather than content.

The Clintons’ attempt at health reform received nothing more than a frosty shoulder from Congress once the President and First Lady unleashed their chimeric beast.  Part of this was because Congress did not care for “Hillarycare” (no pun intended, well perhaps a slight intention), and a lot of it was because Congress felt it had been excluded from the process.  The Obama team believed they could rectify this issue with ease.  For them, it was only a matter of unloading all of the legislative burden onto Congress.  All that was required of the Executive branch was a show of support and a calendar of due-dates.  In my opinion, this was the largest planning failure and impetus for legislative impasse that the administration could have created at such a critical and vulnerable time.

Instead of foolishly believing that a diametric approach would facilitate the process, the administration should have partnered with Congress but still assumed the necessary (and otherwise vacant) roles.  Although Congressional men and women can do a great many things, there is a key thing they never do: assume accountability to all American voters.  I am not implying that they are indifferent toward the greater interests of the country, but no matter how pragmatic they are, they are still elected by their constituents, which are always bound by state borders.  The US President is a bit unique in this regard.  The President is elected by the nation of voters (at least those that exercise their right and through an admittedly obscure process, the Electoral College) and has commensurate priority and perspective shifts.  Mr. Obama should not make light of this, and better yet, he should articulate his appreciation of this fact.  Without this pivotal revelation and subsequent action, no meaningful legislation will be put forward.

To date, the War on Health Care is taking place merely in the abstract.  We are not deliberating over any one bill.  There are many floating in the Capital Building breeze.  Each crafted by legislators with personalized ideas and voting blocks.  This simply will not do.  The appropriate action for the Obama team is to decide what exactly it wants and then clearly describe it to Congress and the American people.  It is fine to outsource the writing and even details to the Legislative branch, but for legislation of this magnitude, the bill’s outline must come from the President.  His insistent reinforcement of “less expensive, more quality/quantity” does nothing to bolster the public’s faith nor silence the critics (even if some oppositional claims are fallacious…and occasionally comical).  Waging a battle against those presumably advocating for “more expensive, lower quality” care is likely not fruitful.  I suspect their numbers are small and political influence nominal.  Better to explain to the public and policy detractors WHAT are the specific aims of the legislation and WHY we need them.  Follow that with the HOW, and the administration may just find its efforts back on track.

Fail to do so, and any attempt to eliminate some of our health care inefficiencies and reconcile our groups of uninsured and under-insured will be lost again for at least another two administrations….maybe more.