Hang around politics long enough, and you’ll start to see reruns everywhere. Fifteen years ago this month, Hillary Rodham Clinton launched a nationwide bus tour to promote her and her husband’s ultimately doomed proposal for an overhaul of U.S. health care. Wednesday, President Obama held a health-care roundtable — ultimately hard to distinguish from a campaign rally — at the Northern Virginia Community College campus in Annandale, Va., just outside the Beltway.
Hillary’s tour ran into trouble at the outset. At the second stop — in Seattle — half of the crowd of 4,500 had been urged to attend by a local radio-talk-show host, and they vocally opposed her plan. The New York Times reported that she “struggled to be heard above the cacophony of shouts, boos, and whistles.” In Portland, Ore., a plane appeared above the event with the banner, “Beware the Phony Express.” Nigel Hamilton wrote in his biography of Bill Clinton that “when the caravan reached the first highway, there was a broken-down bus swathed in red tape and bearing a forbidding notice: ‘This Is Clinton Health Care.’”
There was nothing quite so theatrical at Obama’s event, although someone had lined a nearby wall with small posters that looked like the Obama campaign logo with a hammer and sickle in the center. More than an hour before the roundtable began, a lone young man in an Obama T-shirt waved a sign that said, “Real Reform Is . . . a Public Insurance Option.” With the administration indicating that the president strongly prefers a public plan but won’t reject a final bill that doesn’t include it, even those still wearing Obama T-shirts are left conditionally protesting their own leader.
The event was touted as a national Internet conversation, with the president taking questions submitted via e-mail, Twitter, and YouTube. But on the White House’s Facebook page, the video feed was spotty at best. Response comments streamed in, such as “If our White House is so rich and powerful, why can’t they stream video?” and “They can’t even stream a town hall correctly, you want them in charge of health care?” Whenever the video stream paused or was interrupted, it picked up and attempted to make up for lost time by playing at a faster speed, turning the president’s usually perfectly timed cadence into Porky Pig.
One needed good audio quality to detect the minute shifts and hedges in Obama’s stance on what health-care legislation should and should not include. Early on, he cited figures from the Congressional Budget Office — an unusual source, since the CBO offered some of the toughest analysis of the ideas Obama wants in his plan, declaring that just the portion it had analyzed would cost at least $1 trillion and bring coverage to only another 16 million people. Obama later said that the savings generated under his health-care plan “aren’t scorable” under CBO’s calculations. Perhaps they’re invisible.
Speaking to the American Medical Association last month, Obama said that there was no way enactment of his reform plan could result in Americans who are happy with their current coverage losing that coverage. There was not much room for interpretation: “If you like your doctor, you will be able to keep your doctor, period. If you like your health-care plan, you’ll be able to keep your health-care plan, period. No one will take it away, no matter what.” But Wednesday, Obama hedged a bit, saying only that he “wanted” Americans to be able to keep their current plans.
At the Annandale event, he was asked about taxing health benefits provided by employers. On the campaign trail, John McCain proposed a similar idea, to be partially offset by a tax credit; Obama lacerated his opponent over this with $44 million spent on 16 attack ads in every major swing state. But Wednesday, the president would say only that his preference was to cap the benefits, or to permit a tax on them past a certain amount.
Back in the White House, CBS’s Chip Reid and Hearst Newspapers columnist Helen Thomas took umbrage at the White House’s ultimate control over the questions asked at the event. Reid noted that “even if there’s a tough question, it’s a question coming from somebody who was invited or who was screened or the question was screened.” Indeed, three early questions came from a single-payer advocate, a representative of the liberal activist group Health Care for America Now, and a member of the Service Employees International Union, the last of whom essentially asked, “What can I do to help you?”
The town-hall meeting ultimately represented a solution in search of a problem. Americans don’t need to be persuaded that the current way of providing care is frustrating, paperwork-laden, complicated, and growing more expensive. What’s left to sort out is what ought to be done, a process that would require “honest accounting” on several different levels.
And yet, Obama’s lines haven’t changed much: They’re still the usual combination of attacks on the status quo and catchphrases fit for a self-help guru. “Premiums are rising three times faster than wages.” “If we don’t act, more people will lose coverage, and more people will lose their jobs because their employers cannot afford to cover them.” “This is a problem we cannot wait to fix. We are going to pass health-care reform, this year.” “We’re at one of those rare moments where everyone is ready to move forward. You can’t just be scared.” “It can be done.”
It’s fairly easy to persuade Americans that health care ought to be “reformed.” But the public’s thinking on health care isn’t too far from the prescriptions of “Oscar Rogers,” the faux financial expert on Saturday Night Live who, when asked what should be done in the aftermath of last fall’s economic troubles, kept yelling “Fix it!” No matter how he was asked, his recommendations never got more detailed than, “Identify the problem and FIX IT!”
This is, in fact, the path HillaryCare trod 15 years ago. Americans weren’t terribly pleased by the way they were paying for health care back in the early 1990s. Employees always think their premiums and co-pays are too high; employers always feel like they’re shouldering too much of the burden; and those without insurance always think somebody should step in and provide them with some. Everybody wants everything they need covered by their insurers, as well as some things they probably don’t need (e.g., gastric bypass surgery, chiropractors, hair prosthesis — all subjects of mandates or attempted mandates in various states).
So reform sounds great in the abstract. But then the public learns the details of the legislation — say, from an incredulous Harry and Louise sitting around a breakfast table — and it doesn’t seem like such an improvement. Town-hall meetings don’t build a majority of “aye” votes, and when there is no real effort to engage the arguments of the opposition, just the usual straw man that the alternative is to “do nothing,” one wonders whether these town-hall meetings are worth anyone’s time, much less the president’s.
If Obama really wanted worthwhile reform more than he wants a signing ceremony, he would have to do two things he has not yet indicated he’s willing to do. The first is not only to know what you want — besides “fix it!” — but to be able to rank those often-competing goals in a hierarchy. At some point, policies aiming to cover everyone and policies aimed at reducing costs crash into each other. A review board that aims to ensure that the government pays only for cost-effective treatments is at some point going to deny citizens care that they want. A president has to know exactly what’s a deal-breaker for him, what’s worth a veto threat, what provision or concept is so important that he’d rather see no bill than a bill that lacks it. At this point, it’s not clear that Obama really knows where his own red line is drawn.
The second necessary task — which grows out of that prioritization process — has largely been outsourced to Reid and Pelosi: determining which items in that hierarchy can get 60 or more votes. If we include this provision, does that bring on X many senators, but cause Y number to bail? If we make these changes, can it still get through the House? Can we address that issue in some separate legislation later?
This would require governing, not campaigning; compromising, not promising; and meetings with legislators up on Capitol Hill or at the White House, not the doling out of easy applause lines to an audience at a community college in Annandale.
– Jim Geraghty writes the Campaign Spot for NRO.