Wednesday, January 27, 2010

Has Obama Botched Healthcare Reform?

Tom Schaller's post says things that I would have said were I smarter and better informed.  To overcome our political system's structural bias against liberal reform, he writes, it takes:  "(1) a lot of political capital in the first place; (2) and the exertion of unusual presidential influence on other Washington elites; (3) and a sophisticated and coordinated message campaign; (4) and probably a bit of luck." 

I guess you can't blame liberals for complaining that, when it comes to healthcare reform, Obama has been stingy with his political capital, reluctant to exert political influence when and where it would have done the most good and given to sending mixed signals when the reform effort demanded a clear voice.  When you combine all that with the bad luck of Ted Kennedy's expiring at just the wrong time, failure seems preordained.  Ezra Klein channels liberal disenchantment with Obama's passivity here.

But the idea that ObamaCare is dying because of Obama's tactical missteps is the product not only of 20/20 hindsight, but of confirmation bias.  Pundits who spend their time commenting on political maneuvering are understandably inclined to explain political events in terms of tactical masterstrokes and missteps.  They're prone to forget that, not very long ago, Obama's legislative strategy of deferring to the congressional leadership on healthcare reform looked pretty reasonable in light of the defeat of HillaryCare.  
Whatever you say about it now, Obama's strategy came a lot closer to success than the Clinton strategy of presenting Congress with a fait accompli.  The fact that the Obama strategy now looks like a loser doesn't mean that an alternative strategy would have won.  Kevin Drum reminds us that how quickly, and arbitrarily, conventional wisdom about the Obama presidency is changing; the same people who a few weeks ago were still marveling at his political mastery, are now lamenting his ham-handedness. 
Consider an alternative explanation of healthcare reform's bleak prospects that owes as much to hindsight as Schaller and Klein's explanations, but perhaps less to confirmation bias.  ObamaCare is stalled principally because it's massively unpopular, even in a blue state like Massachusetts.  Lots of liberals would have you believe that's because of a disinformation campaign staged by unscrupulous conservatives to mobilize pliable tea-baggers.  They don't explain why a Democratic majority that controls all branches of government, and has an eloquent president making its case amplified by a friendly mainstream media, can't hold its own in the battle for hearts and minds. 
Here's an alternative hypothesis:  ObamaCare is opposed by a substantial majority of voters because it's unfathomably complex and the product of too many sordid backroom deals.  Given its complexity, no one--not even the policy wonks who've mastered its intricacies--can be very confident that it will work in its present form.  Even the "pass-the-damn-bill" crew regards the Senate bill, at best, as a stumbling first step toward a rational healthcare system.  
That makes the unattractive features of the legislative process that yielded ObamaCare all the more important in the eyes of a rational voter with better things to do than think about healthcare reform.  We sometimes speak of what happens in Congress as a "deliberative process."  But that's just a figure of speech.  When we know an individual decision-maker has deliberated carefully, that gives us a reason for thinking that he has reached the right decision.  Legislatures don't "deliberate" in the manner of a rational individual by applying facts to principles to come to a rational conclusion.  Legislative "deliberation" is a matter of counting votes to aggregate the preferences of legislators (who in turn aggregate the preferences of their constituents) into a collective decision. Even if every one of those legislators were scrupulously rational, it wouldn't follow that the result of their collective "deliberation" is reasonable because it isn't the product of any single intelligence.   
The point of the legislative process is to generate legitimate results, that is, laws we ought to regard as authoritative public decisions even if we think they're wrong.  That a bill makes it through the legislative process doesn't give anyone much of a reason for thinking it's the right decision.  When it's riddled with ad hoc exemptions, like Nebraska's exemption from the incremental Medicare costs or organized labor's exemption from the excise tax on Cadillac health insurance plans, its legislative pedigree makes it look more like a wrong decision.
That points to another cost associated with Obama's legislative strategy.  Suppose that ObamaCare had been formulated inside the executive branch before being presented to Congress in substantially its final form (i.e., Obama had followed something closer to the Clinton strategy).  Wouldn't things have looked different to a rational voter, or a least the majority of rational voters who'd supported Obama's candidacy for president because they thought that the combination of his values and his judgment made him a better bet than the competition?  Then ObamaCare would then have emerged from a genuinely deliberative process that conferred intellectual and moral authority upon it.  In our system, only a president can wield that authority.
That doesn't mean that Obama would have succeeded, where Clinton failed, in pushing his own bill through Congress.  Maybe the same forces that defeated Clinton would have prevailed again.  Maybe Obama had already squandered too much of his intellectual and moral authority before healthcare reform was ripe for legislative enactment.  Or maybe moral or intellectual authority is something that a president has to use or lose.

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