Are The Pieces Aligning on Health Care?

[digg-reddit-me]David Brooks’s column is quickly becoming one of the most insightful, inside looks at the larger plans of the Obama administration (which suggests a column kneecapping Obama is forthcoming so Brooks can maintain his conservative cred). His latest column is practically gushing – but it certainly paints a plausible picture of what the Obama administration sees as it’s game plan on health care. Brooks starts his piece with this half-jesting, half-admiring set-up:

Let’s say that you are President Obama. You’ve inherited a health care system that is the insane spawn of a team of evil geniuses from an alien power. Pay is divorced from performance. Users are separated from costs. Rising costs threaten to destroy your nation and everything you hold dear.

You also know that [the only] two approaches [to actually fixing this] have one thing in common. They are both currently politically unsellable. Others have tried and perished. There are vast (opposing) armies arrayed against them. The whole issue is a nightmare.

You are daunted by the challenges in front of you until you remember that by some great act of fortune, you happen to be Barack Obama. This calms you down.

He then goes on to describe a strategy which runs like this:

1. Table-setting. Court everyone – get everyone to the table and agreeing on some basic meaningless “pablum.”
2. Congress. Ask Congress to put something together, keeping your distance as they investigate and write many competing proposals.
3. The Long Tease. Refuse to rule anything out or commit to anything – thus keeping all the interest groups at the table.
4. The Scrum. At the end of the summer session, when Congress actually begins to assemble health care in a series of all-night sessions, take a stronger role. But be willing to compromise. This scrum needs to end quickly – and send the bill off to be passed before the interest groups have time to realize who has and hasn’t been taken care of.
5. MedPAC. Include in the bill this medical equivalent of the Federal Reserve – an independent, technocratic body to oversee the industry. This is where the real reform will stem from.

This scenario sounds plausible – although a David Brooks column explaining it would seem to undermine the strategy itself.

So far, the Obama administration has been extremely impressive in how it has managed the health care debate. They make it seem as if things really are going according to plan so far – an extraordinary thing given the history of Washington and health care. For example, Ezra Klein provided some insight into why the American Medical Association quickly retracted it’s direct opposition to a public option in the health care debate, citing this Roll Call piece:

Top aides to Senate Finance Chairman Max Baucus (D-Mont.) called a last-minute, pre-emptive strike on Wednesday with a group of prominent Democratic lobbyists, warning them to advise their clients not to attend a meeting with Senate Republicans set for Thursday.

[Meeting] with a bloc of more than 20 contract lobbyists, including several former Baucus aides…“They said, ‘Republicans are having this meeting and you need to let all of your clients know if they have someone there, that will be viewed as a hostile act,’” said a Democratic lobbyist who attended the meeting.

“Going to the Republican meeting will say, ‘I’m interested in working with Republicans to stop health care reform,’” the lobbyist added.

Ezra Klein explains what this means:

They’re saying that you’re either with health reform, or you’re against it. And if you’re against it, you can’t expect to be taken care of in the final legislation. They’re not going to save your seat at the table while you’re trying to burn down the room. And the AMA, it seems, got the message.

This hardball strategy with interest groups plus the extraordinary wooing of legislators by the Obama administration that Matt Bai described in a piece this Sunday, the general agreement among most Americans including business interests that our health care system is broken, the impending deficit crisis, Obama’s mandate, and the unusual role ultra-conservative Orrin Hatch appears to be willing to play to help his good friend Teddy Kennedy achieve a dying wish (Suzy Khimm in The New Republic describes it as, “a particularly senatorial way to pay tribute to a dying friend.”) – with all of these pieces falling together, the Democrats may finally be able to achieve what Harry Truman started all those years ago.

[Image by JonathanHannpberger licensed under Creative Commons.]