Aftermath: What Have We Learned from Health Care Reform?

Begin with this article by Tom Schaller at FiveThirtyEight.com.

Tom's bullet points:

1. Non-incremental policy change is never easy.

2. The presidential pulpit doesn't bully by itself.

3. Misinformation is more easily disseminated than debunked.

4. Have an Administration bill.

5. Proxying process for policy works.

6. It pays to hold out.

7. Bipartisanship is a waste of time—except as a tactical feint.

All of which are true, but they dance around the core points a bit. Here's my version.

1. Fighting requires leadership. Nobody ever said something as initially ambitious as health care reform would be easy. Even with Democratic supermajorities, it was known by everyone (except Barack Obama and Max Baucus) that the Republicans would do everything in their power to sabotage their efforts. This was going to be an uphill struggle from the start... and the man who was elected, in no small part, to see it happen began by telling Congress, "Do something!" and then sitting silent in the White House for seven months. Such leadership as there was until last month came not from our president, but from two deeply unpopular and divisive figures, Nancy Pelosi and Harry Reid- which allowed the Republicans to turn the American people strongly against the whole process.

2. Leadership requires having specific, clearly defined goals, and a plan to achieve them, beforehand. Obama deliberately did not have this- taking the wrong lesson from Hilarycare. Hilary Clinton's 1993 effort failed because she shut out everyone else from the decision-making process, presenting her plan as a take-it-or-leave-it package. Obama responded not by sitting down with his party's Congressional leadership and thrashing out a plan, but by having no plan whatever- leaving it to Congress to make something up that he'd claim as his own after the fact. This left him- and the entire Democratic Party- impotent to defend a plan that didn't even exist from the attacks of Republicans and their media spokespersons.

3. Leadership requires expressing, repeating, and defending that plan. Obama, having no specific plan to defend, spent months generally silent, saying only that "we have to have health care reform" with no solid definition of what shape it would take. This allowed Republicans to lie broadly and shamelessly about the plan, defining it before the Democrats could. In popular opinion, the Democrats have yet to recover from this total strategic failure- and barring a tremendous rally by Obama this fall or the disintegration of the Republican machine, they will pay for it in the election to come.

4. The modern political process doesn't give a rat's ass about the truth- only about what sounds best. Beginning with Sarah Palin's "death panels" lie, the television media- and, indeed, most of the print media as well- have entirely failed to call out Republican talking points on their innacuracy or outright deception. This is fair enough, though, since the media has also failed to call out the Democrats- once they finally got something to bring to the people- on the empty nature of their own claims in support of the bill. About the best that can be said on the Democratic side is that they didn't lie so much as present the perfect best-case scenario for how their overly compromised plan would work. Net result: support and opposition for the bill had nothing to do with any actual, truthful facts, and everything to do with fear, anger, and partisan loyalties.

5. The Democrats, contrary to what Republicans claim, do not have any unifying ideology except greed for power. The only way the Democrats got the bill through the House was to guarantee that health insurance coverage for abortions would be henceforth illegal. One out of eight Democrats still voted against the bill- mostly because it was too strong rather than not strong enough. In the Senate, Max Baucus, Ben Nelson, Blanche Lincoln and Joe Lieberman each extorted concessions that weakened the final plan to the point of impotence while, in the process, destroying the public opinion of the bill through such things as the "Cornhusker Kickback." By contrast, the Republicans- who have been fighting to purify their ranks- stood from beginning to end united as a solid wall against the whole process, even working to deliberately undermine and delay it. The Democrats could not hold together when it counted.

And, last but most of all:

6. What is done in Washington is done for absolutely no other reason than political tactics. Despite the rhetoric, virtually nobody in this whole process on either side stood on principle or voted according to the good of the nation. The final passage of the Senate bill last night in the House came about not because of Democratic unity on the bill, but because of Democratic fear of the consequences should they spend so much time on the effort to come up with nothing. Republicans, on the other side, scarcely even pretended to cooperate with Democrats to find a compromise- despite the pre-compromises initiated by Barack Obama. They knew, from the start, that they would gain absolutely nothing by cooperation, but by determined opposition they could rally their base and take advantage of Democratic divisions. In the end, Republicans opposed what is essentially Massachusetts' Romney-care on the national level not because of the merits but because Democrats proposed it. Likewise, Democrats voted for the final bill not because of the merits, but because they would suffer at the polls if they failed to pass anything- no matter how horrible what they passed was.

We desperately, DESPERATELY need something else in our politics.