What We Have Learned from the Health Care Debate

by John Sides on December 16, 2009 · 22 comments

in Health Care,Legislative Politics

One thing that’s most impressed me amidst this debate is the relative sophistication of some political commentary about the policymaking process. Brendan Nyhan rightly singles out Matt Yglesias as one such commentator (e.g., see this post). Ezra Klein is another. I assume others would fall in this category, although surely not enough.

The pathologies of reporting and commentary on policymaking are well-known: various proposals are simplified into a very few competing alternatives and reporting on these alternatives treats them in horse-race fashion. See, for example, this article by Regina Lawrence on welfare reform.

The specific pathology that Brendan, Matt, and Ezra debunk is a fixation on the president in the policymaking process. Presidential power is assumed to be essentially limitless—e.g., if Obama would just say so, Joe Lieberman would roll over and vote for a single-payer system. (I exaggerate, but only a little.) When members of Congress don’t do exactly what the president wants or when (God forbid) the president “lets” Congress do actual legislating, reporters start in with “news analysis” like this silliness from John Broder in Sunday’s New York Times. Here, climate change is framed around what Obama can or cannot accomplish, complete with portentous questions like:

Can Mr. Obama surmount those problems in his latest effort to save the world?

A while back, I posted about a Ted Lowi essay in which he characterized this sort of news coverage as “unbelievably primitive.” And it is. Understanding policymaking means taking Congress seriously and treating legislators as autonomous. It means acknowledging (repeatedly) the multiple veto points that are built into the system. Policy change is not solely a matter of presidential will or skill—as I and others have noted.

Of course Obama has an agenda with regard to health care, climate change, etc. And of course legislative success or failure has implications for his presidency. But Yglesias and others have rightly pounded away at the notion that policymaking should somehow be framed around the president’s goals, actions, and standing. This frame gets the policymaking process wrong, and it arguably hurts our understanding of the policies themselves, whose details are subordinated to armchair quarterbacking about the president’s decisions or lack thereof. At its worst, you get this stunning contempt from David Broder for the fact that making policy is a process and that the point of the process is to (try to) make the right decision:

…the urgent necessity is to make a decision—whether or not it is right.

I know the usual excuses: presidents are visible figures, they make for easier news stories, public policy is boring, the horse race is fun, etc. I actually think that it’s not that much of a stretch for journalists to improve coverage of policymaking. Herbert Gans noted that political journalism has an implicit value of “altruistic democracy”:

…news implies that politics should follow a course based on the public interest and public service.

You see this value implicit in many stories about campaign finance, political corruption, and the like. I don’t see why better coverage of policymaking wouldn’t also align with this value. When certain problems are widely acknowledged—e.g., the untenable growth in the cost of health care—why not focus news coverage around the frame “What are our elected leaders doing to solve these problems?” as opposed to “Can Obama save the world?” I don’t think that frame crosses the line into advocacy—no solution is being endorsed—any more than do other stories that imply a belief in altruistic democracy.

Of course, I could be depressed that this post even needs to be written. If you are 18 years old and you have been sitting in Political Science 101 for maybe a week or two, you will know more about the separation of powers than is evident among political commentators who act as if presidents make policy. But I will choose not to be depressed, and instead will celebrate how much boilerplate political science is seeping into the mainstream political media.

{ 22 comments }

Kevin December 16, 2009 at 1:09 pm

I blame literature classes. Sure, understanding narrative structure and character development can surely help students understand literature, and possibly help future journalists create more entertaining articles and op-eds. But I would wager that this educational path to a career in political journalism does little to improve the quality and accuracy of future political analysis.

Here’s an empirical question for some undergraduate journalism student seeking a thesis topic: How do the educational background and early work experience of reporters and pundits correlate with the use of the types of frames and arguments identified in John’s post in their later political writing?

ptp December 16, 2009 at 1:47 pm

To quote Glenn Greenwald:

Indeed, we’ve seen before what the White House can do — and does do — when they actually care about pressuring members of Congress to support something they genuinely want passed. When FDL and other liberal blogs led an effort to defeat Obama’s war funding bill back in June, the White House became desperate for votes, and here is what they apparently did (though they deny it):

The White House is playing hardball with Democrats who intend to vote against the supplemental war spending bill, threatening freshmen who oppose it that they won’t get help with reelection and will be cut off from the White House, Rep. Lynn Woolsey (D-Calif.) said Friday. “We’re not going to help you. You’ll never hear from us again,” Woolsey said the White House is telling freshmen.

That’s what the White House can do when they actually care about pressuring someone to vote the way they want. Why didn’t they do any of that to the “centrists” who were supposedly obstructing what they wanted on health care? Why didn’t they tell Blanche Lincoln — in a desperate fight for her political life — that she would “never hear from them again,” and would lose DNC and other Democratic institutional support, if she filibustered the public option? Why haven’t they threatened to remove Joe Lieberman’s cherished Homeland Security Chairmanship if he’s been sabotaging the President’s agenda? Why hasn’t the President been rhetorically pressuring Senators to support the public option and Medicare buy-in, or taking any of the other steps outlined here by Adam Green? There’s no guarantee that it would have worked — Obama is not omnipotent and he can’t always control Congressional outcomes — but the lack of any such efforts is extremely telling about what the White House really wanted here.

In addition to this, Rahm Emanuel has been telling Harry Reid to do whatever Lieberman wants. So how are you going to sit here and tell me the President isn’t culpable in all of this? And please keep in mind that it’s very manageable to blame both the President and Congress, specifically the Senate, for their incompetence and willingness to bend over backwards for the health insurance/pharmaceutical industries in lieu of their own constituency. I can do both – be mad at both of them simultaneously. So if I express anger at one that’s not at the expense of another.

I’m getting kinda tired of people telling me I’m an being silly for holding people responsible for their actions. Stop this rampant apologism, please. Elected officials don’t need or deserve apologism. They are the ultimate and final deciding factor in crafting the rules by which our country is governed, if you can’t hold them responsible for their failures and missteps then you have created for yourself a world in which you are literally resigned to sit on your hands and enjoy the ride until you die.

Jonathan Bernstein December 16, 2009 at 2:12 pm

ptp –

The problem is that Sides is right, and Greenwald is wrong. As John said, Senators are autonomous people; sometimes, there’s just nothing that can be done about their issue positions. The WH can’t threaten Holy Joe on the electoral front, and odds are that taking away his committee would just turn him from an annoying version of McCaskill into something more like McCain. And that’s not to mention the other dozen or so Senators who didn’t want a serious public option.

Sometimes, you just don’t have the votes for what you really want, and you have to settle for what you can get, at least until the next election.

John Sides December 16, 2009 at 2:22 pm

ptp: I’m making an empirical point, not a philosophical one. The empirical reality is that presidential influence is more limited than Greenwald supposes. That simple point is not an apologetic nor is it any kind of invitation to apathy. If Congress passes a bill, the representatives who voted for it are accountable to voters. If Obama signs the bill, he is accountable. If you don’t like the bill, you can yell, scream, vote for someone else, or do what you want. But if you believe, as Greenwald suggests, that there is some magic button that Obama could have pressed that makes Lincoln and Lieberman sit up and say “Yes, sir,” you’re mistaken. Moreover, as Jon points out, this isn’t a one-shot game. Obama will need their support down the line, so a scorched-earth strategy could prove highly counter-productive.

Jonathan Bernstein December 16, 2009 at 2:32 pm

Ezra Klein, Matt Yglesias, and Kevin Drum have all been good on process…I think Steve Benin and Greg Sargent are good, too, and Josh Marshall’s TPM takes Congress seriously and does some really excellent reporting. Ezra, Jonathan Cohn at TNR, and Tim Noah at Slate have been outstanding on policy.

pds December 16, 2009 at 3:06 pm

Ah, another rationalization for the structural failure of the Democratic party… something “progressive” Political Scientists (cough) cant admit because it would render their technocratic careers in “incremental” analyses complete bullshit.

Despite a Democraticaly controlled Congress, Obama found a way to work against his base, and defeat the very public option he publically advocated. But the “objectivity” of Political Scientists tells us his soul is good, his heart in the right place, regardless of performance.

Its Coke debating Pepsi. I know one is less filling, truly i do, but its still Coke debating Pepsi.

ptp December 16, 2009 at 3:08 pm

Johnathan:

Sorry, settling isn’t good enough. What, exactly, am I settling for, anyway? Single-payer? Strong public option? Weak public option? Medicare buy-in? Every single thing that we ‘compromised’ with has been surreptitiously tossed out the window. “No, be patient and settle for what you can get until your next chance to not get anything.” Really? You won’t find a more willing and accepting political climate for universal health care. Indeed the majority of Americans supported the idea, and even the swing for the Medicare buy-in option was something like 30% across the entire nation.

I understand the narrative that you’re working under, but it’s broken. This isn’t progress, it’s marginalization. The results of the health care reform effort should scare you. If Congress can’t make *this* happen when they have broad popular support then what, exactly, do you think they’re going to do about issues like fixing the income gap disparity, getting out of Afghanistan*, and the myriad other things that the American voting public seemed to think were such great ideas before shiny distractions like bipartisanship, political theater, and non-compromise-dressed-as-compromise showed up?

* This one already failed right under our noses, so I already have a head start here.

John:

I agree that the White House isn’t capable of making things happen by sheer will alone, but I think you’re underestimating it’s ability to affect the negotiations. Just two or three days ago Emanuel was telling Reid to give Lieberman what he wants, which effectively killed the Medicare buy-in provision, the last remaining sad-sack vestige of the single-payer ideal we went in hoping for. So while you’re right, it doesn’t make sense to expect the White House to single-handedly save the day, I think what people are actually frustrated about is that HE ISNT EVEN HELPING. Remember when Obama said he would be a one-term President if that’s what it took to get health care reform passed? Remember when he ran on the deliberately vague promise of health care for everyone? Yeah, he couldn’t have given those ideas up fast enough. So be careful that you aren’t conflating hero worship with people expecting their elected executive to stop sabotaging the things they elected him to help pass.

And if Obama will need Congressional support down the line why was he sending Emanuel to bully freshmen Congresspeople into supporting the war spending bill and why has Emanuel been allowed to run his mouth about his open disdain for the progressive constituency that got his boss elected in the first place? The political capital trope is convenient and silly, and it serves as an enabler. Please reconsider whether it actually makes any sense given the events that have transpired.

John Sides December 16, 2009 at 3:38 pm

PDS: I have no idea whether Obama is good-hearted. That is beside the point. The point is that policymaking in the Senate is current dependent on a 60-vote majority, and that empowers Senators who appear to be more conservative than Obama. There is no “structural failure” here that I can see. There is simply the fact that there are not enough Senators who support a public option. This is why my post discussed veto points.

ptp: What I said to pds suggests my sense of the lay of the land. And it reflects the opposite of hero worship. The entire point of the post was that presidents are not heroes. As such, I see little that that Obama can do that will provide a 60-vote majority in the Senate for the public option or various other measures not likely to appear in the bill but that are supported by some progressives.

I don’t know whether Obama “bullied” anyone on war funding. That story is based on a quote from Lynn Woolsey that the White House denied. But let’s say it’s true. Why might the White House put pressure on liberal freshman Democrats in the House, but be more circumspect about conservative Democrats in the Senate? I can think many reasons. For one, liberal freshmen in the House are far less likely to be pivotal votes. For another, there are different norms in the Senate about party discipline, making heavy-handed pressure more likely to be counter-productive.

ptp December 16, 2009 at 4:15 pm

Fair enough, but the matter of the White House telling Reid to do whatever Lieberman wants seems pretty unambiguous, and Obama has done other things to neuter health care reform, like killing pharmaceutical price negotiations. In addition, the White House is getting into it with Howard Dean and his statement that the health care reform bill should be killed.

Most people I know are pissed because Obama’s sabotaging things, not because he hasn’t fixed them. It’s obvious why he hasn’t fixed them. Even if he could, he doesn’t WANT them fixed. Not in that way, anyway.

The issue of disillusioned hero worship is two things: a big strawman, and an odd sort of cognitive dissonance where people are turning their own Obama hero worship into sardonic acceptance of his limitations, and in so doing are turning his former critics into wide-eyed idealists. It’s the same sort of thing that happened with the war in Iraq. People who opposed it early on were right but they weren’t “serious” so they were actually wrong. Kinda convenient, isn’t it?

ptp December 16, 2009 at 4:20 pm

really want an edit button :(

“disillusioned hero worship” should read “naive hero worship”

Jonathan Bernstein December 16, 2009 at 4:49 pm

I agree with John’s responses to PDS and ptp…on Obama’s “true” intentions on health care, what is evident is that he read the 1993-1994 experience as a lesson that you can’t get health care reform without co-opting the major interest groups. My reading of it is that he was exactly correct: the alternative to the bill that appears likely to pass is not a more liberal bill, but no bill at all. Given that a lot of political scientists and informed observers agree with that analysis, I think it’s reasonable to believe that Obama’s strategy is a sincere effort to get the best bill available. It is possible the strategy is wrong, of course, but I just don’t see any evidence pointing in the direction of the 218th vote in the House and the 60th vote in the Senate being to the left of Obama on this issue.

Oh, and it’s fairly likely that the “Rahm told Reid to give Lieberman what he wanted” thing was just deliberate scapegoating by all concerned.

Matt Jarvis December 16, 2009 at 5:28 pm

I just find it unbelievable that John (or Lowi) finds the primitivism of the press unbelievable…..

ptp December 16, 2009 at 6:21 pm

“Oh, and it’s fairly likely that the “Rahm told Reid to give Lieberman what he wanted” thing was just deliberate scapegoating by all concerned.”

What does this even mean? Can you substantiate it? Otherwise it seems like conjecture on your part, because it is pretty clear that this thing did in fact happen.

If a man is beaten and bloody on the side of the street, on the verge of death, and I kick him in the ribs for good measure, do you go around defending me saying “Well it’s not like he could’ve done anything about it anyway”? Do you look at my act as a scapegoat for the prior act that put the man there in the first place? Maybe so, but does it excuse what I did?

Jonathan Bernstein December 16, 2009 at 8:10 pm

On Rahm as scapegoat: it’s Ezra Klein’s reporting, and it makes lots of sense to me:
http://plainblogaboutpolitics.blogspot.com/2009/12/scapegoat.html

What? December 16, 2009 at 8:58 pm

PTP:
How, exactly, is Obama supposed to pressure Joe Lieberman – an “independent” already alienated from the Democratic base serving a term that doesn’t expire until 2012? How is threatening to pull his chairmanship from Homeland Security going to affect Lieberman’s future willingness to work on issues like climate change, job stimulus, etc., where his vote (again, an “independent” not a Democrat) will prove crucial? How is Obama supposed to pressure Lincoln or Landrieu, both of whom serve states in which cooperating with Obama could make them cannon fodder in very near-term elections? I think Sides’ point is very good and quite simple: when you combine a highly polarized electorate (after all, Republicans have mobilized hard on this issue and view this as more or less life or death), and the institutional realities of policy-making in the U.S. (especially in the Senate, where conservative interests are overrepresented), Obama has made a calculated decision (perhaps wrongly) to try to be a broker rather than dictator, since the 1993 dictator approach failed so miserably with enormous electoral consequences for the Dems. Again, I don’t know whether a bit more dictator could have been useful; it’s hard to say given the highly polarized nature of the electorate. This way, with delegation, at least Congress will have to own this bill as well as the President. But I really don’t think Greenwald’s accusation that this is the “real” preference of the Obama team holds any water at all: if a health care bill fails, Obama’s entire governing agenda is in jeopardy, and the Dem majority is more or less finished in the House. He knows that, they know that, and if they don’t figure something out (yes, incremental, but something), they will fail again, in the very same way. Obama must know that any significant shift in the status quo in terms of insurance reform will ramify throughout his whole term and will set the stage for what else he can get done. This is just not a one-shot game and I don’t think you can delink Obama’s preferences from considerations about other areas in which he will need cooperation. I think most of all, he is just very flexible.

steelpenny December 16, 2009 at 9:03 pm

To those who keep saying “60 votes, 60 votes, 60 votes,” I say BULL-FUCKING-SHIT. Under Bush, the republicans never had anything like 60 fucking votes and they still got their shit through. Why? Because they had fucking discipline and the Democrats were fucking chickenshits. ptp is exactly right that the Senate leadership is embarrassingly weak and that Obama’s leadership has been nonexistent. You say there’s nothing Obama can do. I say where’s the fucking bully-pulpit? Obama could get up and say he won’t sign a bad bill; he could could tell Democratic senators to support a public option or no goodies from the Party come reelection time. He hasn’t said shit. HE IS THE LEADER OF THE FUCKING DEMOCRATIC PARTY AND HE NEEDS TO ACT LIKE IT. When Boehner is the Speaker of the House, be sure to tell us again how Obama did the smart thing.

Ben December 16, 2009 at 10:02 pm

Um, Steelpenny, what exactly did the Republicans accomplish that was near and dear to their base? Social Security privatization, for example, died because it did not have 60 votes. As far I as I know, they didn’t dismantle any major social safety net program. In fact, the primary example of Republicans ramming through a bill is the 2003 Medicare Part D expansion, which… provided prescription drugs to seniors using deficit spending, hardly a Club For Growth talking point. The only thing I can think of is the 2001 tax cuts that barely passed with 50 votes (Cheney as tiebreaker), and it’s not exactly politically risky for a conservative Dem to vote for a tax cut, as opposed to HCR which is unpopular in states like Arkansas and Nebraska. Same applies to Iraq/Afghanistan: there was political risk in opposing war, but supporting it was pretty safe. It’s also worth noting that the Tom Delay/Karl Rove strategy was not very smart in the long run.

Now, not to say that Obama is immune to criticism. I think his messaging strategy has been horrendous and has let the GOP hijack the debate. There are also plenty of things to criticize about executive power, financial reform, etc. But, it’s important to focus our critique in the right place. Threatening to withhold “DNC goodies” certainly would have an effect on a Ben Cardin or Jeff Merkley. But like it or not, in the current environment, the party needs red-state Dems like Ben Nelson more than he needs us, especially since a “no” vote virtually guarantees plenty of insurance/Pharma donations. Frankly, I’m kind of surprised there aren’t more conservative Dems to worry about (Pryor and Dorgan come to mind, among others.) By contrast, Obama/Rahm/the DNC have immense leverage over progressive reps like Lynn Woolsey, because they come from safe Dem districts and are easily replaceable. It sucks, but that’s how it is.

Voting for HCR is a genuine political risk for a Ben Nelson or a Blanche Lincoln, senators from heavily red states whose credible replacements would be much more conservative Republicans, not progressives. The White House and the DNC simply do not have a lot of leverage over them. I think they should vote for HCR because it is the right thing to do, but the reality we live in is that politicians look after their own self-interest, and there’s nothing Obama can do to change that.

steelpenny December 16, 2009 at 10:49 pm

So you’re critique is that to advance our agenda we need these assholes’ votes so we have to throw out our agenda to get their votes? Brilliant fucking strategy. Americans may be stupid but we voted for Democrats and we have some idea what that means; fail to give voters what they want and they’ll turn on you (gee, I wonder why the HCR bill gets less popular as it gets more watered down?). If Ben Nelson et al. want to play Republicans, let them try running as Republicans; otherwise, they need to toe the fucking line. Reid can take away their chairmanships; Obama can stop every fucking cent from going to Nebraska if he wants to. That isn’t happening. Instead, we’re being told to be thankful for the shit sandwich they’re feeding us because “it’s better than nothing.”

Eric L. December 16, 2009 at 11:40 pm

On a different point, I have a nit to pick with Sides. We don’t cover separation of powers in Political Science 101.

ptp December 17, 2009 at 1:09 am

Ben: The problem here is that you stand back from this issue and try to look at it pragmatically, but you treat the Centrist backlash against Nelson or others if they vote for health care as inevitable, but you treat the progressive backlash as shameful and avoidable. Don’t make the mistake of thinking that just because you can sit here and talk to me in the comments section of a blog that I’m the one who needs to change or bend. I want universal health care, and I want someone who will fight for it and support it. I will speak out on that point.

I don’t buy all this realpolitik nonsense because by definition it gives up what is ethically right in exchange for what is expedient with no regard for whether the expedient result is actually better than no result at all.

Dave Zimny December 17, 2009 at 6:11 pm

My verdict on the (longwinded but fascinating) bout so far: PTP is so far ahead on points that we might as well declare a TKO. The key point here is the failure of the White House (Barack, Rahm, Joe, or whomever) to deliver a consistent public message or exert any kind of meaningful private pressure (as far as we can tell) to shape the final legislative outcome. For the pedantic among us, I offer two quotations:

“Politics ain’t beanbag” – Finley Peter Dunne

“Leadership is not about being nice. It’s about being right and being strong.” – Paul Keating

Laron Barr December 19, 2009 at 2:56 am

I think that if the contry is ever bank rupt that dering a time of war that treason levyd on the people invalvd will get ther goat.

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