A Lack of Audacity
How Obama's health care plan resembles the candidate himself.
Ezra Klein | May 30, 2007 | web only
The first stumble of Barack Obama's presidential campaign came last March, at the SEIU health care forum in Las Vegas, Nevada. [..] He stammered before the surprisingly tenacious grilling of 23-year-old Morgan Miller, who asked, simply, why his web site had more specificity on lead poisoning than health reform. [..] Obama pleaded, sensibly, for more time. "Keep in mind," he said, "that our campaign now is, I think, a little over eight weeks old
If we have another forum in a couple of months and it's still not there, I'll be in trouble."
He was already in trouble. The reviews were rough. Compared to John Edwards, who had a detailed plan, and Hillary Clinton, whose fluency with the subject is unmatched among the contenders, he seemed uncertain and adrift. [..] The attacks were a bit unfair, and Obama's protests on target. His campaign was new [..]. In fact, he did the right thing that day, offering principles in lieu of a plan. ("Number one," he told Miller, "we're going to have to make sure that everybody is in.") And yesterday, Obama released his health care proposal. If there's another forum, Obama won't be without a plan. But he may still be in trouble.
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Number one, he didn't make sure everybody is in. There is perhaps no more surprising fact about Obama's plan than that it is not universal. It is certainly sold as if it is. In his speech unveiling the proposal, Obama bragged that, "[m]y plan begins by covering every American." But it doesn't. To say otherwise is rhetorical overreach, the appropriation of a popular and broadly-supported goal without an attendant mechanism for achieving it.
There are a few ways to achieve universal health care. You can create a single-payer plan that enrolls the population automatically. This is what Canada does, and how Medicare covers the elderly. You can create an employer mandate, where the primary responsibility falls on workplaces, and smaller mandates mop up the remainder. That was the approach showcased in the Clinton reforms of the early '90s. You can create an individual mandate that charges every American with procuring health insurance, and penalizes them if they don't. This is the approach favored by Mitt Romney in Massachusetts, Arnold Schwarzenegger in California, Ron Wyden in the Senate, and John Edwards in the presidential campaign. Obama's plan offers none of these approaches.
Instead, it seeks to make care cheaper and more accessible, assuming that, if it succeeds -- and that's a big if -- Americans will enroll of their own volition. It is a plan with the potential to be universal, rather than a universal plan. In that respect, it is very much like Obama himself.
There has been, in recent weeks and months, a robust debate over whether the Democrats should offer policy details. This conversation has operated on two levels. The first, explicit, level, is a political argument over whether presidential candidates are well-served by specificity, or at least whether it should be demanded of them. The second level, less often expressed, is really about Obama.
Few are looking to Clinton for details, as her public record is so well-known, and her policy commitments so lengthily expressed. Edwards, for his part, has unleashed a remarkable torrent of policy specifics, hoping to brand himself the candidate of ideas. It is Obama who has remained a relative cipher, the interplay of his ideology and political instincts opaque. His supporters appreciate his willingness to be expansive, to avoid labels, to evade the traps of specificity. His skeptics demand details, protesting that the Democratic base deserves to know whether he was a truly transformative candidate or merely an inspiring speaker.
His health care plan confirms the suspicions of both. He will be harmed by the specificity, even as his transformative rhetoric makes his actual plan seem dull and cautious in comparison. His is a plan of almosts. It is almost universal, without quite having the mechanisms to ensure nationwide coverage. It almost offers a public insurance option capable of serving as the seed of single-payer, but it is unclear who can enroll in it, and talks with his advisors suggest little enthusiasm or expectation that it will serve as a shining alternative to private insurance. It almost takes on the insurance industry, but asks for, rather than compels, their participation.
Make no mistake: There is much to praise in the plan. Obama has borrowed John Kerry's idea to have the government to absorb certain catastrophic costs, and while the details aren't spelled out, it's a promising concept. Insurers will no longer be able to discriminate based on preexisting conditions, and all children will have health coverage. If passed, our polity would be better, our people would be healthier, and our finances would be more secure.
Its failing, somewhat ironically, is a lack of audacity. It accepts the sectioning off of the market into the employed, the unemployed, the old, the young, and the poor. It does not consolidate the system into a coherent whole, preferring instead to preserve the patchwork quilt of programs and insurers that make health care so difficult to navigate. It does not sever the link between employment and health insurance, nor take a firm step towards single-payer, despite Obama's professed preference for such a system.
All the ingredients are in place for this to be a great plan -- a public insurance component, a commitment to universality, an understanding that coherence is better than fractiousness, a willingness to regulate the insurance industry -- but, in each case, at the last second, the policy is hedged before the fulfillment of its purpose. In this, Obama's plan is not dissimilar from Obama himself -- filled with obvious talent and undeniable appeal, sold with stunning rhetoric and grand hopes, but never quite delivering on the promises and potential. And so he remains the candidate of almosts. But as he told Morgan Miller back in March, there is time yet. And he is so very close.
