Health Insurance Reform: Barack Obama's Leadership Test

All the posturing, yelling, screaming and even firearms displaying in the Democrats' health insurance reform road show highlight a crucial weakness in President Obama's tactical approach to the reform process. He's playing politics. By that, we mean he's trying in a politician's way to work with all the important constituencies to formulate a compromise that has bi-partisan support. Earlier this year, he enunciated broad principles for reform, but let Congress put together a detailed package. Since then, he's let the most vocal of his critics shape the contours of changes to the package. Only belatedly has he seemed to realize that he could be at risk of losing the entire initiative, at least for 2009, and has taken to the road himself.

Barack Obama is the most skilled politician of our times. He is cool, subtle, clever and smart. During the 2007-08 primaries and the 2008 general election, he danced like a butterfly and stung like a bee. His opponents, weighed down by outdated conventional wisdom, fought earlier elections and lost this one.

But like so many Presidents in the last 30 years, he has bogged down since his inauguration. Candidates from outside the Beltway have almost always been the winners of Presidential elections in recent decades. That's understandable, but it means we get rookies in the White House. Washington is a tough town on outsider Presidents. Jimmy Carter, Ronald Reagan, Bill (and Hillary) Clinton and George W. Bush all found that out the hard way.

Barack Obama may have Chicago grittiness when it comes to dealing with snow. But nowhere in his political experience has he been in a mosh pit like Washington. Chicago and Springfield, Illinois have their political rivalries and battles. But party discipline still means something in those towns. In Washington, members of Congress quickly learn that the squeaky wheel gets the most attention--to get re-elected, you have to negotiate with your own party's leadership for goodies to take back to your home district or state, so there isn't a big payoff from being quietly loyal. The Democratic Party, in particular, remains a collection of not-Republicans that resembles the coalition governments in countries with Parliamentary systems, where fringe members of the coalition have the greatest voice over policy.

Moreover, the Republicans now get to play their stronger role, that of the opposition party. They're lousy at governing--foreign policy failures in Iraq and Afghanistan, domestic disaster in the financial markets and the economy. But they're really good at the obstructive defeatism that can undermine major policy initiatives like health insurance reform. It's easy to criticize, and the Republicans always take the easy way out when they're the opposition party.

President Obama surely understands that the Voting Rights Act of 1965 was one of the principal reasons why he was elected President. Without this landmark legislation to secure for minorities the right to vote, he wouldn't be sitting in the White House. He should reflect on the President who pushed--no, bulldozed--that law through Congress.

Lyndon Johnson was dramatic, melodramatic, overbearing, ingratiating, idealistic, principled, and hyper-determined to get his way. When crucially important legislation was on the line, he'd sermonize, badger, harangue, and arm-twist. To bring around the last few reluctant legislators whose votes were needed, he'd pigeon-hole them and in his uniquely domineering way, subject them to character-building experiences that made them see the wisdom of guaranteeing fundamental rights for all Americans. He was the greatest domestic President of the 20th Century after Franklin Roosevelt, and he got there by exercising leadership. With a black President in the White House and a much larger role in society for nonwhites, today's America is in many ways Johnson's Great Society. But for the tragedy of the Vietnam War, Lyndon Johnson would be lionized by Presidential historians.

Even though the decibel level has been high, and histrionics have received almost all the press coverage, the contours of an acceptable health insurance reform have emerged. Americans want choice, and do not want to lose what they already have. But they'd also like a safety net. A national health service that forces all medical personnel onto the government's payroll and eliminates all private insurers wouldn't be acceptable. But neither is the status quo, and Republicans, wittingly or unwittingly, will end up protecting the status quo, warts and all, if they succeed. That would be a Pyrrhic victory for them, because Americans don't want the status quo any more. Just about everyone, including the well insured, has a sibling, parent, child, good friend, or neighbor who is uninsured. There isn't one of us who doesn't realize that we or someone dear to us could be uninsured sooner or later. The federal government has for decades provided health insurance to the vulnerable through Medicare, Medicaid and SCHIP. A safety net program, perhaps like enrolling the uninsured in Medicare, or a newly formed sister program, would follow in the same tradition.

Health insurance reform is today's greatest domestic challenge. It's understandable why Barack Obama started the reform process by playing politics. He's a tremendously skilled politician and we naturally fall back on our strengths in difficult situations. But politics won't get the job done this time. This isn't an election. This is a legislative process, with a difficult problem that the legislative process normally would be incapable of addressing effectively. President Obama doesn't have the compliant Congress President Franklin Roosevelt had in his first year. He should take a page from Lyndon Johnson's playbook and lead legislators to places that they may not until later realize they wanted to go. Perhaps he'll need to be more forceful than would come naturally. Perhaps he'll feel like he's at greater political risk if he steps out front and center. But Washington's natural inertia will overwhelm him unless he fights it with all his strength and all his willpower.