Who Won the Health Care Summit Debate?

Who won the health care summit debate?

That was the question media pundits asked in the aftermath of last Thursday’s marathon, 7-hour public health care meeting between President Obama and Democrats and Republicans in Congress. Not surprisingly, there was no consensus answer. Obama partisans thought the President came out ahead because, in his calm, wonkish way, he was able to counter the criticisms leveled against the health care plan by wild-eyed Republicans. As a colleague of mine, (an Obama supporter) put it, “Why do the Republicans bother showing up to these types of events?”  But even more neutral observers thought Obama had showed effective debating skills, in part because he controlled the microphone, a point Dana Milbank made in this Washington Post article. In Milbank’s words, “The forum matched his lawyerly skills — and, less flatteringly, his tendency to act like the smartest guy in the room. Prof. Obama ventured deep into the weeds of health-care policy to contest Republican claims, and, for one day at least, he regained control of the fractious student body that is the Congress.”  At the other end of the spectrum, right-leaning pundits generally took a version of a line that suggested Obama hijacked the forum to push his own talking points and had arrogantly rejected any effort to address Republican policy objections.

I want to suggest that these analyses, which tend to measure the summit outcome in terms of who had the most persuasive argument, or who scored the most debating points, are using the wrong yardstick.  Instead, what we should be asking is: which side came out of that summit closer to achieving its policy and political goals?

From this perspective, the Republicans appear to be the clear winner, and President Obama the loser.  For congressional Democrats – particularly the more moderate wing of the party – the verdict is less clear.

Let me start with the Republicans.  From the opening remarks by Lamar Alexander and Mitch McConnell, the Republican meme du jour was to suggest scrapping the Senate/Obama bill and to start the legislative process over by building on points of agreement between the parties. (Some of those potential points of agreement include malpractice reform, creating purchasing pools of the uninsured, allowing the purchase of insurance across state lines, and preventing insurance companies from denying coverage for pre-existing conditions.)  To their credit, rather than base their line of attack on outlandish charges (death panels!), the Republicans for the most part (and there were exceptions on both sides) came armed with their own set of wonkish talking points that embodied core Republican beliefs regarding the dangers of government regulation, the benefit of market solutions and that focused predominantly on cost-containment. They managed – with some exceptions – to sound quite reasonable. For example, Representative Paul Ryan’s comments were particularly thoughtful and offered a persuasive defense of the Republican positions.

Of course, beginning the process anew is a non-starter with Democratic supporters, including Obama, as the Republicans surely knew.  Not surprisingly, the President used his control of the microphone to shape the debate, and spent much of the summit calmly refuting/addressing the Republican talking points by parroting the Democrat’s own counterpoints.  (Although I wonder if anyone found his use of everyone’s first name in a public forum somewhat patronizing.)  On more than one occasion he acknowledged that there were legitimate differences between the parties before defending the Democrats’ approach. Note that, for the most part, although both Obama and Republicans sometimes skewed the facts, both sides generally stayed away from wild exaggerations and outright misrepresentations.  (This site provides a good fact check of the claims by both sides.)

In this respect this summit provided a useful reminder of the philosophical differences that separate Republicans and Democrats – a difference that is particularly distinct when it comes to health care.

But this was not a philosophical debate with the winner to be judged on his mastery of policy details and clever turn of the phrase.  Nor was it really an effort to find common policy ground. Had both sides been genuinely interested in achieving a real bipartisan solution, Obama would not have unveiled his new health care plan (largely a reprise of the Senate bill) three days before the summit, and the entire proceeding would have taken place behind closed doors, away from public scrutiny.  Instead, both sides went into this determined to win the media coverage and bolster public support. The difference is that the Republicans had the easier task.

Here’s the problem from Obama’s perspective: composite polls at both Real Clear Politics and Pollster.com, as well as the latest Gallup polling, indicate that at this point public opinion is solidly against the current health care legislation in Congress, and it has been that way for several months, with every sign that this opposition won’t budge without dramatic changes to the current legislation. Although polls suggest the public will support individual components of the health care package, when viewed in its entirety, support for the legislation drops precipitously. More worrisome for Obama, the health care summit did almost nothing to assuage the fears of moderate Democrats that if they support the current health care legislation they are going to be washed overboard in a Republican political tsunami come this November.  By making absolutely no overtures to the Republicans, Obama provided the moderates with little to no political cover. He either needed to provide a blueprint that showed how he could bridge the differences with Republicans, or explain to moderate Democrats why supporting an unpopular bill won’t hurt them come November.  He did neither.  More significantly, perhaps, Obama failed to induce any movement toward compromise among the left wing of the Democratic Congressional party.

It is important to realize that Obama’s political interest does not fully mesh with that of Democrats in Congress.  As president, Obama has a stake in achieving a positive health care policy outcome. He wants – needs – to get legislation passed. Even modest insurance reforms would constitute a victory. But as Yale political scientist David Mayhew has long argued, members of Congress are often less interested in achieving substantive policy outcomes and instead satisfied to engage in position taking. In Mayhew’s words, the political payoff for legislators comes by taking the position – not by achieving results.  This means that for many progressive Democrats, it is enough to show their constituents that they took a stance against the Republican efforts to derail health care. There is really no incentive to compromise in order to pass the legislation. For Republicans, of course, the same logic holds: they will be rewarded by articulating opposition to the Democrats’ proposal.  Neither side has a vested interest in necessarily seeing the legislation pass.

This might not necessarily be a problem for Obama if he had the votes to pass health care now.  If he has decided – and I think he has – that the only way health care will pass is by relying solely on his partisans in Congress, he probably decided that the health care summit was primarily for show. The problem with this strategy, however, is that by my admittedly back-of-the-envelope count, the Democrats do not yet have the votes in the House to pass the Senate version of health care legislation. Some 80 Democrats may oppose it either because of the abortion language in the Senate bill or because they are fiscally-conservative blue-dog Democrats, some representing districts won by McCain in 2008, who are uneasy signing on to the Senate plan. Nor, at this point, does it appear that Democrats have the Senate votes to pass health care legislation using reconciliation despite the lower 51-vote threshold. This is because some Democrats are philosophically opposed to using reconciliation for non-budgetary issues, some worry about the political repercussions and some key portions of the health care bill, like abortion, probably can’t be addressed through reconciliation.

Of course, for strategic reasons, it makes sense for wavering Democrats in both chambers who might eventually support the Senate bill to hold back on publicly committing now, in order to leverage their influence.   But at this point, the votes aren’t there.

If Obama wanted to move closer to attracting the additional votes to pass health care, he needed to use the summit to provide a roadmap for getting to yes.  This he did not do – perhaps because there is no bipartisan roadmap.

The bottom line?  Viewed as an academic seminar, Obama did superbly in the health care summit. It was a lawyerly performance, one that would make his Harvard professors proud. As an exercise in political strategery, however, with less than a month left on the legislative calendar before any hope of passing health care ends, Obama lost an opportunity, however slight, of moving closer to achieving a legislative victory.


  1. I agree that Democrats should have made more overtures to the other side. Isn’t there something that they could have included that would have made it much more difficult for the GOP to vote against the legislation? Tort reform would only address 2% of health care costs, but it would have been good political strategy and likely pretty popular. I know the Dems are in the pocket of trial lawyers, but you would think that they would be more creative in at least attempting to capture some semblance of the middle ground.

  2. Orion – One can identify several areas that potentially serve as a meeting ground for Republicans and Democrats, including tort/malpractice reform. I suggested a few others in my post: creating purchasing pools of the uninsured; allowing the purchase of insurance across state lines; and eliminating penalties for preexisting conditions. Yes, some of these are relatively small potatoes cost-wise, but they are areas where compromise seems possible. Ultimately, however, compromise necessitates giving up something. For better or for worse (and my view is that it is for the worse) most members in both congressional parties apparently have concluded that it is in their best interest not to make any concessions at all. What is troubling is Obama’s apparent unwillingness to push Democrats to make these concessions. I’m not sure if this is because he doesn’t think the Republicans will reciprocate, or that he simply lacks the political clout to persuade Democrats to reach out. Whatever the reason, I saw little evidence at the health care summit that he saw compromise as a viable option. And, given the current polarized state of the Congress, he may be right. As of now, however, I don’t think the Democrats have the votes to pass health care. If this is the case, why not push harder for some type of compromise that might win over the moderate Democrats and perhaps even a Republican or two?

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