Obama and The Health Care Legislation

Until Barack Obama’s election I do not recall a president who received so much criticism for doing what he said he would do during the campaign. It is one thing, and perfectly legitimate, to criticize Obama when one disagrees with him. Having said he would do something as a candidate does not make him immune to criticism for his policies once elected. It is a different thing, as some on the left are doing, to claim that Obama sold them out or act shocked by his current policies.

Barack Obama campaigned as a centrist, pragmatic politician who planned to try to consider the views of the opposing party. While campaigning he said he would remain in Afghanistan, and it was clear he would not concentrate on prosecuting Bush administration officials for their acts in office. As Ezra Klein points out, he also campaigned on a health care plan (pdf here)  similar to the one being considered in Congress:

…the basic structure of the proposal is remarkably similar. Here’s how it was described in the campaign’s white paper:

“The Obama-Biden plan provides new affordable health insurance options by: (1) guaranteeing eligibility for all health insurance plans; (2) creating a National Health Insurance Exchange to help Americans and businesses purchase private health insurance; (3) providing new tax credits to families who can’t afford health insurance and to small businesses with a new Small Business Health Tax Credit; (4) requiring all large employers to contribute towards health coverage for their employees or towards the cost of the public plan; (5) requiring all children have health care coverage; (5) expanding eligibility for the Medicaid and SCHIP programs; and (6) allowing flexibility for state health reform plans.”

We don’t know what the employer mandate will look like once the House and the Senate merge their bills, and the exchanges look likelier to be run by states or regions than by the government (though there will also be a national exchange overseen by the Office of Personnel Management), but those are really the only differences. And it’s not even clear they’re differences.

Going through the legislative process has led to some changes. A key difference is the individual mandate. While I wish Obama had stuck with his opposition, the change is understandable. Ezra Klein, whose understanding of  the realities of health care in the real world is far weaker than his study of legislation, believes this is because his plan would not work without mandates. The real reason Obama gave in is more likely that this was a compromise which was necessary to get a bill passed. He first tried to make a deal with the insurance industry by agreeing to their demands for a mandate in return for ending the restrictions based upon pre-existing conditions. Once this issue was taken up in Congress, leaders from both parties supported the individual mandate, making it futile for Obama to fight it.

The other big change, and the one which has disappointed the left the most, is the elimination of the public plan in the Senate bill. Obama’s strategy has certainly been one of getting a bill passed even if compromise is necessary, but he does not deserve the amount of blame he has been receiving for the elimination of the mandate. It was Joe Lieberman who killed the mandate, yet surprisingly many on the left are accepting the word of Lieberman (as well as Howard Dean, who has his own axe to grind with the Obama administration) on this.  Joe Lieberman’s argument comes down to telling the left not to blame him for opposing the public option because Obama didn’t try hard enough to twist his arm.

Tom Harkin has a different take on the public option, disagreeing with the claims that this failed because of Obama. Harkin also says that the public option will be revisited. Even if it doesn’t make it into the final bill during reconciliation with the House bill, it is possible to bring up the public option again as a separate bill in the future. Considering the degree of public support for the public option, it might even make more sense to have a separate battle over this during an election year, or even in 2011.

I will not attempt to say whether the bill should be passed until the final legislation is available. The Senate bill has many faults, but passage is the only way to go to conference with the House and attempt to improve it. The bill must be judged not against our ideas of a perfect plan, but against the status quo, where the individual market might not survive much longer unless one is young and health or has lots of money to burn. Any final bill must be considered on its merits and not be judged based upon litmus tests such as whether there is a public option. Even Jacob S. Hacker, who devised the idea of a public plan, is arguing in favor of passage of the current Senate plan. Whatever the details are in the final plan, it does not appear that it will be radically different from the plan discussed when Obama was campaigning.

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