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Talking About Health Care

Elvin Lim is Assistant Professor of Government at Wesleyan University and author of The Anti-intellectual Presidency, which draws on interviews with more than 40 presidential speechwriters to investigate this relentless qualitative decline, over the course of 200 years, in our presidents’ ability to communicate with the public. He also blogs at www.elvinlim.com. In the article below he looks at Obama’s health care debacle. See his previous OUPblogs here.

As the wise saying goes “if you’ve nothing good to say, don’t say anything.” But President Barack Obama went ahead anyway with a prime time press conference, and as Bill O’Reilly was right to observe on Wednesday night – he said practically nothing specific about what the shape of the health-care bill would look like and viewers were left scratching their heads.

President Obama wanted to let Congress take ownership of the bill, rather than hand them a fait accompli (as Hillary Clinton did back in 1993/4), I hear Democrats chant in his defense. But if Obama wants to stay on the side-lines, then he should do so consistently. Either be genuinely deferential to Congress and stay out of the picture until a consensus emerges, or take complete ownership of the agenda – don’t try to do both. Yet the president is back in the limelight doing prime-time press conferences, and attending town hall meetings in Cleveland and such. Obama should decide which way he wants to go. If he is the salesman-in-chief, then he has to have something to sell, if not his consumers would be left completely befuddled as to why he’s putting on a show for no particular reason at all.

Liberals are mad that Obama didn’t throw a few more punches at Republicans. I think many are unwilling to admit the more pointed fact that he just didn’t do a very good job at all, because he didn’t have much to say.

So Wednesday’s press conference was a squandered opportunity. We are not in 2008 anymore when Barack Obama would announce that he is giving a speech and the whole world would stop to listen. The clock is ticking on his presidential luster, and the next time he says “hey, listen to me,” it’s going to be that much harder.

Let us be clear why health-care reform has stalled, at least till the Fall. Because the Congress, and in particular the Senate Finance Committee could not agree on a way forward. I don’t see why the President and his advisers thought that a prime time press conference last Wednesday night would have gotten things moving. In fact it probably achieved the exact opposite, when we heard on Thursday morning from Senator Harry Reid that a Senate vote before the August recess would not be possible. The president’s time would have been better spent persuading his former colleagues up on the hill in private conversations to compromise on a bill. When they’ve got a bill and all/most are united, then go out and do the media blitzkrieg, by all means. Wednesday night just wasn’t the time for that.

So it looks like the Permanent Campaign is back. The President has chosen to go back to campaign mode, selling himself. Because without a specific plan to sell, all his public appearances amount to going public for the sake of going public. This strategy belies a serious misunderstanding of American politics. Personal approval ratings do not translate to public support for specific policy proposals (not that they were forthcoming) – the president should have known this by now. They barely even translate into congressional support for presidential policies.

This error – of going public with nothing specific to sell – was compounded, and probably encouraged, by a complete underestimation of the push back from the conservative wing of the Demcoratic party (the “Blue Dogs”) worried about spiraling deficits. These were the people Obama should have been talking to. And given he’s still out town hall-ing and speechifying, I’m not sure he fully understands what came over him.

To make matters worse, Obama had to pour fuel over the fire of the Henry Louis Gates controversy during the press conference, accusing the Cambridge police of of a “stupid” arrest when he had incomplete possession of the facts. Have something to say about anything all the time has become the rhetorical ethic of the modern presidency. Obama’s observance of this ethic was a disastrous distraction to what little point he had to make at his press conference. The news cycles are now spending more time covering the Gates controversy than they are covering the health-care debate.

I’m afraid to say – though this is water under the bridge – that Hillary Clinton would have known better. This week, for the first time in his fledgling presidency, Obama looked like a total novice in Washington. His 4th press conference was a waste of time, and probably the first time since Obama broke onto the national scene in 2004 that his rhetorical wizardry had fallen so flatly on death ears. He seems to have bought the bad conventional advice – whenever you’re in trouble, just go out and give a speech – wholesale. The president should take heed:

1. The public is less attentive between election years and he must have something meaningful to say if he wants to keep their attention.
2. Especially on a complex issue like health-care where there are too many details to cover, the media is much more likely to jump at an opportunity to take the path of least resistance to cover something juicier, like Henry Louis Gates and racial profiling.
2. Just because the public (still) loves Obama doesn’t mean that they will love what he is doing as president (and not as presidential candidate).
3. It is often more important to talk to members of Congress – the people who actually pass legislation – than to deliver speeches around the nation where the only tangible return of applause is a fleeting sense of psychic gratification that one is loved.

President Obama, it’s crunch time. Stop yakking.

Recent Comments

  1. hsr0601

    Let’s put aside some distractions caused by the health industry-sponsored Democrats, and the controversial analysis of CBO on the economic effect of the proposed independent advisory council and how to empower it substantively, get back to focus on how to meet the goal of deficit-neutral.

    The House leaders reached a deal on Medicare payments: A “Pay for Value” reimbursement system that rewards doctors and hospitals that achieve the best outcomes at the lowest cost.

    As a result, The House gained a lot of votes, a lot of people who were withholding support.

    The federal Medicare program insures some 44 million elderly and disabled Americans at an annual cost of $450 billion, almost one-fifth of total U.S. health care spending.

    Supporters of the agreement say it could save the Medicare System more than $100 billion a year and improve care, that means $1trillian over a decade. (Please visit http://www.kare11.com/news/news_article.aspx?storyid=820455&catid=391 for detailed infos)
    The Times in a July 7 editorial argued “As much as 30 percent of all health-care spending in the U.S. -some $700 billion a year- may be wasted on tests and treatments that do not improve the health of the recipients,” Thus the remaining $239 billions over a decade do not matter.
    No one can disagree with this best outcome / evidence-based system, and private insurance, too, will be greatly influenced by this change with the focus on value over volume. !

    Dr. Armadio at Mayo clinic says, “If we got rid of that stuff, we save a third of all that we spend and that is 2.5 trillion dollars on health care. A third of that and that is 700 billion dollars a year. That covers a lot of uninsured people.”

    THANK YOU !

  2. HSF

    I disagree with the thesis of this post. The President made a very good case that the current system is in crisis and therefore change is required. He effectively communicated that unless an alternative system is in place, costs will increase greater than inflation, insurance premiums will continue to rise, more businesses will drop coverage and more people will be uninsured, go without preventive and proper care and subject to bankruptcy in the event of a serious illness or accident. I do not think the President could have gone into the details that would have satisfied Bill O’Reilly or even some supporters of reform. Those details are now subject to negotiations and the President’s detailed definitive statements might not have helped resolve those negotiations. Further, the public can take only so much detail before it turns off, nods off and changes the channel.

  3. AMH

    I think reform has failed thus far because it has lacked bipartisan support and of course the cost. A govt exchange is a stalking horse to a single payer system and the right won’t get behind that.

    I think the left is also realizing that if they ram through partisan legislation and it makes changes for the worse, then it will be an enormous political whole (read folly) that will take many years to dig out from under.

  4. [...] about Bill O’Reilly as of July 28, 2009 Talking About Health Care – blog.oup.com 07/27/2009 Elvin Lim is Assistant Professor of Government at Wesleyan University and [...]

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