Analysis: Obama's missteps confuse health overhaul

Thursday, July 23, 2009 | 12:01 a.m. CDT; updated 11:15 a.m. CDT, Thursday, September 3, 2009
President Barack Obama answers questions during a news conference in the East Room of the White House in Washington on Wednesday.

WASHINGTON — Determined to avoid the fatal missteps of the Clinton White House, President Barack Obama is wobbling along his own precarious path to try to overhaul the nation's health care.

Where Hillary Rodham Clinton micromanaged the 1990s effort, Obama has given lawmakers lots of room and held back from offering a detailed plan of his own — but with no indication his strategy is working any better.

The sense of bipartisanship the president infused into the effort in March has been dissipated; lawmakers might never have taken it seriously. And the clear, confident message of last year's presidential campaign has turned into confusing policy options and messy politics, a standoff on Capitol Hill over how to expand and improve health coverage — and somehow pay for it.

Democrats are putting on a brave face, noting that in Congress a legislative standstill can quickly shift into high-gear action.

"I have no question we have the votes on the floor of the House to pass this legislation," Speaker Nancy Pelosi, D-Calif., said Wednesday. But she hasn't scheduled a vote.

Around the country, doubts are creeping in. A majority of Americans — 56 percent — still think Obama can pull off an overhaul. But a new Associated Press-Gfk poll found that disapproval of how he's handling health care spiked in the past three months. Disapproval stands at 43 percent, up from 28 percent in April. Overall, just half approve of the way Obama is dealing with the issue.

Obama says it's not about him. "I have great health insurance and so does every member of Congress," the president said in remarks prepared for his news conference Wednesday night. "This debate is about the letters I read when I sit in the Oval Office every day, and the stories I hear at town hall meetings. This debate is not a game for these Americans, and they cannot afford to wait for reform any longer."

But confidence in his approach is slipping. Independents, middle-of-the-roaders who were vital for Obama's election, are increasingly skeptical. Forty-seven percent disapprove of how he is handling health care, up from 30 percent in April, the AP poll shows.

What went wrong?

The quest to guarantee health insurance for all Americans has never been easy, because it means raising taxes and expanding the role of the federal government. Add to that Obama's goal of taming medical costs, and the degree of difficulty gets much higher.

The last Democrats to attempt it — President Bill Clinton and first lady Hillary Rodham Clinton — were accused of micromanagement after they handed Congress a 1,300-page bill that had taken months to draft in the isolation of the White House office complex. Bill Clinton went on to wave his veto pen at a Democratic Congress, saying he'd settle for nothing short of coverage for all.

He settled for nothing.

Obama was going to take a humbler path, but one that he hoped ultimately would reach the goal. His strategy was to set the tone, paint the big picture and let seasoned leaders in Congress work out the details. Everybody would have an ownership stake in the legislation.

The problem: He may have cut his Democratic allies in Congress too much slack, both on policy decisions and political strategy. He underestimated the depth of ideological divisions on health care.

In the House, liberal committee chairmen drafted a bill that doesn't even represent a consensus of their own members, moderates and conservatives whose votes they need to pass it on the floor. In the Senate, Democrats headed off in different directions. One group produced a partisan bill; another keeps searching for a compromise with Republicans.

Obama — like a modern-day father with a somewhat dysfunctional family — has tried to encourage, not criticize. With Congress, that doesn't seem to be working.

Battles have broken out over major issues: How to raise $1 trillion to $1.5 trillion over 10 years to cover the uninsured; whether the government should offer a plan that competes with private insurance; how to make sure employers and individuals contribute their fair share.

Not wanting to alienate lawmakers who have taken sides on an issue — but could be allies later on — Obama for the most part has avoided coming down hard. And because he lacks his own public plan, it's often unclear where the administration stands.

"He doesn't have a plan," said Sen. Charles Grassley, R-Iowa, one of the bipartisan negotiators. "He's given some broad guidelines of what ought to be done, but you find (the congressional bills) now being completely contrary to the letter that the president sent up here on June 2 when he said that he wanted to bend the inflation curve of medical care downward."

It's created the impression that the administration is trying to have it all ways.

For example, Obama insisted from the beginning the overhaul won't add to the deficit. But this week his budget director said that pledge doesn't include an estimated $245 billion in the House bill to restore programmed cuts in Medicare payments to doctors.

It's unclear how Obama will move forward. Bipartisan talks continue in the Senate, but there seems to be little chance of resuming the civil dialogue Obama sought to launch at the beginning by inviting all sides to a White House summit on health care.

"We need to put the brakes on this president," Sen. Jim DeMint, R-S.C., told NBC on Wednesday. "His goal seems to be a government takeover, not making insurance more available. So I do think we need to stop the president on this."


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Melinda Lockwood July 23, 2009 | 3:18 p.m.

Three ideas that no one seems to be talking about. 1 - tort reform. If our doctors did not have to pay 250,000/year for malpractice insurance, you bet prices would come down. 2 - allow groups to band together to shop for group insurance. Professional groups are not allowed to organize across state lines for the purpose of acquiring insurance. We all know group rates are lower than individual rates - let's do away with these government restrictions. 3- have the government step aside and stop dictating what types of insurance have to be offered in each state. Here is a chance to even things out a bit by letting the consumer get what he/she needs -- no pregnancy insurance if you're 60 for example. If the government would get out of the way and if tort reform actually happened - it would be amazing how much rates could go down.

(Report Comment)
Ray Shapiro July 23, 2009 | 5:10 p.m.

("According to healthcare litigation attorney Jim Saxton even lawyers say empathy works.

"That 'I'm sorry' done the right way with the right process can, number one, derail a lawsuit," Saxton said.

It could also reduce costs. After the University of Michigan health system changed its medical error policy on malpractice cases, legal fees per case were more than cut in half. The legal climate is slowly changing. Twenty-nine states now have laws that protect doctors from lawsuits when they say they're sorry.")


(Report Comment)
Ray Shapiro July 23, 2009 | 5:40 p.m.

The health care industry needs to be reformed.
Obama is not reforming the health care industry.
He is becoming an insurance salesman.
Insurance is just another bureaucracy.
Government workers push paper. Insurance companies dole out benefits, (aka entitlements). It's a perfectly understandable fit, but highly flawed.
True changes to improve health care accessibility could look something like this:
1. Eliminating health care as an insurable commodity from insurance companies. Eliminate malpractice premiums to insurance companies as this too puts a financial burden on the industry.
2. Shift most of the responsibility of accessibility to the AMA. The AMA, directly or through Medical Schools can work out the "malpractice" issue with their accountants and attorneys concerning "risk-management."
3. Government employees manufacturing medical supply/equipment can offset the expense of health care "accessories."
4. Government employees can manufacture most medications.
(Research and development can continue with the "inventors.")
5. The government and the AMA can work together to reduce/subsidize the schooling and certification of physicians and key medical professionals.
6. Remove the military from the management of VA hospitals. Assign these hospitals to Health and Human Services and afford accessibility to vets and the indigent.
These are just a few ideas I've made up off the top of my head. I could come up with more. So can other people. It amazes me that politicians see orchestrating an insurance industry coup as their only option.
The feds already have too much debt and overspend on everything. Their current plan will only cost the taxpayer and corporations more money and heart ache.
When it comes to "reforming health care" they should be looking outside the insurance box and focus on the psyche of doctors, nurses, medical technicians, counselors and physical therapists and patients more so then on their own agenda for an all encompassing bureaucracy.
Obama is wrong on this one.
His ego, and the power crazed efforts of other political left liberal progressives, prevents him from seeing anything but that agenda.
We are all doomed.
(And the officer handling that Gates professor guy followed proper procedure, as far as I'm concerned. Most neighborhood watch scenarios would play out the same way. a. It was an inappropriate question to ask the President at that time and he could have tabled the answer for a more appropriate press conference. b. Obama should've read the police report before jumping to conclusions about police. c. Too many successful black people think they're Al Sharpton or Jesse Jackson material. Even Don Imus was railroaded.... Don't taze me dude.)
I used to wear a great pair of FUBU denim shorts. Did they come out with their presidential line yet?

(Report Comment)
Daniel Goecke September 24, 2009 | 9:50 p.m.

I worked my whole life and always was able to have my own insurance because I was working. I don't like the government getting involved with everything we do in our life. WE are all grown Americans and we can make our own decision. We don't want any government health care system. Keep your nose out of everything.

(Report Comment)
Ray Shapiro September 25, 2009 | 12:05 a.m.

Many good ideas have come forward at town hall meetings and during the September 12th. tea-tax party on Washington.
I noticed the site on the older posting above did not read well.

("Some malpractice-reform advocates say an apology can help doctors avoid getting sued, especially when combined with an upfront settlement offer.

The idea defies a long tradition in which doctors cultivated a Godlike image of infallibility and rarely owned up to their mistakes.

The softer approach, now appearing in some medical school courses and hospital policies, is drawing interest as national attention has turned to reducing both medical errors and the high cost of malpractice insurance, which has been blamed for driving doctors out of business.")

(Report Comment)

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