AP Analysis: Obama Missteps Confuse Health Care Overhaul

July 23, 2009 - 4:39 AM
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 that his strategy is working any better.

From left, House Speaker Nancy Pelosi of Calif., Rep. Donna Edwards, D-Md., and Rep. Rosa DeLauro, D-Conn., listen to President Obama’s news conference on health care reform on Wednesday, July 22, 2009. (AP Photo/Evan Vucci)

Washington (AP) - 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 that his strategy is working any better.
 
The sense of bipartisanship the president infused into the effort in March has been dissipated; lawmakers may 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.
 
It's all recasting Obama's image. The cool, crisp candidate who captivated voters last fall has been replaced by a president who is constantly calling for action, with little to show for it and his credibility at stake.
 
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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EDITOR'S NOTE -- Ricardo Alonso-Zaldivar covers health care for The Associated Press.