Should Obama Have Abandoned Health Care Reform?

I've just finished George Edwards's Overreach. In essence, the book applies the lessons of On Deaf Ears and The Strategic Presidency to the Obama administration. If you've read the two earlier books you needn't make it a high priority, but if you haven't it's as good an introduction to the work of the most important contemporary scholar of presidential politics as anything. The Obama administration reconfirms a lot of what we already know—presidents have essentially no demonstrable ability to shift public opinion in their favor and only a very limited and contingent ability to shift marginal votes in Congress (which is become more attenuated because of increased polarization in Congress—especially for a Democratic president getting opposition support for a major initiative is nearly impossible, which in turn increases the leverage of marginal Democrats in Congress).

As the title suggests, the main thrust of the book is that the Obama administration made the same mistakes most contemporary presidents make by overestimating both the power of going public and the power to generate bipartisan support. By advancing a broad, ambitious agenda, Edwards argues, Obama saw key major initiatives fail completely (climate change, immigration), and while he was able to pass major health care legislation in a public opinion environment much less favorable than the one Bill Clinton was working with in 1993 through very concerted action and by deferring details to Congress, the legislation passed at a high political price. While the general story is right, I don't necessarily agree with every implied judgment Edwards makes about the data.

Admittedly. Edwards is not as explicit about urging Obama to adopt the Rahm Emanuel strategy of abandoning major health care reform after Scott Brown won as Noam Scheiber apparently is. But he certainly implies that going all-out to pass the ACA was a mistake. This is of course a normative, not an empirical question, and Edwards lets the reader make her own judgment, but I don't agree. Edwards does compile data that makes a convincing case that the ACA was very costly politically. The Democrats underperformed by 25 to 40 votes in the House elections versus what would have been expected based on the terrible economy, and the voters who placed a priority on health care were much more likely to be opponents of "perhaps the least popular major domestic policy passed in the last century" than supporters. (Support for health care, as Edwards notes, very closely tracked the popularity of the president in an awful economy as a whole; the problem wasn't so much in the details of the policy, which the public remained largely ignorant or misinformed about despite a massive White House communications effort as the fact that the crystallization of public opinion along partisan lines was not going to be favorable to any major domestic initiative in that context.) Does the political cost mean that Obama should have backed off the ACA? I don't think so:

  • As Jon Chait has pointed out, even if there were substantial political benefits to be had from deciding not to pursue health care reform at all, that these benefits would have accrued from making and then abandoning health care reform is far less clear. How the counterfactual would have played out is unknowable, but it seems likely that abandoning health care after the election of Scott Brown would have still created political problems for those who supported the legislation without even the substantive and perhaps political benefits of getting the legislation passed. Even if we plausibly assume that letting the PPACA die would have been a net political benefit, it's unlikely that the benefits would have made any real difference to the post-2010 governing context.
  • For me, what settles the question is the fact that the Republicans ended up with a 49-seat edge in the House after the 2010 midterms. So even if we accept the upper bound of the seats that the PPACA cost the Democrats and implausibly assume that abandoning the PPACA would have gotten every one of those seats back, the Republicans almost certainly would have ended up with control of the House anyway. Which means that, no matter what, Obama's domestic agenda (including any chance of a stimulus) was DOA for the rest of his second term no matter what. Even if you accept the most favorable assumptions of the Rahm argument, then, Obama and the congressional leadership would have kept their powder dry for nothing.

Evidently, whether the gamble pays off will depend on what the Supreme Court does (or whether Congress can repeal the PPACA, although this is immensely unlikely). But I think it was worth taking. In what is becoming the most famous quote in Caro's The Passage of Power, LBJ responds to some risk-adverse advisers warning him against pursuit of strong civil rights legislation by asking "Well, what the hell’s the Presidency for?"

I think this is right—while in that case the political cost to the Democtats was medium rather than short-term, LBJ's logic remains sound; you exploit the strategic opportunities you have. At some point, political power needs to be put to some purpose rather than self-sustenance. If abandoning the PPACA could have meant that better health care legislation or another major agenda item or even a major stimulus could have been passed after the midterms, that would be a serious argument. But to preserve a larger minority in the House—why? The point of political power is to accomplish things, and forgoing passage of the most important progressive legislation in at least 40 years for ultimately meager political benefits wouldn't make sense.

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