I’ve been alerted to an interesting Boston Globe article about Barack Obama’s role, when he was in the Illinois legislature, in the attempt to get the state committed to universal health care. It turns out that the story very much prefigures the debates we’re having right now.
My thoughts: being president isn’t at all like being a state legislator, Illinois Republicans aren’t like the national Republican party, 2009 won’t be 2003, and the insurance industry’s opposition to national health reform — which must, if it is to mean anything, strike deep at the industry’s fundamental business — will be much harsher than its opposition to a basically quite mild state-level reform effort.
The point is that if national health reform is going to happen, it will be as the result of a no-holds-barred fight of an entirely different order from what Obama saw in Illinois. The president’s role will have to be far more confrontational, involve far more twisting of arms and rallying of the public against the special interests, than Obama’s role as a state legislator in the Illinois case. And it will take place against a backdrop of fierce attacks not just from the industry but from Republicans who fear, rightly, that any kind of reform will move the country in a more liberal direction.
My worries about Obama are that he doesn’t seem to understand this — that he thinks that in 2009, as president, he can broker a national health care reform the same way that as a state legislator, in 2003, he brokered a deal that mollified the insurance industry. That’s a recipe for getting nowhere.
Obama later watered down the bill after hearing from insurers and after a legal precedent surfaced during the debate indicating that it would be unconstitutional for one legislative assembly to pass a law requiring a future legislative assembly to craft a healthcare plan.To be fair, the piece also says this:
During debate on the bill on May 19, 2004, Obama portrayed himself as a conciliatory figure. He acknowledged that he had “worked diligently with the insurance industry,” as well as Republicans, to limit the legislation’s reach and noted that the bill had undergone a “complete restructuring” after industry representatives “legitimately” raised fears that it would result in a single-payer system.
“The original presentation of the bill was the House version that we radically changed – we radically changed – and we changed in response to concerns that were raised by the insurance industry,” Obama said, according to the session transcript.
During debate over the Health Care Justice Act, Obama also attacked the insurers, accusing the industry of “fear-mongering” by claiming, even after he made changes they wanted, that the bill would lead to a government takeover.This story gives a lot of context to the debate over health reform now. Obama clearly sees himself playing the same role as president that he did as a state legislator — as a broker among groups, including the insurance industry, as someone who can find a compromise solution that’s acceptable to a wide range of opinion.
My thoughts: being president isn’t at all like being a state legislator, Illinois Republicans aren’t like the national Republican party, 2009 won’t be 2003, and the insurance industry’s opposition to national health reform — which must, if it is to mean anything, strike deep at the industry’s fundamental business — will be much harsher than its opposition to a basically quite mild state-level reform effort.
The point is that if national health reform is going to happen, it will be as the result of a no-holds-barred fight of an entirely different order from what Obama saw in Illinois. The president’s role will have to be far more confrontational, involve far more twisting of arms and rallying of the public against the special interests, than Obama’s role as a state legislator in the Illinois case. And it will take place against a backdrop of fierce attacks not just from the industry but from Republicans who fear, rightly, that any kind of reform will move the country in a more liberal direction.
My worries about Obama are that he doesn’t seem to understand this — that he thinks that in 2009, as president, he can broker a national health care reform the same way that as a state legislator, in 2003, he brokered a deal that mollified the insurance industry. That’s a recipe for getting nowhere.
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- As long as the Republicans hold 41 seats in the Senate, no progressive health care reform can be passed, even if the Messiah is elected President. Since current projections indicate that it is almost certain that Democrats will not hold 60 Senate seats after the next election, how can there be any hope of a sweeping reform of US health care?
— HH - Before health care reform or anything that big business doesn’t like can happen elections financed by lobby’s must be addressed. First we need publicly financed elections, then a grassroots movement must start to ban giving cash to our elected prostitutes. Then we will have the needs of the people served.
— Patrick - A mollified insurance industry will not fill the bill. The insurance industry is the problem, not the solution. High health care costs are the main problem. If health care costs were reasonable, we could afford to help the forty million with no insurance. Insuring those oeople at current cost levels is not possible. The burden of our medical cost levels is helping to send industry off shore. For example, our auto industry is shifting more production to Canada where health care costs are much lower. Insurance co.s take a thirty one cent margin on every dollar of health care they manage. The higher the cost of those services, the more thay make. Not much of an incentive for lowering costs. Medicare operates on less than four cents of the food care dollar and with improved anti-fraud control could operate at less than three cents. Medicare negotiates and applies standards to the charges of suppliers. A single payer system has the ability to make large reductions in medical costs that will enable us to cover everyone. We are the only industrialized nation that does not provide health care for it’s citizens.
— c. perry - Mr. Krugman’s continued attacks on Barack Obama remain deeply puzzling. To be sure, the points he makes are fair. And yet they would seem to apply in far larger measure to Hillary Clinton, who has gotten a free pass in his columns and in this blog.
Shall we look at the history of health care reform? It was Hillary Clinton who tried to craft a complicated insurance scheme that worked through private insurance, and whose complexity helped bring about its downfall.
Let’s look at campaign donations. Which Democratic candidate takes the most money from the health-care industry? It is Hillary, not Barack. Does Mr. Krugman suppose they are giving her money because they believe she will fight them tooth and nail?
Shall we look at the use of right-wing talking points? It was the Clintons who spent a decade “triangulating,” whose administration “ended welfare as we know it,” and whose liberalism without a conscience furthered the Republican assault on our welfare state and civil society.
One has to wonder why Mr. Krugman focuses so much on Mr. Obama and gives Hillary Clinton a free pass, when the points he is making apply far more to her than they do to Obama. I am a great admirer of Mr. Krugman, and so it saddens me to say that there is no answer to that line of speculation that reflects well on him.
— FF - I’m struck by the omission of Hillary Clinton in your discussion of the “no-holds-barred” versus “big table” approach to health care and other progressive issues in your Monday column and this post.
Isn’t she as much or even more likely than Obama to try the “big table” approach and not confront the insurers and drug companies, especially in light of (a) her experience with a (flawed) confrontational approach in 1993; and (b) her status as the biggest recipient of pharma (and insurer?) contributions?
I understand that you agree with Clinton and not Obama on the mandate issue, but this is a separate question.
— Upper West - Here is a quick thought i just had:
Why to you entitle your blog as “the conscience of a liberal” if your position about health care reform is a statist one?
I’m from Brazil, and here Liberal means someone who defendes free-market, freedom and liberty.
Whenever i read you defending statists reforms, i.e. reforms that increase the role of the state in the economy( even on the margin), I wonder if you should change the title of your blog.
My guess for such denomination, is that the spectrum of political and economic positions are messed up. I’ve read some of your books and I always thought of you as a “first Best” economist. Here in Brazil we argue with some of our teachers that think that markets sucks and most of it should be state planning. Your position about health care has made me confused, because if even Paul Krugman is statist, I simply lose my incentive since I always thought myself as a liberal defending more free-market than less.
Please don’t make me lose my incentives to defend free-market. The title of your blog is confusing me very much.
Thank you
— Bruno - Are insurance companies opposed to mandated insurance? I should think that they would want to enroll healthy people who currently elect out of insurance. If so, Obama might have to reverse himself on this when it comes time to actually make a deal.
— skeptonomist - There’s one aspect of Obama’s personality, specifically in regards to the healthcare debate, that I think you and most other people are ignoring. That is that he is very clearly open to changing strategies.
You depict Obama’s first strategy as the only type of solution Obama would offer, when in reality it would only be the first. And would you want it any other way? Wouldn’t it be nice (I realize it’s a rosy, naive hope) if Obama could involve even the healthcare companies in the changes?
Then, if that doesn’t work, I can very easily see him shifting gears, and going on the offensive more against insurance companies and other lobbyist groups.
If there’s one thing I don’t want in 2008, it is for a Democrat to be elected, only to be stymied by a Republican or heavily partisan Congress. It is time for change, specifically in regards to conciliatory politics.
— AshishT - How bad does our health care system have to become before moderate Republicans like Clinton and Obama get it?
Is an American dying because they don’t have access to adequate health care any different than an American dying as a result of an IED in Iraq?
Why do so many candidates want to be elected only to take the path of least resistance once in office? Why do candidates with a true vision for America find it so hard to get elected?
America is broken and its not going to get any better with either Obama, who, like the candidate W in 2000, just wants everyone to get along or with Clinton who apparently wants to get elected just to be elected.
We need to upset the apple cart and take a completely fresh look at how we organize our society. Another eight years of anything but a true progressive administration may send us beyond the point at we can reclaim the America we all learned about in high school government classes.
Power to the people!
— TSG - OK, we get it that you are in the Hillary camp, but the real “recipe for getting nowhere” involves no compromises – as you suggest. (1993 Hillarycare anyone?) It’s 15 years later and now we have a national crisis because of that attitude.
I think Obama gets it that fundamental reform is necessary but that 15 more years of nothing turns a crisis into an emergency.
A complete 100% government operated healthcare system is simply not politically feasible next year. That means insurance companies will still have a role and that means they must be at the table. I think a move towards all non-profit insurance companies is an achievable step in the right direction towards reform.
— cthings - Mr. Krugman-
I think that John Edward’s approach to the health care disaster in our country makes the most sense – bring a gun to a gun fight. But, I do think Obama’s approach is preferable to the sop that Hillary Clinton wants to pass off as reform. Her plan is simply not going to work. Her plan forces everyone to buy health care and forces the insurance company to sell it to everyone. It doesn’t address prices or coverage. I understand that you and the Obama campaign have been trading barbs and I think you are absolutely right and they are absolutely wrong, but I think you should put Hillarycare under a microscope as well.
— Matthew - So what’s a voter to do in seeking a candidate who’s fundamentally a diplomat? Obama meets my criteria there. Yes, health care is a critical domestic issue but there are other issues to consider as well, including our relation to the rest of the world.
— anne - So, Obama watered down an Illinois health care bill “after industry representatives ‘legitimately’ raised fears that it would result in a single-payer system.”
“Legitimate” fears for whom, Kemosabe? Those “stakeholders” whose seven and eight figure bonuses might have been trimmed down a bit?
Single payer is EXACTLY the direction we need to go. It is disheartening that Obama is caught up in his own self-narrative as the Great Compromiser (triangulator?), self-definition which threatens to make even Hillary seem like a populist.
Perhaps Obama, given a chance, would also aid and abet the attempt of the Medicare Advantage cabal to dilute the single payer structure that has made Medicare the bedrock of senior care. After all, it is important to give an equal seat at the table to everyone, we can hear him solemnly intoning, even to those pillars of free enterprise who would prey on senior citizens to sign away their gold standard Medicare coverage for the dross of Medicare Advantage plans, as documented in the story in the Times yesterday.
http://www.nytimes.com/2007/12/17/us/17medicare.html
Go John Edwards!
— Ed - You are projecting your own ideas onto this article. As best as I can say, you say Obama acted reasonably, if not perfectly, given the fact that he was a member of a state legislature and not the President. You then say it would not be the appropriate way for him to act as President.
What evidence have you presented that this will be the direct model for how Obama will act as President? While you’ve outlined what you consider flaws in his national plan, do those relate to IL? Is is national plan a replication of the IL bill for the whole nation? Do legislators who become Presidents not alter their role in the legislative process?
— dh - That is a very interesting story. So we know that Obama as a state lagislator brokered a deal with the insurance industry, while Hillary in the nineties as a first lady failed to have her health care proposal approved. However, this time around she will get the job done because the American people want universal health care, and the insurance companies and the senate (with 49 republicans) are just going to give in because of that. Really?
— fabio ferrarelli - This is par for the course with Mr. Obama – charge in without thinking things through. He recently proffered that he would ‘delay’ NASA’s Orion program for 5 years to reroute the funding to education. The massive stupidity of this idea apparently escaped him – delay means that the program is effectively killed, people leave, support is gone, oh and then we have no way to get to the ISS – so we just ceded space to the Russians and the Chinese.
Just because an idea is new doesn’t make it good. Obama isn’t ready for the presidency yet, if indeed, he ever will be.
— Craig Della Penna - Legitimate fears that it would lead to a single-payer system? Single payer is a good thing. It’s what we want, it will work, it will be efficient. Who cares about the insurance industry? If it has to be killed for the sake of progress, than let it die and die as fast as it can.
— Iris - What he can do, I think, is paint himself as reasonable and ready to compromise, and turn the insurance companies into obstructionist villains, even in the minds of the opinion leaders in the village.
— Rich Siegel - I wish the democrats would understand that in order to accomplish something of real importance and consequence in the current environment, they have to become confrontational, and openly so. I agree with Prof. Krugman.
— Andrei Schor - I too am puzzled but Krugman’s focus on Obama’s perceived stumbles while seeming to ignore Clinton. At any rate, I think things like “conciliatory” and “compromise” and “a solution that everyone can live with” are what get people behind Obama, rather than being weaknesses and naivaties that aren’t “presidential”.
— Will Schenk - I, too, agree with Prof. Krugman that a progressive agenda will happen only with some confrontation. I do not understand the notion that everything will be better if people are more conciliatory with one another; to me, that is just a recipe for the corporations continuing to control this country. I also do not understand why people get so upset when any question is raised about Senator Obama. It seems to me the media has given him an unfairly free ride and unbelievably favorable coverage. And I’m sorry, but I don’t like the hatred for Hillary Clinton. She has her faults, but I do believe that her work and life reflect a genuine desire to change our society to make it fairer. Lastly, why does everyone ignore experienced and good elected officials like Senators Biden and Dodd? I think Senator Biden would be a fantastic president!
— Sylvia - I agree with posts #4, 5, 8 and some others…
and would like to add that Obama imo can be a confrontational personality and is more likely than Hillary to take on the insurance companies.
Obama is more quick witted and aggressive than Hillary.
Obama has the potential to rally America and is effective even with some Republicans. Imagine Oprah doing a series on health care in America with Obama as president. Lets see a comparison on national tv between the health care in other western nations and the US system. Part of the problem has been the right has dominated the debates in the US while the left responds. (And the right has been lying and getting away with it.)
— colleen - Bravo, Bruno! (#6)
Modern-day leftist have turned the true meaning of classic liberalism on its head. I think a more appropriate name for the professor’s blog would be “Confabulations of a Collectivist”.
— Joseph Hill - Let me start by noting that I am a registered republican, though a very moderate one, and come next November, I will be voting for Barrack Obama or against whoever the Democrats elect instead.
I agree with many that it is naive to think that a universally mandated healthcare system will ever be implemented because far too many of us will fight it to the supreme court. What does Mr. Krugman propose to do about people like me who don’t have health insurance because we don’t want it, and who will refuse to pay for it. When will progressives recognize that progress is not progress if it strips us of our freedoms. I have a right not to pay for health insurance that I don’t want and don’t need, and no amount of drivel about public health or anything else is going to convince me otherwise. I don’t remember the last time I saw a doctor; I and my family (wife and three children) are healthy and take good care of ourselve. We don’t need health insurance, and to force us to pay for something we don’t need and won’t use with threats of incarceration is extortion.
Barrack Obama, unlike Mr. Krugman, is smart enough to see that people’s right to refuse to pay for insurance needs to be respected and that because The US is still the only totally free nation in the world we won’t sit idly by let the government continue to trample on those freedoms.
— john whicker - I often think highly of Mr Krugman – but I agree completely with the postings of FF and cthings —
I would really like to understand the under belly of the anti-Obama columns that have dominated the outflow of PK. He is too smart to be pro-Clinton in this campaign.
