Detailing Obama's Health Care Dilemma

When President Obama held a prime time news conference last week, he hoped to push along the revision of the nation's health care system. He wanted it passed in the House before it left for the August recess and to the brink of passage in the Senate.

Instead, the next 48 hours saw House leaders draw back from a planned floor vote while key committee negotiators in the Senate remained in disarray. Among the many reasons for this reversal, three stand out.

The first is the fundamentally disconnected process by which Congress makes laws, a process designed by founding fathers averse to centralized power. As longtime Republican Congressman Barber Conable put it years ago, the government works just as intended, which is to say not very well.

Refining the workings of one-sixth of the national economy was never going to be easy. Trying to do it fast — or what counts as fast in legislative terms — lent the effort focus and force, but it also heightened the risk of sudden derailment.

The second reason the president was frustrated in this particular moment was of his own making. Allowing his legendary discipline to lapse, he let his own emotions show in reference to the arrest of his friend Henry Louis Gates Jr. in Cambridge, Mass. When he said the police acted "stupidly" in the matter, he doomed his own hope that the next several news cycles would be about health care.

Indeed, once the news media had galloped off after the Gates story, momentum on health care shifted perceptibly on the Hill. The slim chance of passage in both chambers before August was gone.

Why do we in the media prefer a story about one racially charged incident in Massachusetts to the president's most important domestic initiative? For the same reason that one Cambridge arrest was the talk of your workplace this week and health care was not.

Of course we all know that our health and our medical care and the cost and governance of both are more important than what two guys said to each other on a front porch last Sunday afternoon. But our grievances over race and class and identity and authority are far more immediate and deeply emotional. So whether we as news people are reflecting our audiences or ourselves, the result is much the same.

Beyond its visceral impact, the Gates story had the great appeal of human scale. You needed only a few seconds of information, or misinformation, to become engaged in it or upset about it. This sort of story makes great TV and inflames the blogosphere in a way no discussion of controlling structural health care costs in the out years ever will.

And that is the third reason the president was not able to seize the day this time. Everyone has a notion of what health is and what the medical system does, but delving into the particulars of either gets complicated. It requires attention and perseverance.

In his news conference of July 22, the president tried to keep the emphasis on the failures of the current system. He talked about those without care or without insurance. He talked about the runaway costs and the inevitable worsening of the crisis. Here his eloquence and intensity served him well. You could imagine people listening.

But when he responded to questions by dipping into the facts of the proposals he supports, he lost that personal connection. You could imagine people losing the thread, zoning out and reaching for the remote.

That is why advocates of change rend their garments when they hear opponents saying the president has not provided "enough detail." It is at least as possible that the degree of detail the president has tried to provide is in fact hobbling his effort to push the issue forward.

When Ronald Reagan signed a fundamental rewrite of the federal income tax in 1986, he blessed it for lowering the top marginal tax rate for individuals and eliminating "loopholes." He did not traffic in the trade-offs and countless adjustments that made the new mechanism work. He even denied it raised taxes on business, which it manifestly did.

We also have the memory of Bill Clinton's health care plan in 1994, a monument to detail that was understood by few (and loved by fewer). Obama's political situation does not allow him to float above the fray to a Reaganesque degree, but he does want to come down somewhere closer to that model than to the Clinton alternative.

What people usually mean when they ask for more detail is this: How will the changes affect me? Under all the different scenarios that might arise in my lifetime, what will happen? People don't want to be told simply to trust the government, and they obviously cannot be blamed for that.

Detailed information, in the end, is probably not the problem. If it were, the entire debate would be different. In this age of information-rich Web sites and search engines that find them in nanoseconds, those who really want more detail have more access to it than ever before. If the presentational style of the Congressional Budget Office is too forbidding, there are reader-friendly versions, partisan and nonpartisan, all across the cyberhorizon.

In the end, the fine detail of any new program is never entirely clear until the program is place. That is true whether you are talking about changing employment rules or banning a substance or invading a foreign country. The political system produces a new direction; policymakers put it into law. Then a world of players, both in and out of government, co-create the new reality.

That is what will happen with the government and health care, if the president can get his top priority back on track in September.

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