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Ronald Reagan and Obama's Health Care Struggles

6 years ago
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Reading the latest news about the health care reform fight -- that the Obama administration is willing to jettison the public insurance option (which would set up a government-run plan to compete with private insurance and keep the privateers honest) -- I thought of Ronald Reagan.

Barack Obama's problems winning an overhaul of the nation's troubled health care system began the day after he beat John McCain. That's the moment his impressive political machine should have begun a quick transformation -- from using the 13 million supporters who helped him reach the White House to using them to change policy in Washington. That is, to deploy them to apply pressure on the creaky institutions of the nation's capital to advance Obama's ambitious agenda. While Obama was toiling away on the presidential transition, his political operatives -- such as campaign manager David Plouffe -- ought to have been plotting how to reorganize Obama's grass-roots support for his presidency.

Eventually, the campaign outfit did morph into Organizing for America, but this group, an arm of the Democratic National Committee, was not fully ready to roll when the health care fight kicked off. It was operational, but at first it merely collected stories of health care tragedies -- rather than engage in power politics. And it's been playing catch-up ever since. So when Obama needs his grass-roots muscle the most, it's not there. (The New York Times on Saturday pointed this out in a piece too accurately headlined: "Health Debate Fails to Ignite Obama's Grass Roots.")

What does this have to do with Reagan? When the Gipper came to Washington as president in 1981, he and his advisers immediately whipped up his beyond-the-Beltway backers to build support for his ambitious economic program of cutting taxes and slashing social spending. Shortly before Obama was inaugurated, I spoke with several veterans of the Reagan White House and wrote about their strategy:

To pressure lawmakers in their home districts, White House political director Lyn Nofziger, his deputy, Ed Rollins, and Elizabeth Dole, who headed the White House public liaison office, worked with the network of right-wing citizens groups that Richard Viguerie, Paul Weyrich, and others had been building for years. Says [Reagan aide David] Gergen, "Reagan had a well-mobilized base. He could go on television on a Wednesday and by Thursday morning, thousands of telegrams and calls were going into the offices of members of Congress." The message: Do what the Gipper says. "Out of the box, Reagan was creating broad national support," says Kenneth Khachigian, his chief speechwriter early on. "It was critical to get moving and not let the other side develop too much resistance."

It worked for Reagan. He was able to roll the House of Representatives, then controlled by the Democrats (and House Speaker Tip O'Neill, who knew power politics as well as anyone), and Reagan's economic plan passed, thanks to the votes of scared Democrats.

Obama did not come roaring into Washington with millions of e-mailing supporters prepped for battle. In fact, in the first months of his presidency, Obama mounted mainly an inside game, working with Congress on the stimulus bill and other initiatives. At the time, some political observers opined that the Obama camp was not calling in the outside troops because it did not need them to achieve these early victories and that the White House could keep this massive firepower in reserve for the tough health care reform struggle to come.

But troops need practice. It would have been a smart move to have called them into action for the stimulus debate -- if only to gain experience and to test what could be done. Also, success breeds success, and if millions of activists had been given a role in the early wins, these people would perhaps have more eagerly ridden into the health care reform storm.

Yet when the big game came, Obama's organizing team had little practice under its belt and no momentum. This effort was also handicapped because there was nothing specific for Obama's fans to support other than his general principles. They could not demand the passage of a particular bill; Obama had decided to let Congress take the lead in crafting the actual details of reform. Consequently, the Obama-ites had nothing concrete to rally around, while his foes had plenty of running room to define his health care reform initiative. ("Hey, it's gonna kill your granny!")

There's no telling if Obama can pull meaningful reform out of the current morass. It's even possible that nonprofit co-ops, the alternative to a public insurance plan, can provide the necessary competition to force private insurance companies to perform better (though I wouldn't bet on it). But what's certain is that Obama finds himself in fierce combat without many of the folks who carried him to 1600 Pennsylvania Ave.

When I was writing that piece on Reagan, his former speechwriter Ken Khachigian told me that the key takeaway from the Reagan experience was that "it was clear you couldn't get this fairly revolutionary plan in place in the midst of a difficult economy unless there was some kind of clamor back home." Obama has been late to generating (or trying to generate) a public clamor that could be used to pass an effective and far-reaching plan. And Khachigian's observation raises an obvious question: Can a president change such a large slice of the American economy over the objections of special interests willing to spend millions of dollars to protect the status quo without millions of voters beating on Congress and demanding change?

It ain't over, of course. But it could be that Obama has missed his opportunity to pull a Reagan. Partly because of that, he is being forced to wheel and deal, and that's one reason why it's, Adios, public option.

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