Obama May Know What He's Doing on Health: An Ode to Ambiguity

Remember that old "Saturday Night Live" skit called "What if . . . Eleanor Roosevelt Could Fly?" Here's a proposition some people may find equally preposterous: What if President Obama actually has a strategy on health reform? What if there's a method to all of this seeming chaos?

I don't have inside information, but after observing Washington and politicians for more than 25 years, I do have a political brain. And if I were formulating strategy at the White House, I would be thinking it's way too early to play hardball about anything, especially the public insurance proposal that has inflamed both liberals (who insist on having it) and conservatives (who insist it must be dumped).

I'm not saying it's wonderful that the administration has lost control of the schedule and the narrative framework, or that it took so long for Obama to talk about how reform will help people who have insurance as well as those who don't. Still, amid the liberal clamor for Obama to go on offense, to show some spine, draw those lines in the sand, I say, take a breath and think about how Congress works. Think about the endgame, when House and Senate negotiators will reconcile the differences in their bills to come up with a final bill. Now think about what needs to happen to get to that point.

House Democratic leaders have left no doubt their reform bill will include a public, government-run plan to compete with private plans in a new insurance policy marketplace. So right now the most important thing is to get some version of health reform through the Senate. The second most important thing is to get it through the Senate without having to use a budget procedure called reconciliation.

Reconciliation is tempting because it would require only 51 votes, instead of the 60 needed to shut off a filibuster and proceed with business. But reconciliation is so restrictive that the guts of health reform – new regulations on insurance companies, the much debated public option, even the nonprofit co-op model some are discussing as a substitute – probably could not be included. I wrote about the limits of reconciliation here.

So, assume you're in search of 60 votes at a time when Democrats Edward Kennedy and Robert Byrd are ailing and rarely, if ever, in the chamber. At least a handful of those votes need to be from Republicans to reach 60 and also to bring along conservative and moderate Democrats such as Ben Nelson of Nebraska, Mary Landrieu of Louisiana, Kent Conrad of North Dakota, Evan Bayh of Indiana, Blanche Lincoln and Mark Pryor of Arkansas, and Michael Bennet and Mark Udall of Colorado. The same potential GOP converts come up all the time: Maine Sens. Olympia Snowe and Susan Collins.

The best way NOT to get those 60 votes is to declare right now that you won't settle for anything less than a full-scale public plan. The second best way not to get them is to make clear you'll insist on a public option later, when the Senate is in negotiations with the House to mesh their bills. Thus the best strategy right now is to stay flexible – or at least appear that way. Whether by accident or design, Obama and his team have achieved this. Nobody knows for sure how hard he'll push, or when, or what for.

This is, needless to say, beyond frustrating to liberals. As Jon Stewart put it Monday night on his "Comedy Central" show: "Mr. President, I can't tell if you're a Jedi 10 steps ahead of everything or if this whole health care thing is kicking your ass just a little bit. Why is this so hard? Why can't you guys just stay on message? Remember the Bush team? Little bit of discipline, little bit of repetition? They sold us a war nobody wanted and nobody needed."

But health reform has many more complexities and congressional phases than the Senate's one-shot authorization of a war. My view – to be honest, my hope – is that Obama is deliberately keeping people guessing as the delicate process unfolds. Princeton scholar Fred Greenstein, author of "The Presidential Difference: Leadership Style from FDR to George W. Bush," told me that's a definite possibility. He called Obama "a constructive political chameleon" who is making "studious use of ambiguity."

It's not like Obama is the first president to employ strategic uncertainty. Abraham Lincoln used "persuasion and force and ambiguity" to keep border states in the Union in the weeks before the Civil War began, Greenstein said. When one of his generals ordered the emancipation of slaves in Kentucky, "Lincoln reversed it and stressed that while he thought slavery was an evil, he was not on an anti-slavery crusade." That was frustrating to Northern anti-slavery forces. But it was also short-lived. When it became clear that the Union "really had to take its gloves off," Greenstein said, the politically savvy Lincoln issued the Emancipation Proclamation.

Franklin Roosevelt had similar skills. In "No Ordinary Time," author Doris Kearns Goodwin quotes Eleanor Roosevelt as telling Winston Churchill, "You know, Winston, when Franklin says 'Yes, yes, yes,' it doesn't mean he agrees with you. It means he's listening." Greenstein said FDR compared himself to a quarterback -- the objective was to win the game and he didn't know what his next play would be until he saw the previous play. The metaphor served "to justify an enigmatic performance in terms of people not knowing how far he was going to go, what he was standing for," Greenstein said.

That sounds a lot like where we are right now with Obama on health reform. Let's envision a time when the first round is over. The Senate has passed a bill that does not have a public option. Maybe it has a co-op option, which my colleague Patricia Murphy explained here. The House has also passed a reform bill and it includes a strong public insurance plan. Negotiators from both chambers are now ready to shape the final bill. And now we are at the point when a huge presidential investment makes sense.

Obama could try carrots and sticks – threats to withhold campaign help or promises to do everything he can to get someone re-elected. He could make a moral appeal – How can we continue as the only industrialized nation without universal coverage? – and hint at or promise administration jobs to any electoral casualties. He could try to extract pledges from conservative Senate Democrats that they will vote to cut off a filibuster, even if they intend to vote against the bill itself. Because once the filibuster is broken, all Obama needs is 51 votes – and that 51 could include Vice President Joe Biden breaking a tie.

If there must be compromise, if for instance the Senate won't accept the House's public plan, negotiators would have substantial flexibility to go beyond what's in either bill. Say the two sides agree on a "trigger" mechanism – that is, a public plan would be added to the marketplace at a certain point if insurance companies had failed by then to meet a pre-arranged standard of broad, affordable coverage. Longtime Washington player Ron Pollack, executive director of the liberal health care advocacy group Families USA, told me the negotiators could do that even if neither bill contains a trigger. "There is lots of room for creativity," he said.

He knows that from personal experience. In the early 1970s, Pollack said, conferees on a food stamp bill decided out of the blue to eliminate "hippies" from the program. They added a ban on participation by people who lived in houses with unrelated people – their definition of a commune. He successfully challenged the provision in court. "It wasn't knocked out because it was inappropriate for something new to come up in conference committee," Pollack said. "It was knocked out on constitutional grounds."

In the end, if Obama must give up on the public option or any other element of health reform that he considers significant, he retains his own option to make another push at any point in his one or two terms. And modifications would hardly be unusual.

The Social Security Act originally excluded agricultural workers and professions dominated by women. Medicare only recently expanded to cover prescription drugs. Even more basic, slaves weren't freed and women couldn't vote for generations after the country was founded. As Obama himself once said, changes came, providing evidence that the Union "can always be perfected." He may have to sign an imperfect reform bill in the end, but it won't be because he declined at this precise moment to dig in his heels, define what's acceptable and threaten to veto anything that falls short.