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Obama health care: What went wrong?

When the history of President Barack Obama’s first year in office is written, scholars will try to answer this question: What went wrong with health care? Howard Fineman gives his list of Obama mistakes.

When the history of President Barack Obama’s first year in office is written, scholars will try to answer this puzzling question:

How did a gifted, charismatic young Democrat — who won the White House by a large margin and brought in huge congressional majorities — manage NOT to enact fundamental health care reform, a goal his party has been seeking since Truman?

I still think Obama is going to get a bill, just not one very worthy of the name. Why?

Well, Republicans and their conservative and corporate allies are a big part of the explanation. Health care is one-seventh of the economy. You can’t expect to rewire it easily. There are going to be losers, and they are not going to go quietly.

Also, there are no moderates left in the GOP. Only conservatives who want to deny Obama success or legitimacy. They’ll oppose anything he proposes and call it principle.

Together, Big Money and Big Mouths will say anything to scare folks: death panels, government abortion, socialism — you name it.

That said, Obama and his team share the blame for the slow but steady shriveling of his claim to be the agent of “change you can believe in” on health care.

It’s time to ask what they did wrong. Here’s my list:

Murky campaign promises
Obama’s candidacy was fueled at first by opposition to the war in Iraq, then by his own life story, then by the economy. Yes, health care proposals were always there, but they were less of a central rationale than a policy box to be checked.

His proposals were written in part to draw useful political contrasts, first with Sen. Hillary Clinton and then with Sen. John McCain. As a result, it is hard for Obama to claim a mandate for a single, coherent detailed plan. The president is for “reform,” which says… nothing.

Orszag’s fantasy
Every president wants to reconcile frugality and generosity, and there is always an ambitious and clever aide willing to tell him it can be done. In Obama’s White House it is Budget Director Peter Orszag, who confidently told Obama that carefully administered universal health coverage would save the government money in the long run.

Perhaps in some decade hence that is possible, but for the foreseeable future the truth is just the opposite, at least according to Douglas Elmendorf, the independent head of the Congressional Budget Office — and a fellow just as credentialed and brilliant as Orszag.

Bipartisan naivete
Obama doesn’t like to make enemies, and he loved the idea — fueled by the likes of Orszag — that he could fight the reform battle on conservative turf: that we need to completely change the system because otherwise we will go bankrupt as a country.

But that was a tactical mistake on two fronts. First, Elmendorf undercut it with three devastating CBO reports.

And even if the proposals did save the government money, Republicans in Congress weren’t going to care!

For two generations, they were on the receiving end of Democratic fear-mongering how the GOP wanted to “throw grandma in the snow.” Now they are relishing the chance to accuse Obama of the same thing. They never had any intention of cooperating on a deal, and Obama should have known that from the start.

Too many 1,000-page bills
Americans are not an ideological people, for the most part. If they have an ideology about government, it is a hypocrisy: they want small government but they want government to address their every need.

It is not good politics for a president to rub this hypocrisy in their noises, and Obama has done just that. It’s not entirely his fault.

He had a near-Depression to deal with, and a banking crisis of mammoth proportions. But all the telephone-book-sized legislation and proliferation of czars left a lot of independent voters scared — and they are running from him now.

Cap and trade
Against that backdrop, the decision of the White House to jam through the House a colossal cap-and-trade energy bill might have been a mistake.

The president used up a lot, if not all, of his political capital with conservative Blue Dog Democrats when he made them vote for it. Chief of Staff Rahm Emanuel wanted to “put points on the board,” and he did, brilliantly, but then the Senate Democrats balked, making the House guys feel abandoned — and wary of the next “Rahmbo” deal.

Focusing on the have-nots
From the beginning, some of Obama’s shrewdest (outside) political advisors have been telling him — almost waving their arms — that the sweet spot on the issue is clamping down on abuses by insurers.

In other words, the White House all along should have been focusing on the fears of the 85 percent who have insurance, not on the 15 percent who do not.

These days the president is calling his plan “health insurance reform,” but it is late in the game to reframe the issue.

Wrong lesson from the Clintons
As everyone knows, Bill and Hillary Clinton failed in 1994 to get a big health care reform bill enacted — one that would guarantee health care to all. The Clintons were reviled for putting the bill together in private, and then springing it on the world.

Obama promised to be open about the process and let Congress write the bill. But the real problem with “HillaryCare” was its almost lunatic complexity. It purported to create a rational system, but it was impossible to comprehend.

The real lesson should have been simplicity and sweep. Maybe it can’t be done, but we still haven’t tried.