Obama Health Care: The Real Version

One of these years, maybe we’ll finally learn: those bulky, detail-rich policy plans that presidential candidates incessantly hype and commentators and their opponents pore over? They don’t matter. At all.

Just consider Barack Obama’s evolution on health care. At the end of May 2007, not long after he announced his candidacy, he unveiled a highly specific plan to make health insurance available to all Americans. It was the product of months of work by a team of impeccably credentialed policy pros and provided plenty of fodder for policy wonks.

“If you are one of 45 million Americans who don't have health insurance, you will after this plan becomes law,” Obama promised at the time.

That should have been our cue to take his proposal with a grain of salt. After all, even if he won the election and submitted the same plan to Congress, it would invariably look far different if—and it would be a very big if—it actually made its way through the House and Senate and to his desk. That’s the nature of the legislative process.

Instead, we all went along with the ruse, pretending—despite decades of evidence to the contrary—that every detail of every plan offered by a presidential candidate will automatically be enacted into law by that candidate’s election.

A few months later, Hillary Clinton produced her own health care plan. It wasn’t radically different from Obama’s, but her policy team made sure to build in one significant, 30-second ad-friendly distinction: an “individual mandate” that would require all Americans to have health insurance. By contrast, Obama’s proposed mandate only covered children.

Thus, Clinton was free to spend the rest of the Democratic campaign—all eight months of it—trying to scare up votes by accusing Obama of “leaving out” 15 million Americans from receiving health insurance.

“I don’t understand why we have this difference on the Democratic side,” she proclaimed. “If anything, Democrats should stand for universal health care.”

Obama countered that he didn’t include an individual mandate because it would be too costly for some Americans and charged that Clinton’s proposal was a toothless tiger, since it provided no mechanism for enforcing any mandate.

What’s important to remember is that this wasn’t some minor dispute that briefly erupted at the tail end of a debate, only to be immediately forgotten. The dispute was central to the Democratic race—the subject of speeches, sharp debate attacks and television and radio ads and a prime feature of the talking points each campaign handed out to surrogates. Pundits got in on the act, too, playing up the competing plans as a fundamental philosophical choice for Democrats.

But it was all hot air. The only thing that really mattered was that both candidates expressed clearly their commitment to making coverage available to everyone. The details of their plans were irrelevant—as Obama’s presidency as shown. That plan he trotted out in May ’07? He never submitted it to Congress and it won’t become law. Instead, he’s done what smart presidents do—use his muscle to influence his allies in Congress while they put the actual legislation together. In the process, Obama (surprise, surprise) came around to Clinton’s view on individual mandates. So much for that Dispute for the Ages.

In the same spirit, Obama now seems to be warming to the idea of taxing the health benefits of certain Americans. Again, this runs flatly counter to his campaign proposal; last fall, he savaged John McCain for offering a plan that “taxes health benefits for the first time in history.” But this is how laws are actually made: through the tedious and protracted push-and-pull of legislative compromise, not by policy teams crafting campaign documents.

This isn’t to say that the legislative process will produce a superior product to the one candidate Obama presented. It may not. And, in fact, there are now worrisome signs that it won’t produce any product at all. But as dispiriting as this may be, there’s nothing new or revolutionary about it. It’s how Congress works—something we knew full well during the campaign, even as we fell victim to “My plan will…” syndrome.

The reality is that plans offered in campaigns are mainly designed for the psychological benefit of voters, who feel better just knowing that Candidate X has a 14-point plan for Issue Y (even if 99.99999 percent of voters will never read one word of the plan). Plus, if a candidate doesn’t offer a specific plan for every issue, his or her opponent will point this out and accuse him or her of not being sufficiently serious—a charge that will resonate with voters. So the candidates play along and, for some reason, so does the press.

Yes, it’s important to know where candidates stand on policy matters—to have a good sense of their basic ideological orientation and of what particular issues they’d most aggressively pursue in office. But it’s just as important to remember that, on Election Day, the choice is never between two plans; it’s between two leaders.