Clive Crook has a characteristically smart column on the political troubles Obama has had with health-care reform:
As Ezra Klein noted last week, Obama's strategy on health-care reform has essentially been: "Figure out what Bill Clinton did. Do the opposite."
One of the things Clinton did was give Congress a lengthy, exceedingly detailed overhaul plan. As the body ostensibly in charge of writing legislation, however, Congress didn't take well to being told exactly what legislation to write and pass. Obama's approach has been to give Congress almost no direction whatsoever, letting them draw up a plan aimed toward universality of coverage. The president's only requirement was that it be paid for.
As a strategy for dealing with feisty personalities in Congress, this may have been savvy (although recent Democratic infighting suggests a little more leadership from the party's most popular figure might have been useful). But as strategy for selling the plan to the public, it's had serious problems. Stories covering health-care reform have necessarily focused on process, which tends to drag down public support. And without backing a specific plan of his own, Obama has been unable to stand as firm as he might have on specific policies.
Beyond that, there's been a simple problem of trust. When Obama took office, his poll numbers were impressively high. The same could not be said for his fellow Democrats in Congress. By turning the reform process over to Congress, then, Obama left health-care in the hands of politicians the public does not particularly like or trust.
The result of the president's don't-do-what-Clinton-did strategy has been infighting amongst Democrats, widespread confusion about the various plans for reform, and declining public support—not only for reform, but for Obama. Rather than move Washington beyond politics, as he promised during last year's campaign, Obama, has, despite studied efforts to avoid the mistakes of predecessors, allowed the bickering and factionalism of political dealing to hijack his top legislative priority.
It may be somewhat unfair to blame Obama for this outcome. He was naive, certainly, but that's simply the way Washington works: It's magnetized toward pettiness and politics. But the takeaway, as far as I'm concerned, isn't, as Obama has continually suggested, that we need better politics or better government; instead, it's that we need less.
I wrote about declining support for a government-run insurance option here, and the "buy now, pay later" strategy employed by health-care reformers here. Jacob Sullum wrote about the unnecessarily high costs of reform here.