Trump can’t make a health care deal because he doesn’t understand health care

The blame in the Senate’s health care omnishambles is attaching to Majority Leader Mitch McConnell, and understandably so — he wrote the bill, he designed the process, he owns the result. But the absence of President Donald Trump from the story is, itself, an important part of the tale.

For better and for worse, policy leadership in the modern era tends to come from the White House. Take the Affordable Care Act. Though the bill was written in Congress, President Obama and his staff were involved at every step of its construction — they set the policy vision, used the technical resources of the executive branch to work through trade-offs, were deeply involved in the legislative process, and led the communications effort on the bill’s behalf.

The apex of this was the Blair House summit. As the bill was floundering, Obama invited congressional leadership from both parties to the Blair House to debate the legislation on live television for hours. Obama was trying to prove to congressional Democrats that they could win the argument on health care, that he could win the argument on health care, and that they should trust him and pass the bill. It really is worth watching a few minutes of Obama’s performance in this, and contrasting it with Trump’s role in the replacement effort:

Obama’s performance was effective because it was, to Democrats, persuasive. Obama knew the details of the legislation, he knew the issue, and he knew how Democrats thought — and so he made arguments they believed, and persuaded them that even if the Affordable Care Act was a dangerous vote to take, it was still a vote worth taking.

What happened publicly at the Blair House happened privately every day. Obama and his team were constantly working to sell wavering Democrats on the bill, to persuade them that the trade-offs made were the right ones, to convince them this was a historic opportunity to achieve the Democratic Party’s 80-year dream of universal health care. It’s no accident that Obama’s health care address to a joint session of Congress ended by wrapping the bill in the legacy of the late Sen. Ted Kennedy, and framing it as the “great unfinished business of our society.”

The campaign worked. In the Senate, Democrats had 60 votes, they needed 60 votes, and they got 60 votes.

 

 

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