Phantom of the Health Care Soap Opera

I missed the hot fun this summer. While much of America seemed to be screeching over the incredible — in the truest sense of the word — notion that angry citizens could tote a gun even to a town hall meeting with the president of the United States, I was pondering the relative merits of bike ride versus beach walk.

The brouhaha that has stripped away the thin veneer of good will that greeted the start of Barack Obama’s presidency is over health care revision, and specifically over something the media keep calling the “Obama health care plan.”

That one stumps me, too, because there is no “Obama health care plan.” Nor has there ever been one. That’s part of the problem.

The Obama political strategy has been that the White House would not propose its own health care legislation, lest it meet the same fate as the Clinton initiative of the early 1990s. The Obama political operation believes the death of the Clinton plan was foretold because President Bill Clinton sought to impose a White House blueprint on Congress, rather than letting lawmakers do their own thing.

Yet red-faced people are now hurling the same falsehoods (it’s socialized medicine, communism or a death sentence for Grandma) at the nonexistent Obama plan that they hurled at Clinton’s plan — and Harry Truman’s national health insurance proposal, and Lyndon Johnson’s Medicare. So the theory that somehow health revision would glide through Congress if only the president would let the lawmakers grease their own skids has been pretty much debunked.

There’s plenty of evidence that the look-ma-no-hands approach hasn’t helped, and it probably made the painful politics of health care hurt more, not less. For one thing, the president has outsourced his signature legislative proposal to a political entity — Congress — that has a public approval rating of about 30 percent in most recent polls, far lower than the president’s own standing.

But the foundering has as much to do with schoolbook civics as it does with contemporary politics.

The president and vice president are the only leaders elected by Americans as a whole. Obama won 53 percent of the popular vote last year, carried states in every region and won support among most demographic groups. Members of Congress can’t claim to be such unifying figures.

They are by definition creatures of their home states and districts, compelled to meet the needs of their constituents, correctly sense their pulse and accommodate their wishes — or risk losing re-election. That’s why moderate Democrat Kent Conrad of North Dakota has such wildly different ideas about health care than does liberal Democrat Henry Waxman of California. And don’t bother to wonder aloud about the divide between Democrats and most Republicans.

With no White House plan to serve as a political marker, it’s been every member for his or her self. That’s why there are competing Democratic plans, and rifts within rifts in the party. Vacationing lawmakers have no single plan to defend or even explain to the throngs of detractors — and, sometimes, supporters — who are turning out in the heat to harangue them.

Without the president even setting out clear lines about what will or won’t win his signature, there is no political penalty to be paid by any Democrat who crosses Obama.

And who can even tell when he’s been crossed?

The White House is now in retreat from the president’s often-repeated support for a public insurance plan to be offered to consumers who currently lack insurance, or who are unable to afford what they now have. It hasn’t said publicly which of the competing tax proposals it will accept as payment for expanding coverage, a minefield set to explode in the coming months.

Thus far, the Obama White House has stood firmest behind its own agreements — reached in secret, without public hearings or congressional input — with lobbyists for the drug industry and hospital groups who have promised to deliver cost-savings at some unspecified time in the future. It even has backed the drug industry’s insistence that Democrats be prevented from writing legislation that would allow the government to negotiate discount prices, a congressional goal since the Medicare prescription drug benefit program emerged from Capitol Hill as a slush fund for industry profits.

The phantom Obama health care plan eventually will take form, no doubt with a lofty title and some gesture to the ailing Sen. Ted Kennedy. Those who have hoped for more substance than sentiment are likely to be disappointed.

Marie Cocco’s e-mail address is mariecocco(at)washpost.com.

© 2009, Washington Post Writers Group