White House Chronicle

News Analysis With a Sense of Humor

Obama Diagnosis, Won’t Prescribe

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President Barack Obama starts from a pretty compelling argument: In the rich industrialized nations, the rich and the poor should be able to afford to get sick. They surely will. Disease does not means test.

 

But after that, the health care argument gets away from the president. In fact, he hasn’t made his own argument.

 

This week Obama has argued passionately for reform, as he did in his prime-time news conference Wednesday night. But we have yet to hear his personal view of what an American health care system should look like. One suspects that it is the solution that dare not speak its name: a single-payer system, a government system. Yes, a–dread word–socialist system.

 

The empirical evidence from Australia to Ireland, Canada to Norway is that this is the way to go. Every country with a national health service pays less for health care per capita than does the United States. And not one has contemplated canceling their system.

 

Yet it is a concept that may be too radical for Americans. It also may be too late in the evolution of the health care industry to nationalize the system.

 

Canada had the most difficulty nationalizing health care of any major country, and is still groaning. Canada did not plunge in; it waded into a state system, and put it all together in an age of sophisticated medicine. But it is not without problems: for example, Canada failed to comprehend that if everyone who needs to see a doctor sees one, more doctors will be needed. There is a chronic shortage of doctors in Canada.

 

Britain, by contrast, nationalized its health system after World War II, when medicine was simpler and the process was easier. It was also a time of post-war idealism. Today, like most state systems, it functions well enough but not perfectly. Well enough for Britons living abroad, including in the United States, to fly home for major surgery.

 

The world of single-payer does allow for private insurance, and it is flourishing in countries like Ireland. This provides a second tier for those who feel the basic system is too rudimentary. Under this arrangement if you want a procedure for a non-life-threatening ailment, which would require a long wait in the state system, you visit the specialist–called a consultant in the British Isles–and the insurance company picks up the tab. The idea is that the well-off get what they want, and the rest get what they want.

 

Obama’s problem is that he can diagnose the problem but has failed to prescribe a solution that he appears to believe in. He is waiting for Congress to produce something that he can sign onto, called reform, and that will not expand the budget. Where European and some Pacific countries have allowed private systems to piggyback on state systems, Congress is struggling with the reverse and the president is going along. Congress is planning to have the state piggyback on the employer-paid system.

 

The idea that employers should carry the health care burden probably goes back to the 19th century when railroads, coal mines and ships found it best to employ a doctor to keep workers on the job. Today, it is an incongrous burden on American firms in an age of globalization.

 

The three principal schemes for a new day in health care seek to preserve private insurance as primary, mandate portability, demand that commercial insurers do not reject pre-existing conditions, and provide some kind of safety net from the government. And, yes, the whole new edifice will be revenue-neutral.

 

At his press conference, Obama was ebullient, funny at times–the very picture of a man about to get what he wants. By contrast, in the halls of Congress, the lawmakers who are supposed to deliver this package are despondent. They do not know what the president will accept and are not persuaded that huge federal spending will not result. There is real political fear on Capitol Hill. Wednesday night did not allay it.

 


 

 

 

 

Favoritism from the White House Podium

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Like others who ply the newspaper trade here in Washington, I have attended many presidential press conferences, and I am always struck by the same thought when the president steps up to the podium: how alone he seems to be.

Because presidents are nearly always surrounded by staff, security and often other politicians, the essential aloneness of the president can be missed. At press conferences, a president is both alone and on his own. No assistant can whisper in his ear or produce a useful statistic. Unlike the British prime minister who sits among members of his cabinet—and has advance notice of the questions–during Question Time, when a president hears a question he must answer it with the full knowledge that his words are circling the globe, and that later he must defend them.

A presidential press conference is intolerant of slips of the tongue, twisted history or evasion. You might say a press conference is an enhanced interrogation technique.

So it is strange, and unfortunate, that President Barack Obama and his media team leave the impression that his press conferences are rigged.

The appearance of “rigging” came in with George W. Bush and, along with some other aspects of the Bush press operation, has survived. I am referring to the practice of preselecting who will be called upon to ask questions. This gives the impression that the either the reporters in question know they are going to be called upon or, worse, that the president has advance knowledge of the questions themselves.

Until Bush, presidential press conferences were free-for-alls with dozens of correspondents shouting, “Mr. President.” Sure it was untidy, but it was fair and transparent. One imagines that the prescreening now takes place between the press secretary, Robert Gibbs, and Obama. Hence the favoring of television networks, The New York Times, and one black and one Hispanic correspondent, as was witnessed last week. This kind of engineering wrings spontaneity out of the proceedings and causes more and more reporters to stay home and watch the travesty on television.

This trend was obvious in the drop-off in attendance from Obama’s first and second prime-time press conferences to his third. If there is no chance that you will get to ask a question, what is the point in attending?

Many White House regulars, some of whom have covered the White House for decades, are expressing dissatisfaction with Gibbs’s fascination with a handful of reporters–most newly arrived on the beat, like Gibbs himself.

It is not reasonable to expect the president to be familiar with inner workings of the White House press corps. But it is upsetting that Gibbs has clearly not sought to learn from Bill Clinton’s last two press secretaries, Mike McCurry and Joe Lockhart, both of whom were masterful in difficult circumstance. Or, in the spirit of bipartisanship, he might put in a call to Dana Perino, one of the stars of the waning days of George W. Bush’s presidency and his last press secretary.

One of the questions Gibbs might usefully ask of past press honchos is how they kept things running on time. Seldom were briefings late or rescheduled during the day, the way they are now. Clinton was a terrible timekeeper, but the press operation was sensitive to the time demands on correspondents. Not so Gibbs. When it comes to tardiness, the press operation at the Obama White House is in a class by itself.

Back to last week in the East Room of the White House. As is the way in these days of tribal politics, the Washington commentariat saw what it wanted to see in Obama’s performance. One conservative friend, John Gizzi of Human Events, thought Obama was in campaign mode. Some fit the press conference to their belief that the president is hell-bent on taking the country down the French socialist road, and that he will not rest until the tricolore flies over the White House and American schoolchildren sing the “Marseillaise.” Others, amazingly, found proof that Obama would be only a one-term president.

I think I can speculate with the best of them and I saw only a tired, slightly impatient but impressively articulate man alone with big troubles.

Obama is trying to fix everything at once. The only person who really pulled that off militarily and domestically was Napoleon Bonaparte. It was Napoleon who gave us the idea that a new leader’s effectiveness should be assessed in 100-day increments–except it was 111days for Napoleon, but the Paris newspapers shortened it to 100 days. And the 100-day timeline was not at the beginning of Napoleon’s reign, but at the end–the time between his escape from Elba and his final defeat at the Battle of Waterloo.

 

A Tale of Two Summits: London and Vienna

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Truth be to tell, the Group of 20 meeting in London was not much of a summit. That honor belongs to the Congress of Vienna which met from September 1814 to June 1815, and hammered out a peace that lasted for about a century.

 

The London summit has been a largely a European-American affair. But it did include the next stage in the coming out of China; the first was the Beijing Olympics.

 

It also was the international coming out of President Barack Obama, who was hailed by the European press as the most popular politician in the world. That was a real problem for the continental Europeans, who wanted to be seen to be his best friend while admonishing him that he was, economically speaking, full of it.

 

From the start, the G-20 delegates seemed to have only one goal: to write a communique that implied they were all on the same page when clearly they were not. Those in the eurozone could not accede to Obama’s stimulus ideas, even if they wanted to, because legally they cannot go as far in deficit spending as the United States without violating the rules that created the euro. Also the European Central Bank, which just lowered its key interest rate to 1.25 percent, when it was hoped it would go lower, is much more conservative that the Federal Reserve and its independent chairman, Ben Bernanke.

 

The Euros are also deeply suspicious of the Obama administration’s plans to save the car industry. Nearly all of them have been down that road over many years with disastrous results. They also have been trying to create jobs with government programs, incentives and retraining which have not put a dent in their structural unemployment. “Look, we know a thing or two about messing up,” is their message to Obama.

 

The Euro pols could not have agreed with Obama, even if they had wanted to, but they wanted to wrap themselves in the magic, the popularity and the originality of the American president and his wife. Who would have believed that first lady Michelle Obama would outdazzle Nicolas Sarkozy’s wife, the gorgeous former model Carla Bruni.

 

The big news, according to the participants, was the $100-billion trade credit plan and the strengthening of the International Monetary Fund.

 

The real news, not missed by the storied British tabloids, was that the first lady hugged the Queen–something that has not happened in all of recorded English history–and that Canadian Prime Minister Stephen Harper missed the de rigueur group photo because he was answering the call of nature.

 

More than anything else, the London summit was brief. The delegates only met in plenary session for few hours–a time frame that guaranteed that they could neither overhaul the international banking system, nor really get to know each other.

 

How different from that greatest-of-all-summits in Vienna with its parties, Lipizzan stallions walking on their hind legs at the Spanish Riding School, and chefs and musicians composing great dishes and exquisite ballroom music.

 

The congress was convened by the great Austrian foreign minister Klemens Wenzel von Metternich to tidy up after the French revolutionary wars, the Napoleonic wars and the end of the Holy Roman Empire. It never met in plenary session and relied on an endless informal exchanges between the delegates from more than 200 states and princely houses. But the big states dominated and pushed the lesser states around, assigning them new borders, monarchs and sometimes names. Europe was carved up on conservative lines, with a determination to lesson the impact of the French Revolution and the American Revolution.

 

Some of the arrangements had to be modified and there were some wars followed (the Franco-Prussian), but nothing like the endless fighting on the continent that had preceded the congress. It set in motion the consolidation of Germany and established Vienna as the place to be for New Year’s.

 

The London summit may be remembered not for its economic achievements, but for the first American president who has no of hint of Eurocentricity, and cannot trace all of his ancestry to that continent.