Obama: The First Term Did It

Obama Health care.jpg

Pablo Martinez Monsivais/AP Images

President Barack Obama speaking about health care at Prince George’s Community College, Largo, Maryland, September 26, 2013

Despite all the lamentations about Barack Obama having second-term blues and bad luck, and the talk about how a painful second term is not atypical, it’s what happened during the first term that matters most. With the exception of possible exogenous events, a president’s first term defines his second one. The enormous difficulties that Obama is having with his signature issue, the health care law, are the shining example of how that can work. Almost everything that has gone wrong with the program was set in motion in the early years of his presidency.

The first term is when the president makes fateful decisions about what kind of people he wants in his White House, how he wants them organized, the nature and role of his cabinet members (are they essentially staff, as most tend to be in the Obama administration?), which initiatives he selects as his most important, whether he builds a strong cadre of outside allies, how he deals with the Congress and how hard he is willing to fight for what he wants.

Not unlike some other presidents, Obama essentially surrounded himself in the White House with his campaign staff, or others he knew well, rather than finding people experienced in governing. Newly elected presidents pay a heavy price if they are themselves inexperienced in governing and select top staff who lack a broad sense of what it means to run a federal government.

The shock of adjusting to the presidency—the myriad amounts of information and decisions to be made thrown at them—hits most newcomers. Where to begin? Which decisions to tell your staff are presidential-level ones and which ones are they to work out on their own? How much authority to give to the cabinet—a set of relationships that is almost always fraught. Only if a newly elected president has served as vice president or in a tiny number of other high offices can he have been given a prior sense of the vast chasm between running for president and being president. There is a lot of talk these days that former governors are the only ones who are truly prepared to occupy the oval office. But that’s hogwash. To my knowledge none have a Pentagon to run, or a raft of foreign policy decisions coming at them every day, or fifty sub-states and a potentially obdurate Congress to deal with. There is no training for the presidency.

Barack Obama had an unfathomable inability, beginning in his early years in office, to grasp the difference between campaigning and governing—and for that he’s been paying a fearful price in his second term. Campaigning and governing call for different kinds of rhetoric. For some reason, Obama never got control of the health care argument. He cited its attractive provisions many times, but he just didn’t get through.

As for his promise that if people liked their health insurance policy they could keep it, former aides say that they were uneasily aware that it was misleading, or oversimplified. But they figured that it represented a small slice of the probably large group who would eagerly sign up for the new plan. They also figured that if the federal website was working the way it should, most people would be aware they had access to better options. They didn’t come clean that some people were going to lose out under the new plan. The president, now on the defensive, and almost groveling, remained unable to get across the enormous benefits of providing some 30 million uninsured people with coverage.

Fateful decisions made in the first term reflected Obama’s lack of understanding of what it meant to govern. Early on, I received a startling insight into how the Obama White House approached working with Congress. I asked a senior presidential aide why the White House hadn’t sent up its own health care legislation, so that there would be something coherent to start with and more leverage. His reply: “Because any time we lost a provision that would be seen as a loss.” This was a most unusual way to deal with Congress—tying one’s own hands at the outset.

As the health care legislation moved through Congress, Obama and his top aides became swallowed up in the details. Rahm Emanuel, Obama’s first chief of staff, had much to recommend him: he’d served in the Clinton White House and been a member of Congress. But he was an inside man, buried in the maw of the legislation—and apparently unable to see the big picture. Moreover, it’s virtually impossible for Congress to write a coherent complex piece of legislation. In this case, particularly large interests are at play: the insurance companies (who would still play the major role as insurers), manufacturers of medical equipment, hospitals, drug companies, religious organizations—and without its own bill the administration had limited leverage over numerous strong-minded legislators. Five hundred and thirty five people are unlikely to produce a fine Swiss watch.


But Obama and his staff’s failures at governing led to the disastrous roll-out of the exchanges. Simply put: they went about it all wrong. Such a major part of the president’s signature initiative should never have been assigned to the multilayered bureaucracy, however honorable and well-intended its people are. Obama needed to put in charge a single strong figure who could go straight to him and was known to have his backing—and, obviously, knew enough about the complexities of such a large high tech program. The president needed to be kept very informed as to where matters stood. (The White House put about after the calamity became clear to the public that the president had occasionally asked how things were going; this wasn’t reassuring.) Short of appointing a strong outside person, the president could have relied on a figure such as Joe Califano, Lyndon Johnson’s chief domestic policy adviser, to be on top of the implementation and raise hell if the people charged with building the exchanges weren’t doing the job.

It remains unclear to this day who in the Obama White House was responsible for seeing to it that the program was on schedule and working as it should—or if anyone was. There’s no sign that the president’s serial chiefs of staff—after Emanuel, who left in October, 2010, and then Bill Daley, Jack Lew, and now Denis McDonough—were engaged in any meaningful way.

Another misfire was the brobdingnagian nature of the Obama plan, like that of the Clintons’ plan before it: wonks were in charge and there seems to have been little checking to see if real people could handle it. While the Affordable Care Act was moving through Congress, White House aides explained that it would all be very simple: the consumer would go online and pick out a health plan from among choices—just as, they said, people do with Expedia. Quite apart from the federal web site’s own flaws, the Obama plan suffered from an overestimation of computer literacy among the public at large.

Finally, the president’s offhanded way of dealing with Congress in the first term has weakened his hand with members of his own party in the second term, at precisely the point when he needs them most. The very self-contained Obama, less needy than many of his predecessors, and his impatience with some of the folderol of politics—albeit it’s his chosen line of work—left him with few senators or House members, or even outside groups, who would go to the barricades for him when he needed them in the second term. One can understand and even sympathize with Obama’s view of listening to tedious people who lecture him on how things should be done (they might actually know more than he, but he doesn’t care to be told), but it’s been very costly for him.

The health care law is a delicate instrument, built on sets of assumptions which may not pan out, or which could be undermined if out of panic the president or Congress fiddles with the law. The anecdotes about people losing their policies have frequently been over-simplified, but make for more dramatic news stories than the advances already achieved under the law; there’s been little attention to the already slowing rate of growth in the cost of health care—one of the law’s major goals.

Obama’s governing style in his first term lit the fuse for his second term. Politically-driven decisions on the health care law along with a failure to understand some of the rudiments of governing have resulted in his current difficulties. It’s far from over of course, but should his proudest achievement fail to work—its outcome not at all certain at this point—the rest of what he does in his second term may not matter much.

Subscribe and save 50%!

Get immediate access to the current issue and over 25,000 articles from the archives, plus the NYR App.

Already a subscriber? Sign in