There have been a series of stories in recent weeks seeking to answer the most fundamental question about President Obama's first year in office: why, exactly, did he ignore prevailing advice and tackle health care reform?
Numerous explanations have been offered, ranging from the moralistic to the politically compelling. The common thread among them, however, is that Obama is, above all else, a bean counter. And when faced with a bleak economic landscape, in which government spending had to accelerate in the short term even though daunting deficits loomed on the horizon, he saw the health care system as the biggest vehicle for savings.
During a speech on Monday, Obama's top economic adviser, Larry Summers, made much the same case, arguing that the president tackled health care not because it was one way to achieve economic soundness... it was THE way.
"The president believed and acted on the conviction that reforming our health care system had to be the top priority in renewing our national economy," Summer said at the Johns Hopkins School of Advanced International Studies. "The legislation this year represents the most serious prospects for addressing health care costs through public policy in more than four decades. A prerequisite for any serious attempt at cost control is insuring universal coverage, otherwise cost constraints will have manifestly unacceptable human impacts as they are shifted from one provider to another. And the easiest way to reduce your costs is to stop providing uncompensated care." (emphasis mine)
Summers failed to mention that during the campaign Obama's approach to health care reform was the most tepid of all the candidates in the Democratic field. The mandated coverage that Summers hails as an integral component was absent from the Obama campaign plan. It was only once in office that the president's view of health care reform as budget-balancing (and not morally righteous) legislation seemingly crystallized.
As one White House ally put it to the Huffington Post: "He was persuaded to do health care, I believe, by Peter Orszag [the budget director], not Ted Kennedy [the moralistic former senator]."
Summers also touted various other cost-saving components contained within the health care bill, including the encouragement of prevention, cost effectiveness research and reimbursement reform. But in a hint at just how difficult the economics and politics of health care has been, he hinted that whether or not the legislation will be considered successful is out of the administration's hands.
"We are under no illusions this legislation is not self-executing, its impact will depend on decisions made going forward," said Summers. "Success will depend ultimately on our ability not just to contain federal health care costs but also to contain all health care costs. Because a situation in which fed payments come to lag far beyond private insurance payments will be unacceptable for our seniors."