As Democrats sift through the consequences of Martha Coakley's defeat in Massachusetts, it's time to confront one of the core fallacies in our approach to governance: Richard Neustadt's "100 Days Myth."
Neustadt first promulgated the 100 days notion in his book, Presidential Power. Drawing largely from Franklin Roosevelt's first term and recognizing the inherently limited nature of presidential power, Neustadt suggested that Presidents needed to accomplish the key elements of their agenda in the first 100 days of their term.
Every Democratic President since Kennedy has tried to follow this model, in part because most of their staffs (and I suppose, now they) took a political science course where it was taught, and every press account since then has adopted this lens, suggesting that not too long after inauguration members of Congress start looking to their own re-election and drift away from the President's agenda.
In this space I am committed to discussing the nature of change, mostly in the world of law, but from time-time I will look at other fields because I think the issues and patterns are so similar.
The 100 days model makes sense if what you're trying to do is make a "Greenfields" change -- Reagan's tax cuts, Roosevelt's creation of the FDIC or even Kennedy's push to put a man on the moon, but where trying to reform existing institutions, especially something like healthcare which is not a single institution, change of that nature takes time. Specifically, it takes time for a President to put in a place a team, to earn the trust of the public, and to define and gain some consensus on the "problem statement". In many fields, it's axiomatic that "if you can name it you can tame it," meaning once folks can agree on the problem, you can come up with a solution. But everything about the way we're doing politics now seems to avoid having a crisp and truthful problem statement, and instead we get a bunch of rhetoric about who we can blame for a problem and a generalized statement about how things will be better once we solve it, but not much specifics.
If we look at healthcare as an example, there are really five very different types of spending going on under the rubric of "insurance"
• Standard, annual, basic/preventive healthcare, which everyone should have access too, and which is priced very mysteriously;
• True "insurance" for adverse, catastrophic events, like cancer or a car accident, which fits the insurance model well and where broad-risk sharing and public subsidization makes sense;
• Chronic or lifestyle induced illness, like most diabetes, where it not obvious either for fairness or behavioral reasons why people with better lifestyle and lower costs should cross-subsidize others;
• Simple aging, which is inevitable and spending is undoubtedly excessive, where it is not obvious why it is either fair or progressive for working people to subsidize wealthier older people; and
• Pure "consumption" that happens to be administered through our healthcare system, like Viagra, Botox or Lasik, where cost shifting and the administrative cost of insurance add huge overhead to what is largely an individual choice.
Because, as in so much of our public life, any attempt to discuss or break apart any of these issues gets discussed as "so you want to kill granny," we end up with a jumble of a problem statement and a jumble of a solution
But while my friends in DC would all defend the process by saying "you have to start with the politics," in fact we've seen time and again that the interest-group based approach inevitably ends with the Nebraska exception and the Massachusetts defeat.
A CEO coming in to manage a corporate transition (see, e.g. Ed Whitacre at GM) follows a different playbook
• Focus on core competencies and goals
• Put a team in place
• Lower expectations and exceed them to build trust
• Communicate the heck out of the problem and the steps you're taking to solve it
• Develop mechanisms for execution
• Go after more aggressive goals
The Obama team -- as talented as dedicated at they are -- seems to largely lack anyone with experience in actually running and/or changing anything, so it's no surprise that they would stub their toes in this way, following a more academic approach to how to manage change.
It's ironic that Obama, who seemed to want to distance himself from President Clinton in the campaign, seems to have repeated Clinton's initial healthcare mistake verbatim. The good news is President Obama will undoubtedly be lucky and bounce back from this as well as President Clinton did. Despite the debacle in Massachusetts, I think it's almost certain that President Obama will be re-elected, and he and his team should focus on building capabilities and trust for a long-term effort for change. Let's start thinking about 2,922 day Presidencies, and approach the job according to what can be accomplished over that period.
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