So the short version of President Obama’s positive case for his presidency is “General Motors is alive and Osama bin Laden is dead.” The longer version appears in a video the campaign released earlier this week. Yet even the long version, despite having seven minutes to lay out its case, makes no mention of two of the most important, albeit technocratic, facets of Obama’s agenda: his efforts to reform health care and education. Their absence says a lot about Obama’s struggles to sell and entrench the core of his domestic agenda.
The video does tout Obama’s efforts to expand access to health care — the subsidies for the uninsured, allowing young people to buy into their parents’ plan, and lower prescription-drug costs for Medicare beneficiaries. It lacks any reference to the broad-ranging effort to control health-care costs. But this is probably just as vital. The cost of medical care has swallowed up an ever-rising share of the economy, making any decent solution to the long-term fiscal crisis impossible. Likewise, the video boasts of Obama’s expansion of student loans, but it neglects the far more consequential efforts to overhaul education.
Why the omission? Well, for one thing, these reforms are fiendishly complex. Obama did not come up with a single bullet to reform health care or education. The administration put in place a wide array of experimental reforms designed to align cost and quality, encourage innovation, and penalize providers who charge higher prices without higher value. The health-care law featured a wide array of technocratic reforms long-proposed by a bipartisan array of health-care wonks — better use of information technology, more sensible payment methods, and many, many more.
In education, the administration created “Race to the Top,” an enormous reform that, I have found, almost nobody who does not work in the field of education policy knows anything about. (I happen to be married to somebody who does.) The administration dangled grants to states that would overhaul their education systems along a set of criteria, like changing the way teachers are paid or encouraging charter schools. It resulted in a national wave of education reform. The administration has likewise spread the approach to Head Start (where it is trying to weed out poorly performing programs and keep good ones) and has even taken tentative steps toward reforming higher education.
You’re bored already, aren’t you? You probably skipped those last two paragraphs. Okay, summary: The overriding theme in both these areas is that two vital sectors of the economy are growing radically more expensive and unaffordable, and the administration is overturning their basic models and, by using measurements of quality, trying to make them provide better value.
Of course, this creates a second problem: People don’t like having their way of doing business overturned. People like getting paid regardless of outcomes. That’s why these reforms have well-organized skeptics, or even outright enemies: large chunks of the medical industry, teachers unions, and the like. The boringness contributes to the dilemma. Almost nobody knows about these reforms, but of the people who do know about them, a large proportion consist of people who stand to potentially lose money from them.
And so Obama is downplaying them, touting the parts of his program that involve the government giving people stuff, and ignoring the parts that involve the government taking it away. (His video even highlights such picayune reforms as “incentives to hire unemployed veterans.”)
But one result of this decision is that Obama is running as a more liberal figure than he actually is. His reform agenda is a more ambitious version of the Clinton-era movement to overhaul the way government operates, but he has adopted none of the thematic centrism that Clinton used to such great effect. And by giving up on trying to explain these policies, he has made it harder to build a long-term coalition to sustain them. The boring stuff really, really matters.
