How the Organizer-in-Chief got Obamacare done

As we are celebrating the initial success of the Obamacare exchanges, I thought it might be interesting to go back and look at how the greatest expansion of healthcare in half a century got done.

If you remember, back in the 90's the Clintons were making some progress with their health care reform plan until the insurance companies took them head on with their Harry and Louise ads. That's what killed reform for almost 20 years.

President Obama learned from that failure. He negotiated buy-in from the health insurance companies by keeping the current system of private insurance intact and offering them the chance to compete for new customers in exchange for:

1. No denials for pre-existing conditions
2. No lifetime caps
3. Community ratings
4. A guaranteed set of benefits (including free prevention services)
5. Medical loss ratios that limited administration and profit to 15-20% of premiums

Some might call that a faustian bargain. But it is one of the main reasons we have health care reform today.

If you recall, in his days as a community organizer, President Obama learned about the concept of meeting people's self interest.

The other fundamental lesson Obama was taught is Alinsky's maxim that self-interest is the only principle around which to organize people... Obama was a fan of Alinsky's realistic streak. "The key to creating successful organizations was making sure people's self-interest was met," he told me, "and not just basing it on pie-in-the-sky idealism. So there were some basic principles that remained powerful then, and in fact I still believe in."

I've demonstrated before how that comes into play in the President's dealings with foreign opponents like Iran and Russia. Its exactly the same principle that he applied to the health insurance industry. His goal is not to defeat his opponents - but to co-opt them. That is the Aikido Way.

In a world where power is regularly conflated with dominance, its not surprising that a lot of people see that as weakness and/or inferior negotiating. That is...until it gets the job done.