Saturday, April 5, 2014

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.


  1. You've been doing your thing for a minute now. I'd like to ask a favor. Could you check this site and see if you can get interested parties to send videos? The site is Somebody has to get the President's back if the "professionals" don't want to.


  2. I've noticed a pattern to how Obama tackles a tough issue that others have tried to deal with and fail: he first identifies who were the most influential opponents in the previous fight and then he works to get them to buy in to the change before he then comes forward with his full proposal. For example, Clinton tried to open up the military to non-heterosexuals, but he quickly got burned on it and Don't-Ask-Don't-Tell was the unfortunate result. So who were the most influential opponents in that fight? The top brass of the military. So what did Obama do? He got the top brass to develop the plan to open the military to non-heterosexuals.

    I can imagine something similar happened in the healthcare fight. The insurance companies sank Clinton's efforts. So Obama went to them and asked: if you lived in a world where you couldn't refuse service to people with pre-existing conditions then what kind of world would you like that to be? That's how we got to Obamacare: it was written by the insurance companies with a few essential requirements set down by the administration.

    Of course, those on the left hated this idea because they saw the fight over healthcare as a fight to defeat the insurance companies. But Obama saw it as a fight to get people universal and complete coverage.

    So maybe this is how we can formulate the Obama doctrine:

    1. Decide what it is you really want
    2. Identify the biggest opponents to what you want.
    3. Go to them and ask them a hypothetical: Assume a world in which what I want is a reality. What would you have to have in order for you to be able to accept that reality?
    4. If they don't immediately refuse you, then you have a big clue that there *is* a world in which they could accept what you want. And once you have that you are well on your way to a workable resolution.

    The rest is details and fine print.

    1. Yep. What your describing are the details of what it means to re-define your opponents "self interests."

      And I'm going to file this one away for future reference. IOW, nailed it:

      Of course, those on the left hated this idea because they saw the fight over healthcare as a fight to defeat the insurance companies. But Obama saw it as a fight to get people universal and complete coverage.

    2. It seems to me that too many on the far left care more about the fight than about the outcome. They would rather lose on principle than win... problem is, this isn't just a mental exercise. Lives rise and fall on what happens legislatively, and President Obama understands that. He cares more about getting help for those who need it than he does about getting a "pure" win. I'm with him there, and I truly appreciate that he takes the long view. I'd rather see 75% win than a 100% (but pure and principled) loss.


    3. *a 75% win* Sorry - not feeling all that great today, and my proofreading skills are essentially nil.


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