It’s implementation, stupid
By Ira Sharkansky
JERUSALEM–Several of my Internet friends have ridiculed my concern with American health policy, and several have ridiculed my dismal assessment of Palestinians seeking statehood.
Nonetheless, I will reiterate the importance of both issues, and emphasize some commonalities that provide useful lessons about politics. And while many view politics as not a fit topic for conversation, I insist again that it is the essence of civilization. Political maneuvers and deals may offend the delicate, but they are the best way to deal with disputes that get to the public arena.
What is most prominent in bringing together the politics of American health and the politics of Israel-Palestine is the intense involvement of Barack Obama.
I have praised his Cairo speech about the Middle East, and his proposal to expand health care for Americans. Both were well crafted efforts to deal with serious problems, using the leverage available to the leader of the world’s most powerful country.
As Obama’s efforts have gone forward, he has demonstrated that he does some things very well, but more important things very badly.
The Cairo speech demanded from Israelis, Palestinians, and other Arabs what seemed able to resolve a conflict that had defied numerous earlier efforts at peace making.
What is crucial to politics, however, is not the grand idea, but how the follow-up deals with the numerous problems of implementation. If those problems did not exist, there would be no need for the grand idea. Ordinary people can conceive of what might be done, but genius consists of knowing how to defuse the land mines created over the years by hostile actions and distrust.
Obama’s grand idea about the Middle East made both Israelis and Palestinians suspicious. Numerous Arabs said that he was arrogant shortly after they applauded politely. He flubbed badly when he gave Israeli naysayers an ideal target by demanding a freeze on Jewish neighborhoods of Jerusalem. A politician claiming religious sensitivity should have recognized the centrality of Jerusalem going back to the Biblical origins of Judaism. Then when he backtracked and praised the Israeli prime minister for doing less than what he had demanded, he alienated whatever support he had from the Palestinians. Now the two sides are further apart than at any time since 1993, when they first agreed to negotiate.
The President’s record in health is similar. Initially there were good ideas to expand coverage, move against the worse abuses of insurance companies, and reign in costs.
Patriotic Americans continue to claim that no country has better health care, and that all residents can go for treatment to a hospital emergency room.
Facts are that the United States scores so poorly on longevity and infant mortality that no efforts to find reasons in social problems can account for the dismal record. It is the only wealthy democracy that does not assure access to basic care for all its citizens. Access to emergency rooms for those already severely ill or injured does not make up for what is missing.
Those who trumpet the quality of American health care sound like deranged individuals saying that everyone else is crazy.
When actually submitted for Congressional deliberation, the proposal of a thousand pages provoked more fears and suspicions than it soothed. Now it is said by some to cover 2,400 pages and by others 2,700 pages. Whatever the size, there are at least as many reasons to oppose as to support.
A public encounter between the President and Members of Congress, billed as a way to find a common path, is being reported as a confrontation. “By day’s end, it seemed clear that the all-day televised session might have driven the parties even farther apart.” http://www.nytimes.com/2010/02/26/health/policy/26health.html?hpw
Could the President have been challenging the Republicans, and setting them up for defeat at the polls?
His adversaries are salivating at election returns from Massachusetts, Virginia, and New Jersey, as well as pointing to the lack of accord on health between Democrats in the House and Senate.
For Obama to qualify as a good president, he must go beyond successful lessons in rhetoric, and learn more about implementation.
A major test will come with mid-term Congressional elections in November. By 2012, it may again be the national economy on everybody’s mind.
And you cannot beat somebody with nobody. If tea-party conservatives think they can win with Sarah Palin, it may be the best news a Democratic candidate has received since John McCain chose her as his running mate, or since an earlier generation hoped that Barry Goldwater could defeat Lyndon Johnson. Unless Barack Obama comes to look too much like Jimmy Carter.
Politics is not for those who are overly certain.
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Sharkansky is professor emeritus of political science at Hebrew University.
