Shades of Richard Nixon

Is Obama playing defense or offense?

Those of us of a certain generation remember Richard Nixon and all the gory Watergate details that oozed out and finally toppled a sitting president. None of us can forget Nixon’s defiant “I am not a crook”—a remark which he made in a question and answer session with 400 Associated Press managing editors in 1973, at the height of the Watergate scandal. Nixon was on the offensive—or maybe it was the defensive.

This week there has been an eerily similar Nixonesque feeling coming from the White House, which has been criticized for not being upfront about what, exactly, the president stands for when it comes to the details of health reform legislation. We at Campaign Desk—and, now, others in the media—have been urging the President to be more forthcoming and tell ordinary Americans just how they’ll be affected by health reform.

On Monday, according to the Christian Science Monitor, White House press secretary Robert Gibbs summoned reporters around his desk and chided them “for not giving credit for what the administration has accomplished in the battle to enact what President Obama calls health care reform.” According to Monitor senior editor David Cook, Gibbs said that there was 80 percent agreement on a health care package, and disagreed that the last 20 percent was the hardest to get. He urged reporters to remember President Clinton’s efforts to enact health care reform: “My guess is that if you rewind to that, you would have found getting the endorsement of the doctors, the hospitals, the AARP, and the drug manufacturers might have well ranked as some of that hardest things to do.” “Those are all steps the Obama administration has achieved,” Cook wrote.

Do we really know for sure that all the hospitals—non-profit and for-profit—are on board, as well as all the doctors? (The AMA represents many fewer docs than it once did.) Are drug makers jumping up and down because, according to The Wall Street Journal, they’ve won a “string of victories” at the Senate Finance Committee, including no direct government negotiations to lower Medicare drug prices and no importation of cheaper Canadian drugs. Will the chief stakeholders—who are sooo supportive right now—get more goodies once the bills hit the House and Senate floor? Another historical digression here: these stakeholders bought into the Clintons’ plan, too—but that support vanished when it became clear that specific details of the bills would affect how the stakeholders did business.

The offense—or defense—continued Tuesday when the president sat down with Time senior writer Karen Tumulty to talk about his work, both public and private, on behalf of health reform. “The truth is we’ve actually, I think, provided more guidance than has been advertised,” Obama told Tumulty.

I mean if you think about how we’ve moved this forward, we didn’t simply put out some broad principles; we were fairly specific. We said we need to have insurance reform, and that’s going to include things like preventing insurers from dropping people because of pre-existing conditions. We said that we are going to need to expand coverage; that an insurance exchange that would provide people a menu of options was an important mechanism to expand choice and help to deliver help to people who didn’t have health insurance or were underinsured. We talked about the need for a public option as part of that health-care exchange.

In the interview excerpt released by Time on Wednesday, Tumulty asked if it was the right decision for the president’s grandmother to have expensive hip replacement surgery when she was terminally ill. That question, it seems, gets to the crux of the U.S. health care system’s cost problem, which has emerged as the major issue for the president. But instead of addressing it head on, the president said that she had surgery at Kaiser Permanente, which is one of the models of “high quality, cost-efficient care.” He said his grandmother was generally very happy with her care, adding that if we could get our system to hit the efficiency levels of Kaiser and a few other examples, “we actually would have solved our problems.” But should we spend money on hip replacements for people about to die? Obama did not answer that question.

Those kinds of answers have caused the media to question the president’s positions—or lack thereof. On Tuesday, when reporters asked Gibbs about the likelihood that the Senate Finance Committee bill would lack a strong public plan, Gibbs declined to say, instead noting: “I think the broader principle is that, do we have a mechanism that provides adequate choice and competition.” Ah, those presidential principles again!

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.