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Tuesday, August 18, 2009
A Fictional White House Internal Memo

Fictional! As in, Not Real! As in, Didn't Really Come from the White House! But maybe it could have, and that's the point.

Date: August 18, 2009

From: White House Czar of Hope and Czhange
To: White House Senior Staff, Democratic Congressional Leadership, Executive Allies at Big Media Acronyms

Re: Health Care Reform Strategy Reminder


Dear Colleagues:

This seems to be a good time to remind you all of our two-part strategy for Phase Two of the health care takeover.

Despite the ongoing furor and even the Democrat Member of Congress who is avoiding his district for the entire recess, things are going well enough for our overall strategy. The only part of the plan that is failing is Plan A, the Blitzkrieg, which we knew from the beginning was a calculated risk.

As you will recall, Phase One was the insertion of language into the stimulus bill earlier this year to create a centralized, governmental database of all health care records; to monitor the health care decisions made by doctors and patients; and to reward or punish doctors based on their use of treatments we approve or disapprove, respectively. This language went almost unnoticed in the broader debate on the stimulus, survived conference mostly intact, and is now law. The strategy of creating the bureaucracy, giving it a general area of responsibility, and then limiting its activities as little as possible is clearly a winner. This indirection allows us to deny that a bill contains troublesome language, forces opponents to extrapolate rather unsteadily and unpersuasively on relatively inoffensive language, and leaves the bureaucracy with broad authority when the debate is over and public attention has turned elsewhere.

As regards Phase Two, our hope was to pass substantial reforms quickly, exploiting the continuing economic crisis, the President's high approval ratings, and the willingness of many in Congress to vote for large, expensive legislation without having read it -- to exploit all this before the radical, un-American minority of political terrorists could awaken itself and disrupt the legislation. We can now safely conclude that this Blitzkrieg has failed. We knew from the beginning that this was a likely outcome.

However, you will note that the House of Representatives has one plan, and the Senate has five, but none of these is the White House plan. This has yet to be released, even though the President has been stumping for health care reform generally quite a lot lately, and referring in some cases to specific provisions of the House bill in particular. The late arrival of the White House plan is by design, to accommodate Plan B.

Plan B, the Stealth Attack, will be launched by a Presidential address to the nation. It is designed to look to the enemy like a retreat. The President will concede quite frankly that the bills currently on Capitol Hill are discredited, but will note that they have launched widespread and very productive debate of health care reform generally. He will explain that his own health care reform proposal has not yet appeared in the House or the Senate, but is now fully prepared and incorporates the feedback the voters have provided. He will ask the sponsors of the House and Senate bills to withdraw their bills and sponsor his.

He will itemize the essential differences between his plan and the earlier, now defunct proposals. Together, the differences will answer all the major objections to the House and Senate bills which appear to have roused such vigorous opposition. There will be no "death panels" (twice as much as there were never any before, so to speak). There will be no government-sponsored "public option" to compete with private insurance. And so forth. In some cases, we will actually back away from a feature to some degree in this legislation; this is a long project, requiring multiple bills over a period of years, and a little less progress at this stage is better than no progress at all. In other cases, we will preserve the essentials of a feature but package it differently, so that we can explain persuasively that we have heard the objections on a particular point and answered them by proposing something different.

For example, it matters little whether there is a government-administered "public option." What matters is that we move regulation of the insurance industry from the states to the federal level, establish a clear precedent for massive funding to help the uninsured afford insurance (even if all the options are private), and that we exploit the opportunity presented by this new, much-increased level of intervention to impose our will upon private insurers and their customers. To the degree that we do this successfully, it does not matter that we are controlling private insurance rather than destroying it. We can omit the "public option" from the proposal entirely, trumpet the fact that we are doing so, and still advance our objective quite effectively.

Likewise, we will restructure the "death panels." In fact, in any health care system someone has to make difficult decisions about levels of treatment, quality and length of life, and so forth. Now these decisions are mostly made by patients, families, doctors, insurers, and, of course, Medicare. With even the slightest creativity, we can structure our proposal so that we can reasonably claim to be leaving these decisions where they are now, perhaps even moving them away from insurance companies and more completely into the hands of the patient and his family. Meanwhile, we will add some stealthy but irresistible incentives to various parties to comply with our will in making their decisions.

Admittedly, Plan B makes Congress a scapegoat; we will do so overtly in one additional respect. Right now, the American people in large measure do not trust Congress to make health care decisions. We will exploit this by proposing and accomplishing one of the most essential aspects of our takeover strategy, moving the funding and regulation of Medicare away from Congress and into the executive branch, where the White House can control these decisions without meddling by elected representatives, who must be accountable to their constituents every two years. If we handle this matter competently, the opposition will surrender this essential territory willingly, even eagerly, and be quite pleased with themselves for having done so.

In summary, Plan B is to yield to the popular will on every essential point, but in most cases only cosmetically, and without surrendering much, if anything, essential; to pass an effective bill; and to allow us to make the case in upcoming elections that we not only reformed health care, but also listened to the collective wisdom of the American people as we did so.

Plan A was a calculated risk, even with sharp execution. Plan B is, so to speak, a lead-pipe cinch, if we are reasonably competent in executing it. When Plan B succeeds, Plan A's temporary damage to approval ratings should be undone in plenty of time for the 2010 election campaign.

Kindest regards, etc., etc.

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