September 01, 2009

US Health Care and Obama’s Janus Problem

Just eight months into his term, Barack Obama is facing a severe crisis that will define his leadership as president. The immediate challenge is health care reform, but the deeper issue is whether Obama the Leader or Obama the Politician will dominate.

Like the Roman god Janus, with two heads facing in opposite directions, Obama the Politician pulls against Obama the Leader. This identity crisis is eroding the President’s political capital, hampering his chances for legislative success on health care, and alienating recession-stricken Americans.

We have always known there were two Obamas: one, the idealistic and compassionate community organizer whose service changed lives; the other, the skilled operative who emerged from the political wars of Chicago’s south side. During the long, brutal presidential campaign, Obama did a brilliant job of integrating these two facets of his persona. Many who supported him hoped and trusted that once elected to the nation’s highest office, Obama the Leader would retain his passionate commitment to certain ideals over and above political considerations. Since January, however, politics has seemed to dominate many of his decisions, with health care being the most recent example.

Rather than provide the leadership he promised on this crisis by presenting a comprehensive, integrated health care policy to the American people, Obama is instead playing politics by ceding leadership to Congress. In leaving the details of the reform bill to Congress, he has effectively abdicated, removing himself from substantive Capitol Hill discussions. Congress, in turn, has focused on only one aspect of this complex problem: health insurance reform that will provide guaranteed access. The other essential aspects of health care — cost, quality, and consumer focus on wellness and prevention — are being virtually ignored. All three must be addressed in an integrated fashion before the health care crisis can truly be resolved.

This will require real sacrifices and concessions from everyone, and a politicized executive cannot make that happen. What’s needed here is realistic and, above all, forthright leadership. How can the President shed political pretense and become the same galvanizing leader on health care that he was during the 2008 campaign? How can Obama the Leader predominate over Obama the Politician and take full ownership of this process?

As leader of this all-important reform effort, he must immediately face the reality that the debate is going in the wrong direction, acknowledge the mistakes he made in abdicating and ceding leadership to Congress, and put the legislation on hold until early 2010. In my recent book, 7 Lessons for Leading in Crisis, this is Lesson #1: Face reality, starting with yourself.

Then he needs to go on offense. Obama should introduce an integrated plan that focuses first on wellness and prevention, develops detailed programs to incentivize quality outcomes and reduce costs, and offers affordable access. Most important, he must take his case to the American people and convince us that this plan is the only way to resolve the health care crisis for the long term.

During the campaign President Obama delivered a remarkable, uplifting speech on race in Philadelphia that elevated our level of national discourse. As president, he has demonstrated strong leadership in the Middle East peace process, and he has guided us away from financial collapse. Here is a man who is capable of authentic leadership.

Now, on health care, the United States needs Obama the Leader to step up again.