THE QUESTION
Health Reform: Top-Down or Bottom-Up?
President Obama has apparently decided not to craft his own detailed plan to revamp the health care system, but instead lay out a set of broad principles and then hammer out the legislation with House and Senate leaders. On a high stakes issue like this, is it better for leaders to decide on a plan to push or to work gradually through others?
Posted by Ben Bradlee and Steve Pearlstein on March 2, 2009 9:57 AM
FROM THE PANEL
The Thunder of Marching Feet
Mass popular support will be crucial to passing health care reform legislation, so the administration and its supporters should be mobilizing a broad range of nonprofits and constituencies to exert pressure on the legislators.
Posted by Pablo Eisenberg, on March 5, 2009 10:03 AM
The Real Issue
A framework of broad principles, as President Obama has proposed, is good but the real issue is the willingness of stakeholders to address the toughest trade-off: containing costs versus expanding coverage.
Posted by Patricia McGinnis, on March 5, 2009 9:47 AM
Decision Making, Government-Style
In government, with the possible exception of the military during combat, decisions are not made, they are negotiated.
Posted by Norm R. Augustine, on March 4, 2009 12:23 PM
A National Conversation
The last time an administration tried to fundamentally change health care policy they gathered a group of very bight people, spent months is closed-door conversations, and produced a well-reasoned plan. It failed, and here's how to avoid those pitfalls.
Posted by Jim Kouzes, on March 3, 2009 11:37 AM
Five Key Principles
The Obama administration is right in inviting stakeholders to take part in the reform process, but it must remain true to five interrelated principles.
Posted by Michael Maccoby, on March 2, 2009 4:30 PM
Surviving "Enemy Contact"
Knowing that, as military leaders say, "no plan survives contact with the enemy," President Obama should still plan thoroughly -- and, for the moment, keep his cards to his chest.
Posted by Gen. Monty Meigs (Ret.), on March 2, 2009 4:22 PM
Man on the Moon
Just as JFK could convince a janitor to work toward putting a man on the moon, so Obama must define health care reform as an important challenge.
Posted by Yash Gupta, on March 2, 2009 4:16 PM
Slicing Up the Task
President Obama needs to do the tasks he can do -- like lay out general principles -- and delegate the rest to others, who are probably hungry for the responsibility.
Posted by Roger Martin, on March 2, 2009 4:04 PM
Magic Time
There is no formula for getting the job done: It's as much about personalities as it is about principles, as much about close-to-the-ground politics as it is about high-minded policy prescriptions.
Posted by Alan M. Webber, on March 2, 2009 3:53 PM
Friends In the Right Places
Like Clinton and Carter before him, Obama faces an enormous challenge in overhauling health care, but he also has what they didn't have: broad consensus among key congressional players.
Posted by Benjamin W. Heineman, Jr., on March 2, 2009 3:34 PM
Why Less Is More
On ambitious proposals like this, leaders who do all the work for everyone, laying out a detailed plan, become easy targets for criticism, like the Clintons did. Better to step back and let others craft the details.
Posted by Marty Linsky, on March 2, 2009 12:00 PM
The Only Strategy
President Obama can not, on his own, do very much about health care reform. Involving congressional decision-makers -- thereby coopting them and building support -- may be his best, and only, strategy in this case.
Posted by Jeffrey Pfeffer, on March 2, 2009 11:49 AM
Get Congress Involved
Congress is going to have to approve whatever plan he suggests. Why not skip ahead and get them involved in the development of the plan?
Posted by Marshall Goldsmith, on March 2, 2009 11:35 AM
"People Support What They Help Create"
President Obama is wisely setting forth the principles of his health care plan rather than the details and then having the patience to work out the details with the right congressional committees.
Posted by Bill George, on March 2, 2009 11:31 AM
Knowing His Limits
President Obama seems to realize what Bill Clinton did not: that Congress will write any new laws, and that his job is to spell out the grand idea.
Posted by Mickey Edwards, on March 2, 2009 11:06 AM
A Lot of Listening
President Obama should launch a public campaign pushing the outlines of the plan, work closely with legislators on the details -- and listen to everyone's responses.
Posted by Abraham Zaleznik, on March 2, 2009 10:59 AM
Reduce Costs First
We should not expand health care coverage until we have meaningfully reduced health care costs and the tens of trillions of existing unfunded federal health care promises. We must not shoot ourselves again!
Posted by David Walker, on March 2, 2009 10:54 AM
Hold the Details
The president is most effective when he lays out general principles and places specific plans and priorities within them. Too many details at this point are likely to cause disengagement on the part of the public and quibbling on the part of the Beltway partisans.
Posted by Howard Gardner, on March 2, 2009 10:46 AM
Open Debate
Empowering stakeholders and opening up a national debate is the right leadership decision to succeed in an arena where others have failed.
Posted by Andy Stern, on March 2, 2009 10:30 AM
Save & Share:
shadary1: One of President Obama's strengths is his openess to the ideas/insights of others. I am particularly pleased that Governor Sebelius will be...
cmburn: There are many good recommendations provided by the panel on how the Obama administration should champion health care reform. There should b...
carolinev: All I know is that I've been using medtipster.com to compare generics with my prescriptions. The site also allows you to type in your drug n...
