The ebola epidemic in West Africa is not just a health care crisis. It has affected every corner of society in the countries most affected. Schools have been closed for months, infrastructure projects have been put on hold and GDP growth has slowed to a crawl. A discussion of the social and economic cost of Ebola in Guinea, Liberia and Sierra Leone.
President Barack Obama has faced criticism in recent weeks for what the White House says he did not know. The first has to do with the Affordable Care Act’s website and whether Obama should have been informed about the extent of the technical problems before the rollout. The second is why the president was not aware the NSA was eavesdropping on European leaders. Obama has the reputation for being the kind of leader more interested in major policy initiatives than minor details. But the latest embarrassments have even some of the president’s supporters questioning his management style. Diane and her guests discuss President Obama’s leadership and management style.
- Stephen Wayne professor, Georgetown University and expert, American presidency.
- Donna Brazile Democratic strategist; adjunct professor at Georgetown University; nationally syndicated columnist.
- David Gergen professor, Harvard's John F. Kennedy School of Government; senior political analyst, CNN. He served as a White House adviser to Presidents Nixon, Ford, Reagan, and Clinton.
- Ruth Marcus columnist and editorial writer, The Washington Post.
MS. DIANE REHMThanks for joining us. I'm Diane Rehm. Americans have been asking why the Affordable Care Act website had such a troubled rollout. Around the world, the attention has been on news that the U.S. is spying on European leaders. In both incidences, the president was caught off guard, apparently unaware of details.
MS. DIANE REHMJoining me to talk about President Obama's management and leadership style: Ruth Marcus at the Washington Post, Stephen Wayne of Georgetown University, and Democratic strategist Donna Brazile. Joining us from the studios of Harvard University's Kennedy School, David Gergen of Harvard and CNN. I hope you'll join in the conversation. Give us a call at 800-433-8850. Send us an email to email@example.com. Follow us on Facebook or send us a tweet. Welcome to all of you. Thank you for being here.
MS. RUTH MARCUSHi, Diane.
MS. DONNA BRAZILEIt's great to be here. Thank you.
MR. STEPHEN WAYNEGood morning. Thank you very much.
REHMAnd, David Gergen, if I could start with you, people are saying that President Obama is far more concerned with the big picture than the small details. Is that fair?
MR. DAVID GERGENI think all presidents are more concerned with the big picture than the small details, or at least they certainly should be. And, Diane, I think he is -- he's coming under relentless attack right now on both fronts you said. As we begin the health care discussion, I think it's worth pointing out that, in fairness to the president -- we may say some critical things about the execution of this program, but in fairness we had seven presidents before him who tried and failed to get healthcare -- national healthcare passed. I worked for two of them, both in the Nixon White House and the Clinton White House.
MR. DAVID GERGENAnd so along comes President Obama, and he gets it done. And it's historic, it's important, and he deserves credit for getting the healthcare law passed. I do think that since they got it passed, the execution of the law has been extremely spotty if not disastrous. And the salesmanship of the law, I think, has also been very, very weak and unfortunate.
REHMAnd when it comes to both the NSA and the Affordable Care Act, are you surprised at what the president says he did not know?
GERGENI am surprised. The NSA, it is -- it's interesting. I think it was Mr. Clapper who said he'd been there for 50 years. And the first thing you learn in the first year is that America's had a pattern of spying on foreign leaders. Now surely they told the president that. Surely his national security team knew that and should've told him if the NSA did not.
GERGENAnd knowing how sensitive it is and how much this has blown up and come back and backfired on them, especially with Chancellor Merkel out of Germany -- but others say in Brazil -- I think they're paying a heavy price for the president being sort of out of touch on this or not being informed. On healthcare, I frankly am even more surprised because that was the signature issue. It is his biggest legacy.
GERGENAnd we learned in the Washington Post on Sunday in a very revealing story that there was an internal debate in which Larry Summers and Peter Orszag, two heavyweights on the economic team, pushed very hard to have someone with real startup experience, someone who'd run a business, knew high tech, knew the insurance industry, and was a major heavyweight of the kind that we have seen in previous administrations when big laws are passed, that -- they pushed for that and were rebuffed, that the president himself said he didn't want to go down that road.
REHMRuth Marcus, you wrote a column in which you talked about presidential scandals. How different is this one?
MARCUSThis is not a scandal in the traditional sense of scandal. And this is not -- but scandals and problems are a fairly common hallmark of second term presidencies. There's a lot of reasons for that. The president may be feeling very emboldened and verging on cocky/arrogant. The staff -- many of the best staff may have left, or they're exhausted. You've gotten opposition that's just so furious that they haven't won the White House for a second time that they're going to make your life even more miserable.
MARCUSThis has been really -- and I know people are going to call about Benghazi and other things, but this has been really a very -- and the IRS -- this has been a really relatively scandal-free administration first term and second term. What it has not been, and particularly right now, has been a very well-executed, very well-managed from the top in terms of a chief executive (word?) chief executive, somebody who really knows how to run the show. That's where we're seeing the failure.
REHMAnd, Stephen Wayne, as someone who studies the presidency, do you see this one as different from what has come before?
WAYNEI don't see it as different as what's come before, but I see it as neglectful as what's come before. The framers of our constitution charged the president his principle role to take care that the laws be faithfully executed. That was his job. That was his primary responsibility. But President Obama seems more interested, as David Gergen said, in making new policy than in overseeing the implementation of the old policy.
WAYNEAnd it's incredible to me that he could not have been informed by his advisors. And if he wasn't, it's his own fault because you have to tell your advisors you want to hear bad news first from them. You have to create that environment. No one likes to tell the president what that president doesn't want to hear, particularly from a loyalist who's worked there for eight years. Obama seems into vision. He seems into speech making, but he doesn't seem into governing.
REHMNot into governing, Donna Brazile?
BRAZILEWell, I think it's laughable that he's been a bystander. And I think he's been a very hands-on, creative, pragmatic president who seems to have his hands tied and what I call the in a work and in a gridlock of Washington, D.C. The one criticism I have, of course, of the Obama Administration is that often they're too insulate. They don't really, you know, come out of the shell so to speak to sort of lay out the strategy and then give people a sense of where they're going.
BRAZILEIt's like being in a car with a driver who has the setting sun in front of him. And we know we're heading north or south or east or west, but somehow or another that blinding sun keep us from knowing exactly how far we've gotten to our goal. This has been an unusual program because it's a bold new program. And like most big federal programs, it's gotten off to a slow start.
BRAZILEObama -- look, Obamacare has survived two election cycles, 44 attempts to defund it, a Supreme Court decision. And the problem with any launches of programs like this, Social Security, Medicare and the prescription drug insurance is that you really (unintelligible). You need somebody who's hands on who could really marshal that implementation process.
REHMWhat about his internal advisors, Donna? Are they telling him, as Stephen says, what he needs to hear, not necessarily what he wants to hear?
BRAZILEWell, I know many of them, and they're not shrinking violets. I'm sure they're telling the president what he needs to hear. Now, whether or not the president will actually accept their advice, that might be a different story. But when you think about Joe Biden who is very, very strong, very tough, very opinionated, Joe Biden has never left a conversation off the table so to speak. But, you know, this is a president who is very smart, loves to be involved and engaged in a big conversation. But the implementation part of governing is just as important as the inspiration part.
REHMSo how do you account for the bad rollout of the Affordable Care Act?
BRAZILEIt's embarrassing. I'm stunned by it for two reasons. One, as a strong supporter of ensuring that all Americans have access to quality healthcare in this country, I was excited about the Affordable Care Act. I think it's a very important program. It's a very important initiative. And to see these website problems, you know, just remind me that my old boss Al Gore, who some people say inspired the creation of Internet, would have brought in the best IT, you know, programmers in the world to ensure...
REHMSo what is that two hands off on the president's part?
BRAZILESomeone let the president down, and the buck stopped with the president. But there's no question. When you read the Affordable Care Act, the secretary shall, the secretary shall -- it's referring to Secretary Sebelius. And she took full responsibility last week for some of the foul ups.
GERGENWell, I agree and disagree with a lot of what's been said. I particularly agree that -- with Ruth that this has been a scandal-free administration by and large, and we should appreciate that. I also agree with Donna that it's laughable that President Obama is a bystander. I don't think that's truth. He's being very deeply involved in a lot of these programs.
GERGENWhat I do think is there is an insularity problem and that is that the president, as all presidents have done, brought in some terrific people with him from Chicago. He brought the people he trusted, have been with him two campaigns, naturally enough. But what good president have done -- most effective presidents have done have then supplemented those -- that inner circle with heavyweights whom they can look to.
GERGENJohn Kennedy, when he came to Washington, reached out and got Republicans to serve as Secretary of Defense, Secretary of the Treasury, National Security Advisor and many other roles. And they helped him enormously. And similarly, Ronald Reagan got Jim Baker to come in, an outsider, but he helped enormously. And this president has simply not done that. He's refused to do that quite frankly.
MARCUSI think it may be an insularity problem, but it may be actually somewhat larger than that. It may be a management experience problem. I do not think that this is a bystander president by any means. He is smart. He's engaged. He is working on all of these issues. The right information did not come to him on healthcare. And lord knows what happened on the NSA.
MARCUSBut he did come into office with very little management, no executive branch, executive office experience like former governors, very little time in public federal office. And I think that we may be seeing the consequences of that, and particularly in health care, where you know you've got this enormous complicated program that would be a challenge for the most experienced manager. To not have brought in the ultimate czar is obviously a huge mistake in retrospect.
REHMRuth Marcus of the Washington Post. Short break. We'll be right back.
REHMAnd welcome back. In light of the disastrous rollout of the Affordable Care Act and concerns about spying on our allies through the National Security Agency, people are beginning to question the president's leadership style, his management ability. Here's an email from Nat who says, "What role do you believe Republicans' insistence on undermining this president has made it especially difficult for him to lead? In other words, when you don't have a true partner in governing, isn't this an indication our system may not work if one side decides to undermine the other?" Stephen Wayne?
WAYNEI would think, given the behavior of the Republicans, that would've been a greater incentive for President Obama to oversee the health care initiative, so there would be no mess-ups. And knowing that the government might close, knowing that the House passed a bill first to abolish and then defund Obamacare, you know, he know that they're watching him closely.
REHMDonna Brazile, you've talked to some of the people in the White House.
BRAZILEWell, you know, from time to time, we go over to the White House, Democratic strategists, pundits, others, and we interact with the top staff just to share our information on what's going on outside the bubble so to speak. They call living inside the White House the bubble, so we live outside the bubble, I guess. And we advise him. We give him our best advice in terms of, you know, what's going on.
BRAZILESometimes it's critical. Most often we're there just to gain information from them. There was clearly -- and, you know, from the people who often go to those meetings, their so-called off-the-record -- Ruth Marcus know about off-the-record conversations. We give them our best advice, make sure there's an application, make sure that...
BRAZILE...an app, right -- an app to ensure that -- because there are four ways to sign up for the -- you know, in the exchanges. And this was going to be a very big rollout, Oct. 1. We kept saying Oct. 1. All these other issues are distractions. We're talking about the IRS scandal and all of the other little things that blew up here in Washington, D.C. from time to time.
BRAZILEWe kept saying, you need an app. It needs to be credible. But here's the one problem that goes to the question. Thirty-four states, many of them, you know, managed by Republican governors, opted out of the so-called exchange -- the state exchanges. And that forced the federal government to create federal exchanges in these states.
BRAZILEI think one of the complications of this whole process and the website -- again, I'm not an IT person -- is that you had to put together these programs in states like Louisiana where the governor said no. So if I go on -- I live in D.C. Now I can get, you know, directed to D.C. links, but in Louisiana, you have to go on the federal exchange.
BRAZILEThat created some of the problems.
REHMClearly the folks in the White House were far more concerned about avoidance of scandal than perhaps they were attentive to your comments about it's got to roll out really, really well.
BRAZILEI think, you know, to be fair, is that they assume that somebody was minding the store over at HHS. And somebody else was responsible for the rollout -- the White House might've been responsible for the communication strategy of the rollout. But I assume that they were focused on just the communication part of it. And the technical part was, you know, HHS issues.
REHMDavid Gergen, do you concur that HHS should have taken more responsibility here and that the buck actually stopped there with Secretary Sebelius?
GERGENI do not. The president is the chief executive, as Stephen Wayne pointed out earlier. That's under the Constitution. The president then delegates to other aspects of it, but he remains the chief executive. And it's been true, Diane, throughout this White House period, that power has been centralized in the White House to an unusual degree.
GERGENThe departments haven't been able to exercise a lot of the power that you often see in cabinet officers. We frankly saw the same sort of pattern under George W. Bush. It's not a healthy pattern when White Houses draw all the power inside, and then they don't have the people to carry out the missions. No, I don't think the HHS is putting the blame there. I mean, do they share in the blame? Of course.
GERGENBut I want to go back to the larger point about the Republicans. Republican opposition, there's no question that the near-hatred that comes out of the Republican part of the -- the mere mention of Obama, you know, puts a stain on legislation, had it -- made it much, much more difficult for this president to govern. Having said that, the NSA issue here has nothing to do with Republicans. This is entirely within the executive branch of the government, what kind of communications they had.
GERGENThe high tech rollout of Obamacare had nothing to do with Republicans. They could've gone and gotten Google and all these other folks to come in and to run this. And the final thing, you know, what is really irking Americans -- we haven't really talked about it much -- it's not just that the network isn't working. It is they feel they were misled, that they were promised they could keep their healthcare plan if they liked it. And now we see this backlash coming, and some apologists would say, well, it wasn't all that important. There are a lot of Americans who feel they were lied to.
WAYNEWell, I definitely agree with that. And the problem with this presidency, it seems overly-programmed by a small group of people. And the president's day and what he gets is prepared, whether it's the 10 letters he reads at night or the briefing that he gets. Now, when this happens to other presidents, when this happened to President Bush on Iraq, one of the criticisms was he didn't ask a lot of questions.
WAYNEAnd Democrats at the time attributed that to his lack of intellectual interest or capabilities. I -- we know President Obama's very bright. He's very rigorous. He's very rational. But why wasn't he asking people how things were going?
REHMStephen, is this a problem of presidency in second terms?
WAYNEIt tends to be more of a problem in second term not only because some of the issues, which are first-term issues, come to light in the second term, but presidents have a tendency to surround themselves with believers who come up from the ranks, who work very hard, who are very loyal and who just aren't critical enough to keep the president in touch with reality. That's what happened to President Obama.
MARCUSTwo quick points. First of all, on the healthcare point, my reporting at the White House tells me that the president did ask repeatedly, how's it going, how's it going? Are we sure it's going right? He did not get the accurate answers, whether it was from inside the White House, per se, or from HHS. But where I would blame him on this is to understand that it is very difficult to deliver bad news to any boss.
MARCUSIt is particularly difficult to deliver bad news when your boss is the president. And he should have known that he needed to have somebody in there who was going to make sure that those assurances were in fact based on reality. Number two, if I could, on the NSA -- so the administration comes into office and it knows that it has got a closet full of problems, as it perceives it, left over from the Bush/Cheney Administration when it comes to the operations of foreign policy, national security and espionage, whether we're talking about torture or Guantanamo or renditions or anything else.
MARCUSAnd if it -- certainly, it's easy to say this in retrospect, but one could say, if I had been president, you would have said, I need to know from each of you agencies, what are the problems that I don't know? What's been going on that I don't know about that could come back to haunt me, not just Bush/Cheney. That, as far as I can tell, was never asked of the NSA. The focus was on other problems, known problems rather than to quote Donald Rumsfeld, "the known unknown problems."
GERGENI think Ruth Marcus just nailed that. Let me make one other point, Diane. What has struck me increasingly is that in past presidents the kind of people you can trust to give you straight advice and hard things -- and to say hard things are people who have a power basis independent of the president. In other words, they come into the office as people who are important in their own rights already, and their word is respected outside the White House.
GERGENAnd that gives them a certain amount of, I think, both a confidence and authority inside the White House. And this president today is surrounded by people whose power is largely derivative from him. You know, they -- he is the person who made most of these people who they are. They didn't -- you know, they've had good resumes.
GERGENThey're very, very good people, Diane, but this is not a criticism of the quality of the individual. It is rather that that inner circle needs one or two people -- you know, I think right now they need Tom Daschle on healthcare. And I think they need somebody from the Google community or the international -- the high tech community to deal with both of these problems they've got on healthcare.
REHMSo, David, as the NSA story seems to get bigger and bigger, what should the president be doing now and saying now?
GERGENWell, I think he's gotten himself into a place on the NSA where he might want to empower three or four people, or maybe even one or two, from the past who could be independently come in who have the security clearances and who can look really, really hard at this to figure out what can be done. I think someone who commands national trust, you know, Bob Gates, Leon Panetta, you can make your choice.
GERGENBut when Ronald Reagan went through (unintelligible) and it darn near ruined his presidency -- it was a terrible scandal -- he brought in David Abshire, you know, a Washington pillar of strength who knew a lot about national security. And they did a terrific job at damage control. I think they need somebody in there now independent who doesn't have a full-time job.
GERGENSusan Rice has a full-time job. She's got her hands full. Secretary Kerry has a full-time job. But they need somebody, I think, independent whose judgments will then be sent to the president, also become public, and try to bring the -- there's a sense right now the NSA's out of control.
BRAZILEWell, there's a sense that the NSA's on autopilot. And one of the reasons why the president has called for broad reviews is to figure out how to ensure that they're delivering the product that is intended and not beyond the scope of what they were authorized to do. I think the president receives a broad range of information to prepare for his work.
BRAZILEI don't know exactly how he synthesize and get all of this information and then follow through. I agree with David that there are a lot of good people inside that White House. But when you're putting together a bold new federal program, you need someone who can really marshal the resources and marshal the right kind of people to ensure that it's implemented effectively.
WAYNEJust to add a quick note. Add to this four chiefs of staff, four heads of OMD who presumably have a lot of data at their proposal, constantly changing. He's not being well served. And as far as asking NSA about its problems, when a team is losing, it's aware of its problems. But when a team is succeeding and getting all this information, that's great. We have no problem.
GERGENDid you believe that story, Diane, yesterday that the -- this is all. Everything is blamed on Snowden. We just learned in The New York Times over the weekend that the Secretary General of the United Nations goes in to see the president, and they've intercepted his talking points. And they put -- that's out in our newspapers, you know, a few days later? This has nothing to do with Snowden. There's a gigantic problem here.
REHMIt's almost as though Snowden is out there getting all the blame, but NSA continues. And you're listening to "The Diane Rehm Show." Ruth Marcus, the Economist wrote the story of healthcare.gov, saying it should be in every textbook on presidential management.
MARCUSYes. Well, we are going to be having the Harvard Kennedy School of Government studies on this. But let's first...
GERGENI hope so.
MARCUSAnd David can write the forward to the definitive study. But before we get there, we have to get this fixed. The president has been distinguishing between the product, which he says is the insurance that's being offered, and there clearly are an enormous number of people who are going to be way better off either because they're going to have access to Medicaid coverage or because they're going to have access to affordable much more comprehensive coverage.
MARCUSBut you can't totally distinguish between the product and the sale because -- for two reasons. First of all, if you can't sell the product, the only people who are going to buy it are going to be the people who you kind of don't want to buy it, the ones who need it but are going to be really expensive. You need those young healthy people in.
MARCUSAnd also I think that the salesmanship, that fateful sentence, that, if you like your policy, like your health insurance, you can keep it, really, there was a very disturbing report in the Wall Street Journal over the weekend about how they knew that wasn't correct and how there was an argument about how that should've been a little bit more caveated. There was an asterisk. An asterisk is not good for political salesmanship, but that is sure coming back to hurt them now.
REHMDonna, how should the president have rolled this out?
BRAZILEWell, you know, from the very beginning, much of the conversation around the entire bill was on things that didn't exist in the bill.
BRAZILEWell, death panels. We spent an inordinate amount of time talking about forced abortions. I once remarked that I talk more about sex during the healthcare law than I have an opportunity to read "50 Shades of Gray."
MARCUSIt makes you Miss Lewinsky and the impeachment.
BRAZILEReally. Yeah, the...
REHMNo blue dress.
BRAZILENo blue dress. But, you know, Sen. Tom Harkin at the time said that he called a new healthcare bill a starter home with the need for plenty of renovation. This bill was a complicated bill that was put together. And then, of course, the Senate changed it. All along, Democrats wanted a public option in the bill. We didn't want the private health insurers to really have control over the market and all of the new exchanges.
BRAZILEThat being said, this -- as complicated as this bill was crafted and it should've -- the White House had a responsibility along with all of its allies to roll it out effectively. I don't believe that the bill should be defunded or delayed or removed. There are problems that need to still be addressed. And if Congress is not willing to do it, then the administration has a lot to do over the next six months.
WAYNEYou asked at the beginning, was this different from other presidents? In one respect, it is different. In all of these issues, there are substantive problems, but technology is the problem. It was the technological problem on healthcare. It was the expansion of the technology on NASA. It was some kind of technology on the IRS. Technology is moving so quickly that we don't have the expertise to match it at the moment. That's new.
REHMDavid, how should the president have seen to the implementation of this law?
GERGENWell, I think there's agreement -- or maybe there's not, but I think there's a general consensus among us, it would've been helpful to have some strong heavyweight who understood startups, understood healthcare insurance and the like right there from the beginning. In retrospect, as Ruth Marcus said, that was a terrible mistake.
GERGENBut, you know, as much as I agree with Stephen Wayne, a lot of what's at stake here is technology and trying to master technology. There's also human nature at stake here. And going back, Ruth Marcus made a good point. The Wall Street Journal article said they knew when they told us that they were lying, in effect that they were misleading us. That's what really continues to sting.
REHMDavid Gergen of Harvard University and CNN. Short break. When we come back, your calls, comments. I look forward to speaking with you.
REHMAnd welcome back. Time to open the phones as we talk about the president's leadership and management styles. Here with me Ruth Marcus, columnist for The Washington Post, Stephen Wayne, professor at Georgetown University -- he's an expert on the American presidency -- Donna Brazile, Democratic political strategist, and, from studios at Harvard University's Kennedy's School of Government, David Gergen of CNN and Harvard University. We'll open the phones. Let's go to Desoto, Texas. Hi, Brenda, you're on the air.
BRENDAI love the show. I listen every day.
BRENDAI just have a comment. You know, we listened. And every guest that you have, nobody's willing to really ever tell the truth. The problem with this administration, it's not the president and the laws that he's trying to get passed. It's the person that the people -- those Republican people don't like. And nobody's willing ever to tell the truth. No matter what he does, how he does it, it's not right.
REHMDonna Brazile, what's your reaction?
BRAZILEWell, it is true that there's a lot of partisanship here. There's a lot of disingenuous people in Washington, D.C. The truth of the matter is, is that I served under Bill Clinton and Al Gore. I worked on Capitol Hill, and it was just as much acrimony, just as much back and forth, just as much partisanship.
BRAZILEPerhaps this is the modern presidency, David and Steve who knows -- got a little bit more history than myself. I do believe that this president has faced some unseen obstacles as a result of what I call some of the, you know, dysfunction overall of government. But honestly it is pretty much par for the course when you think about what we've seen over the last 20 years.
WAYNEPartisanship no doubtedly has fueled anti-president criticism, and that fueling has been accelerated by a more partisan press than we have today. So it seems worse. But the fact of the matter is, I remember Harry Truman was quite unpopular towards the end of his administration. Jimmy Carter was unpopular. Democrats didn't like Ronald Reagan.
REHMBut was it because of management and leadership, or was it just the way it is?
WAYNEI don't think people distinguish between the two.
WAYNEI think there's something they don't like, and they displace it all on the person.
REHMAll right. To Rich in Cleveland, Ohio. You're on the air. Rich, are you...
RICHHello, this is Rich. My comment would be is I think they needed somebody with the IT experience, but somebody who had some failures who'd seen it from some perspective of realizing that IT people do make mistakes. We look at Microsoft, and they roll out a new operating system. And Windows 8 one year later still is having problems. And so to realize if you've been in a position -- I've done it several times. I'm a professor of education.
RICHAnd so I've done a couple things where I wanted to put things online, and it's -- I have to do my own error checking. I have to check every single time. OK, does this work? Does this work the way I want it to? Does it work? And it's a really hands-on process that I have to be involved talking to those IT people all the time. Otherwise, they go off on tangents, and it's nowhere close to what I want.
GERGENWell, I agree fundamentally with Rich. I've never gone through a startup. I've had numerous friends who've done it. And I do think that you'd learn an awful lot about how to look ahead and expect problems. And what that goes to is that there was -- there was so little -- they left themselves so little time to pretest this before the system went live. You know, they only had it in the last two weeks or so that they were pretesting.
GERGENYou know, big companies in the IT field do rollouts well before that so that they -- by the time they roll it out, they have glitches. And in this case we thought -- started thinking these were glitches, but it turns out that the mistakes were very systemic, and they're very, very hard to fix at that stage. If they'd had rollouts earlier, if this had been well planned, if it'd been run by somebody who would actually built a business, who also understood health, I think we'd be in a lot better shape.
REHMAll right. To San Francisco, Calif. Denise, you're on the air.
DENISEHi. I just can't believe -- can everybody just take a breath? You're already calling this entire bill, the healthcare, a disastrous failure when in reality nobody can actually get healthcare until Jan. 1.
REHMActually I think people are calling the rollout a disaster, but not the bill itself, not the law itself. Republicans are calling the law a disaster.
DENISEWell, they have from the very beginning, but...
DENISE...what the point is -- and if I could just very briefly finish it -- I mean, we're only 33 days into this process. And I think that we need to pull back and realize that all of this criticism about leadership style and management skill and how it's going to be taught as a class is a little bit ridiculous when, in reality, spies spy, and the Bush-Cheney years, when everything was privatized through the private sector, Snowden would've never gotten through the grid of a CIA or an NSA evaluation. But he did get through as a private contractor.
DENISESo, you know, I think this president deserves a Congress that's going to implement his ideas. And Democrats should stop apologizing for themselves all the time and say, this is ridiculous that we're...
REHMAll right. Ruth Marcus.
MARCUSSo the -- I hear the caller's frustration, and she's frustrated in part with the absolute implacable partisan opposition of the Republicans on the Hill, not just to the healthcare law which they don't want to see succeed -- they want to see it fail. But that's a sort of fact of political life, and it's a fact of political life that the administration needed to factor into its planning for the -- and I'll say it again -- disastrous rollout 'cause you know you've got an implacable opposition.
MARCUSSimilarly, with the information technology piece, Stephen was saying before the break about how this presidency is a little bit different because of the difficulties of IT and how complicated that is. Yes. But to me it comes back to knowing how to manage given the circumstances that you've got. I would point out, really, look at the handling of Syria, right. Syria's not an issue that has to do with information technology.
MARCUSIt's actually not an issue that has to do with an implacable partisan opposition, but it has to do with the way the president set out a red line, backed away from the red line, said he was going to do something, change course, decided to go to Congress. That to me tells us that this is not a problem of partisanship or complicated IT. It's a problem in part of the presidency.
GERGENI just wanted to say to Denise and others, look, the country felt grossly mislead by George W. Bush and his administration going into Iraq -- weapons of mass destruction, mushroom clouds and all the rest. And there was a hullabaloo about that, as there should have been. In this case, telling it to everyone, you know, 15 million people who have private -- their own health insurance plans, that you can keep that plan and knowing that that's not the case, for a lot of people, they feel lied to.
GERGENAnd it's worth remembering, Diane, what brought down the Clintoncare -- Donna will remember this. The Harry and Louise ads way back then that sank Clintoncare were all about that the government is going to tell you what kind of healthcare plan you can have. Your bureaucrats are going to choose your healthcare plan.
GERGENOnce people heard that, they got turned off. This time around, they were told something different, but it turns out not to be true. So there's naturally -- this has nothing to do with the -- not only -- this is not just about the disastrous rollout on the technical side. It is about whether the country was mislead in getting the law passed.
REHMAnd whether the president himself knew or not that that was not true. Stephen Wayne.
BRAZILEWell, I'm on the individual market because...
BRAZILE...I'm self-employed, and so...
BRAZILE...I think during the entire healthcare debate, the administration did tell you that your plan had to include certain things in order for you to get the kind of coverage you needed. And so, if you had an old coverage plan that didn't cover maternity leave, for example, then under the exchange you would be able to get that care. There's an important piece in The Washington Post today about self-employed people, and some of the things that we have to go through. Now, my plan, thank the lord, is grandfathered in large part because I'm a former federal employee and I continue on the plan.
BRAZILEI pay a higher premium because I'm not subsidized by the government. I cannot get subsidized by the government because of my income. But there's so much misinformation about the so-called Affordable Care Act that people need to know the facts. There are four ways to enroll in the plan. The rollout, while the individual exchanges have been bundled, the Medicaid expansion is still going very well, 26 states. I know it's not all 50 states, but just recently Ohio accepted the Medicaid expansion. Two hundred and seventy-thousand more people will be enrolled as a result of this.
REHMAnd that's going to cost the government a lot of money.
BRAZILEBut what's costing the government a lot of money now is uninsured individuals...
BRAZILE...who are using emergency rooms when they have a headache.
WAYNEPresident -- candidate Barack Obama criticized George W. Bush because he didn't educate the American people well on the problems. And he said in 2008 he would not dumb down the information. But the fact of the matter is he has. He won the healthcare issue, but he lost -- he lost the popular debate, and is still losing it, is still losing the popular debate. A majority of people still don't think that the program that's going to go into effect, that they approve of it. The fact of the matter is he has fallen down as a manager, but he really also fell down as a public educator.
REHMAll right. To Stephanie in Raleigh, N.C. You're on the air.
STEPHANIEHi, Diane. I heard a congressman speak on Morning Joe, and he was on the committee that's appropriated funds. And he said, when they were trying to set it up, that he requested funds over and over again, so they could get better IT help. And the Republicans always turned him down. So it was like they were already defunding before they were defunding.
MARCUSThat -- excuse me, that's certainly true. And if you read this magnificent story that was in my newspaper, The Washington Post, over the weekend, it talks about how power had to be transferred from the Secretary Sebelius' office over to the Center for Medicare and Medicaid services because of issues regarding funding for implementation. But that is simply a fact of life that the president was dealing with and needed to factor into the equation of how, when to roll this out.
REHMYou also talked about a memo from a person within the White House.
MARCUSThis is a memo from David Cutler who is an outside advisor and expert on healthcare. And he sent a memo that's reported on in this story. If you go to the story at washingtonpost.com, you can click on the link to this memo. And it is prophetic in terms of its forecasting of the...
REHMWhen was it written?
MARCUSI think it was written in 2010.
MARCUSBut I can't...
MARCUS...can't swear to that. Is that right, David?
GERGENYes, it's about two months after the law was passed, I think, it was written. David Cutler is a healthcare economist. And he not only wrote the memo, Diane, but he was a chief architect of the Affordable Care Act itself.
REHMAnd what did the memo say?
MARCUSThe memo basically said, you all -- you all meaning you all in the Obama administration -- do not have the right people in place with an understanding of how to implement a societal change this significant. And if you don't get somebody in place right away, you are not going to have the right architecture and the right ability to get this law done, and it is going to be a disaster. Well, guess what?
REHMAnd you're listening to "The Diane Rehm Show." Do you want to add to that, Donna Brazile?
BRAZILEYeah, the memo was written on May 10, 2010, two months after the Affordable Care Act passed Congress. It was a four-page memo to Larry Summers and others basically saying that you -- as Ruth said, you better get a real good strong team to implement the law. He went on to talk about how difficult it is to have a big startup in the world. And, of course, he talked about how this will -- the program will be damaged if there's not a better implementation strategy. So it's a very important memo to be -- to read and digest.
REHMSo do all of you believe that this experience with both the NSA and the Affordable Care Act is likely to affect, have an impact on the way President Obama goes forward? Or is he too entrenched in his style of management, his way of leading? Stephen.
WAYNEWell, it should have an impact, but, you know, you don't leave your personality at the front door of the Oval Office when you enter. And he's always been more interested in policymaking than in policy execution. And he seem -- and the tendency in a second term for any president is more international interrelations and less domestic. So I don't see a man, as Ruth said, without management experience becoming a manager overnight.
REHMDavid, is this a wakeup call for the president?
GERGENI think it is a wakeup call, but I'm not sure it'll be heard inside the White House, Diane. I think they feel that they're being blind, and it would be much closer to Denise, for example, that, you know, give this some time. It's all going to turn out all right. But I do think it's going to have a secondary effect, and others may comment on this.
GERGENAs it rolls out across the nation, it is convincing a lot of people maybe Washington can't handle big problems. Maybe we should not look to Washington for big solutions. I'm worried that it's going to have some negative impact on the Common Core, for example, in K-12 education. You know, a number of states are having second thoughts about Common Core, and they say, well, this is just a Washington, you know, made product.
GERGENThey're trying to control our schools. Actually, Common Core is going to advance public education a great deal. And there are going to be other questions like this. I think it's going to have a dampening effect upon liberalism as a way of thinking about government problem -- I mean, national problems ought to be solved by Washington. It's too complex.
MARCUSI'm a little bit more hopeful. I think the NSA issue can be dealt with by some very strategic, intense stroking of allies and getting them to calm down and promising that we'll do better by them in the future. I also think the president knows that, unlike the IRS scandal, unlike the Benghazi scandal, the -- well, I say scandal -- and I'm withdrawing those words, episodes.
MARCUSThis is one that is going to linger, that the rollout of healthcare and the -- more important the execution of healthcare is a legacy of his presidency. And so I think he has every incentive and every understanding the importance of making sure this law works. And I think he will do what it takes to get that to happen.
BRAZILEYou know, he has three more years in office. Romneycare got off to a slow start. Only 123 people signed up in the first month. I think this program, as they've fixed the website and all the other problems, will be a very strong program that will provide insurance to those who never had it.
REHMDonna Brazile, Ruth Marcus, Stephen Wayne, David Gergen, thanks for a great discussion.
MARCUSThanks a lot.
REHMThank you. And thanks, all, for listening. I'm Diane Rehm.
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