Sausage Making: The Art and the Science

The Disease Management Care Blog is a physician. Like most physicians, it thinks that health care policy should be implemented using the same science-based process that forms the basis of medical decision-making for individual patients. It naively wishes the President would stand up Grand Rounds style, state the case for his version of health reform and let reasoned evidence and logic win the day.

Right.

It remains mystified by all the political factors that influence elected and appointed officials. It struggles to understand our legal and regulatory system of outside authority, conflict resolution, the relative importance of procedure and substance, the nature and significance of risk, and the legitimacy of politics as a method of solving problems.

That’s why it’s looking forward to Mr. Obama’s Wednesday night speech. Sure, there may be some new insights about healthcare and then there is the drama surrounding the President's legacy, but the DMCB will use special address to Congress to observe, listen and learn how the sausage-making of politics can trump policy.

It will be on the look-out for four key ingedients:

1) The Casings, made up of suspense, secrecy and timed unveilings: after all, if this was a legitimate open dialogue over policy, there wouldn’t be any silence. By keeping things in the dark until Wednesday night, the President can seize the rhetorical high ground at a time of his choosing without having his opponents preempt him with partisan criticisms.

2) The Meat, consisting of politically timed shifts to the center: Movement away from the loyal base can be done too slowly or quickly. The DMCB will be closely watching to see how Mr. Obama navigates to the Clintonesque center, perhaps by defusing the contentious public option with an endorsement of the trigger mechanism ascribed to Senator Snowe of Maine.

3) The Spices, a.k.a., governing by campaigning: sure, there’s a difference between governance and running for office, but the science of modern politics calls for mobilizing supporters. It’s not winning the ballot box exactly, but the process calls for the same networking, rhetoric, advertising, emails, texting, marketing, focus groups, calls, petitions, demonstrations and getting network news time.

4) Water to fold things together i.e, a kick off – The President’s speech will only be the beginning. As you are reading this, the DMCB suspects coordinated marching orders, talking points and morning news show appointments are being issued to members of the Obama administration and other officials to follow up. Expect additional enforcing appearances, editorials, conference calls, testimony, leaks and interviews.

Will this be enough to kick start the Dem's stalled healthcare initiative? The DMCB has no idea, but this should be a fascinating lesson in the art of modern bill making.