David Axelrod Wants Everyone To Know That He Is Tough. OK, We Believe You. But The Real Issue Is The Health of the American People. Remember Them?

White House senior adviser David Axelrod is quoted in The Washington Post this morning, talking about kneeing people in the groin, or not.

Here's the money quote from Axelrod:

"I know there is great value associated in this town with the straight right jab and the occasional knee to the groin," said David Axelrod, a senior Obama adviser. "He'll throw the jab when he sees it, when he feels it's necessary. But he's not likely to throw the knee."

Once again, the White House illustrates that it is lost on process, as opposed to substance. I have lived in DC for three decades, during which I worked on five presidential campaigns and served stints in two White Houses, Reagan and Bush 41. I know that process is important, and so is toughness--for seven years, during the 80s, I worked for the late Lee Atwater. But as Atwater, hard-nosed politico he, was always the first to understand, substance is more important. Never get lost, he counseled, in "the politics of politics." That is, process, and toughness, are not ends in themselves, at least as far as the voters are concerned. In a small "d" democratic country, if you aren't offering something that people want, then people won't accept the offer, period. In which case, overt toughness, to say nothing of "ungentlemanly conduct," makes the problem worse, because people always notice good manners, or their absence.

But of course, Axelrod was careful to stipulate that Obama is "unlikely" to throw the knee to the groin. See, he is telling his foes that he is unlikely to throw the first knee. Listening to such talk, who doubts that the Chicago-born Axelrod has memorized Sean Connery's famous riff in the 1987 movie, "The Untouchables," in which Connery tells Kevin Costner, "You wanna know how to get Capone? They pull a knife, you pull a gun. He sends one of yours to the hospital, you send one of his to the morgue. That's the Chicago way! And that's how you get Capone."

There's no shortage of tough-guy talk on both sides of the political aisle, of course, then and now, so we might dismiss Axelrod's Chicago-style posings as more of the same. (Which doesn't mean that the American people like it.) Except for one thing: Axelrod is working in the West Wing of the White House, a place where you are famously, very powerful--and also not there for very long, because power is its own kind of revolving door--or flushing toilet.

In the brief period that Axelrod and his fellow tough-guy, Rahm Emanuel, are in the White House, they will discover that the key to accomplishing something for Barack Obama is not proving whether they are tough enough, but rather, on proving whether they are adroit enough to find a package that can be enacted. As Otto von Bismarck, not a Chicagoan, observed, "politics is the art of the possible." That's a distinction: It's not toughness that's the key variable, but rather adaptability. And a sense of opportunity--taking the best deal you can get.

For example, all year, Obama has had, if he wanted it, the Healthy Americans Act, a.k.a. the bill put forth by Sens. Ron Wyden-Bob Bennett , which represents incremental but positive change in health care. Bennett, a respected senior Republican lawmaker from Utah, would obviously support his own bill, and he'd probably bring a dozen or more Republicans with him. Q.E.D. Problem solved. Or it could have been solved, except that by all accounts, the White House never seriously considered the bipartisan health care bill that was right in front of them all along. Of course, top Democratic leaders, notably House Speaker Nancy Pelosi, have never thought much of the Wyden-Bennett bill, deriding it as a giveaway to the insurance companies. And so thus the question: Who, exactly, is Obama/Axelrod supposed to get tough with? Are they going to put a knee in Pelosi's groin. As we can quickly see, tough talk has its limits in mixed company.

Also in The Washington Post this morning, there's a thoughtful editorial praising a new report from The Brookings Institution, calling for a bipartisan approach to health care, including tort reform. Just last week, Bill Bradley, the former senator and a certified Thoughtful Observer, also endorsed tort reform as part of any genuine reform.

Axelrod should know that somewhere in the cluster of ideas and legislation put forth by Wyden, Bennett, Bradley, and Brookings are the elements of a health care plan that could actually find its way to passage. But Axelrod and his crew won't find their way by being tough. They will find their way by being smart. If they find their way at all.

Unfortunately, little of today's pulling and hauling over health insurance and universality has much of anything to do with Serious Medicine. As argued here, what Americans REALLY want is to live better and longer. That takes research and development, and heavy investment. And strictly speaking, few of these proposals have much to do with heavily investing.

Although I was encouraged to see this piece, too, in the Washington Post: Dr. Arthur Feldman, of Jefferson Medical College in Philadelphia, puts in a strong plug for medical research:

Every modern treatment for human disease is related in some way to research at U.S. academic medical centers -- much of it supported by the National Institutes of Health. These include new treatments for cancer, devices to prevent sudden cardiac death and medications that save the lives of patients having heart attacks.

However, decreased federal funding for research over the past six years has threatened to decimate a generation of young scientists and the cures they could discover. While the stimulus package provided $10 billion for NIH-supported research, the allocation was for only two years. The health-care reform legislation provides no information about the level of research funding after 2011.

Unfortunately, this item is #8 on his list of ten things to worry about in health care. That's the challenge that Serious Medicine faces, to get past all this process stuff, to get to the real essence of health and life. But the Serious Medicine solution, when it comes, will have to be bipartisan, and so that's one reason I am following the current "health insurance reform" debate so closely.

But in the meantime, with a big presidential speech coming up on Wednesday, we will see how far Axelrod & Co. get by threatening to knee people in the groin.