There are two dominant views about how presidents accomplish fundamental change.
The first might be called the “deal-maker-in-chief,” by which presidents threaten or buy off powerful opponents.
Barack Obama got the Affordable Care Act this way – gaining the support of the pharmaceutical industry, for example, by promising them far more business and guaranteeing that Medicare wouldn’t use its vast bargaining power to negotiate lower drug prices.
But such deals can be expensive to the public (the tab for the pharmaceutical exemption is about $16 billion a year), and they don’t really change the allocation of power. They just allow powerful interests to cash in.
The costs of such deals in “the world we’re living in” are likely to be even higher now. Powerful interests are more powerful than ever thanks to the Supreme Court’s 2010 Citizens United decision opening the floodgates to big money.
Which takes us to the second view about how presidents accomplish big things that powerful interests don’t want: by mobilizing the public to demand them and penalize politicians who don’t heed those demands.
Well now that’s just crazy talk, Bob.