Does US Health Care Reform Have Any Diplomatic Impact?


It’s well known that domestic political failures/successes impact foreign policy-making ‘capital.’ This is especially so for the US president, because the US foreign policy-making process includes the legislative branch far more than in other democracies (much less in dictatorships). In other words, the US Congress intervenes a lot more in US foreign policy-making than the parliaments of other countries do, so presidents need more than the usual amount of congressional support to act overseas. You see this in lots of ways: Congress routinely derails trade deals, intervenes in US aid planning (to avoid abortion funding, or to support Israel, eg), pushes unsought weapons-systems on the Pentagon, demands recognition for preferred foreign constituencies (Armenians, Cuban exiles, Christians in China and the Middle East), etc. So the connection between ObamaCare’s passage and the general ability of Obama to push Congress to follow him later on foreign policy is real.

(Addendum: In European and Asian democracies, the legislature is rather deeply excluded; the executive branch runs the whole show. The logic is that when the country acts abroad, it should speak with one voice, and only the executive branch – the president or prime minister –can actually aggregate all the diverse interests in the country into that one voice.  Parliaments cannot do this realistically, as they are so fragmented among competing parties and egos.)

Mead argues that ObamaCare’s failure would have ‘crippled his presidency.’

1. Not really. Health care is such an overwhelmingly internal, domestic issue, I don’t think the specific foreign policy benefits are that high. States pursue all sorts of different health care strategies, and their linkage with specific foreign policy issues is minimal. ObamaCare won’t provide any dividends abroad on the burning immediate issues of US foreign policy, like Israeli settlements, Afghan or Mexican corruption, China’s currency, Iraqi elections, etc.

But it does send some oblique signals:

2. It does bring the US into line with the OECD norm that when countries get rich enough, they are supposed to provide near-universal health care as a basic gesture of ‘social justice.’ One in six Americans didn’t have health insurance, and any American travelling abroad has probably tried, awkwardly, to explain that one away to skeptical interlocutors from other OECD states.

So in this way ObamaCare pulls the US toward the global normative consensus of what a good society looks like; it helps make the US look ‘civilized.’ It aids Obama’s stated goal to return the US to moral authority after W and restock its soft power. It therefore helps the US shame and criticize illiberal states more effectively, because it is less vulnerable to hypocrisy charges. (The US embrace of gun ownership and the death penalty, e.g., make the US a less compelling advocate of the rule of law and state restraint. The US move toward torture similarly undermines the US as an opponent of it.)

3. It does signal that the US will have a harder and harder time maintaining a huge defense posture. The more the welfare state grows, however noble the cause, the more its spending will eat into defense and diplomacy spending

4. It does improve Obama’s domestic political capital and general standing as a powerful POTUS who can get things done. This will increase his leverage in Congress, and perhaps with democratic leaders overseas too. He should be able to more successfully push controversial foreign policy initiatives through Congress, like the Korean-US trade deal or a tougher line on Israel. Reputation and prestige matter in IR, and looking like a winner helps bluff others.

4 thoughts on “Does US Health Care Reform Have Any Diplomatic Impact?

  1. Prof. Kelly,
    I think the thrid one is the most convincing among your four points. And for the fourth one, I disagree with you (and Rachman).
    As Rachman admits in his op-ed, the relationship between the Obama’s success in domestic politics and his empowerment in foreign policy is at best indirect. I suspect ObamaCare could have rather negative impact on his handling of foreing policy than positive one because disgruntled Republicans are likely to be unwilling to make concessions.


    • I think your first point is accurate. A longer view would note that as America’s welfare burden piles up and its debt stock, that eventually cuts will come at the expense of defense. The US combined defense annual expenditure is close to 1 trillion USD. That is simply not sustainable when the USG is also borrowing 1 trillion USD a year. The expansion of the welfare state will only accelerate these tensions. This is arguably the most important foreign policy impact of welfare reform. Agreed.

      On point 4, I don’t think GOP opinion makes any difference really. The Republicans have given Obama nothing in the last 12 months. They haven’t budged on any major issue. Maybe a better phrasing would have been to say that the Dems in Congress are more likely to follow Obama on tougher stuff (Israel, KORUS FTA, Afghan surge) if he looks like a winner. And ObamaCare helps him look like that.


      • Didn’t the GOP back President Obama’s surge in Afghanistan when you and the Democratic Party were against it?


  2. Dr. Bob:

    “The Economist” and “the FT” wrote both discussed this about two weeks ago. Their take is pretty interesting.


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