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I’m sure others will soon, if they haven’t already, write on this topic and I imagine the business schools will take it on as a case study, but the passage of health care reform strikes me as chock full of practical leadership-management lessons. My interest is not in the pros and cons of the legislation, but rather in the approach President Obama took as a leader of the process. Leadership is, after all, a value neutral proposition; history has shown many times over that great leaders can do horrible or wonderful things. Often only the passage of time will reveal which is the case.

Health care reform of course suffered greatly from a dynamic already discussed in this blog–reform efforts are expected to be letter perfect from the get-go, even though the status quo itself evolved unevenly in fits and starts over a very long time period. It is this dynamic that almost always places reform efforts in defensive positions, regardless of their merits. So to lead the effort to pass the legislation, President Obama had to demonstrate great persistence. But it was more than just persistence. The President had to indicate, by his actions not just his words, that passage of the health care reform legislation was his single most important priority (Lesson 10). That’s why it was particularly effective, I thought, at the end when the President postponed and then rescheduled his Asia trip to stay home to continue twisting Democratic appendages. Whether the postponements were genuine or part of a considered strategy hardly matters. Creating drama, after all, is a useful leadership strategy when you’re in a difficult struggle. Battlefield commanders have long known this. (The need to create drama is part of what I’m driving at when I say in Lessons 7 and 8 that Leadership is emotional and corny. If you’re above a little theatrics when something is really important to you then you do not understand fully the high emotional content of leadership and followership.)

Another consequence of Obama’s dramatic personal interventions in the Republican/Democratic congressional death match was that he was able at key moments to reframe the debate. The televised working sessions with Republicans were really about trying to regain control of the context of the legislation. Whenever you’re involved in a change effort, you will find those who don’t agree with you will likely first try passive/aggressive approaches. If those don’t work then they will still, I think, try indirect approaches such as reframing the terms of debate. This you must avoid at all costs. Just think back on the number of times a reform effort you considered worthy was ambushed by issues that were only tangentially related to the central thrust.

By the way another leadership lesson was illustrated by President Obama’s sessions with Republican lawmakers. And that is Lesson 4–conflicted, crunchy meetings are usually a very good thing. In this case I think both sides of the debate gained by discussing the substance of their disagreements, rather than the headlines.

But I think the most important lesson to be illustrated is #12, first articulated to my knowledge by Ron Heifetz of the JFK school: leadership is disappointing your followers at a rate they can tolerate. To get the legislation passed, President Obama had to abandon several goals that were and still are dear to his core followers. He certainly disappointed people and, although he carried these followers  in the health care vote, only the passage of time will reveal whether in the end they will tolerate the disappointment. One of the disappointments these followers carry, no doubt, is the regret that President Obama was not more heroic. What do heroes do? They fall on their swords. But as Lesson 13 states: heroism is not a leadership strategy. Why? Well, you can’t be heroic very often; it does not bear repetition. And in the end, heroism depletes your leadership savings account, leaving you with nothing to call upon to face the next challenge.

And so I’m reminded of Lesson 19: Leaders essentially have bank accounts that contain the deposits of their employees’ trust. Unlike the spending habits of the American public in the last decade, leaders need to draw down upon those trust accounts very carefully. You will gain new deposits when you meet your employee’s expectations but remember more often than not you’re in the business of disappointing them, so make withdrawals carefully. If you don’t you will find that when you most need your employees’ discretionary energy, your trust account is overdrawn.