Contrary to what the president frequently asserts, even Republicans on the Hill  support health care reform. But they prefer something more incremental than what the president wants. Tort reform, for example, has made an enormous difference in health care costs in several states. Why must we change the character of the country?

Well, but that’s the point: health care reform is merely a means to the end of overall policy change. Venerable Washington Post columnist David Broder explains today that this radical approach stems from President  Obama’s sheer ambition to change the country. Broder relies on an article by Bill Schambra, a respected scholar with the Hudson Institute. Here’s Schambra:

[Obama’s] ambition and his unique style of issue management show that Obama is emphatically a “policy approach” president. For him, governing means not just addressing discrete challenges as they arise, but formulating comprehensive policies aimed at giving large social ­systems — and indeed society itself — more rational and coherent forms and functions. In this view, the long-term, systemic problems of health care, education, and the environment cannot be solved in small pieces. They must be taken on in whole, lest the unattended elements react against and undo the carefully orchestrated policy measures.

Quoting Schambra, Broder offers a pretty convincing analysis of where this hubristic approach usually takes us:

“In one policy area after another,” Schambra writes, “from transportation to science, urban policy to auto policy, Obama’s formulation is virtually identical: Selfishness or ideological rigidity has led us to look at the problem in isolated pieces . . . we must put aside parochialism to take the long systemic view; and when we finally formulate a uniform national policy supported by empirical and objective data rather than shallow, insular opinion, we will arrive at solutions that are not only more effective but less costly as well. This is the mantra of the policy presidency.”

Historically, that approach has not worked. The progressives failed to gain more than brief ascendancy, and the Carter and Clinton presidencies were marked by striking policy failures. The reason, Schambra says, is that this highly rational, comprehensive approach fits uncomfortably with the Constitution, which apportions power among so many different players, most of whom are far more concerned with the particulars of policy than its overall coherence.

The energy bill that went into the House was a reasonably coherent set of trade-offs that would reduce carbon emissions and help the atmosphere. When it came out, it was a grab bag of subsidies and payoffs to various industries and groups. Now it is stymied by similar forces in the Senate.

Schambra’s essay anticipated exactly what is happening on health care. Obama, budget director Peter Orszag and health czar Nancy-Ann DeParle grasp the intricacies of the health-care system as well as any three humans, and they could write a law to make it far more efficient.

Making health care more efficient and affordable isn’t the goal. Making the United States a different country is the goal.