What Obama Does With U.S. Healthcare Could Make or Break His Presidency

Posted by Michael Tomasky, Comment Is Free at 4:00 PM on June 15, 2009.

President Obama officially started withdrawing chunks of his political capital on behalf of universal healthcare as he hosted a town-hall meeting in Green Bay, Wisconsin, on Thursday afternoon. It's not too much to say that it's the project, more than any other single thing, that can make or break his first term.
"I'm not doing this because I don't have enough to do," Obama told his Green Bay audience, which giggled in recognition of the many fronts on which the administration is moving. "We need healthcare reform because it's central to our economic future." He didn't say, but could have, that it's central to his political future as well.
This will be a huge fight that will play out over the summer and culminate in congressional votes any time between September and November. If something passes, even if it's not everything Obama or liberal healthcare advocates want -- and it won't be -- Obama will be able to make a claim that has eluded every one of his predecessors: he passed universal (or, more like, "universal") healthcare reform.

And if nothing passes, Republicans and conservatives will be able to claim that they won again. Obama will have been just as weak and beatable on this issue as the Clintons. After their defeat in 1994, the Clintons vastly reduced the ambition of their agenda. Obama would probably be forced to do the same.

The same thing is true today, in other words, that was true in 1994, which is that both sides understand full well that healthcare is both (a) a major thing in and of itself, since health care costs soak up around 15% of the US economy and (b) a harbinger of a larger shift leftward, because people tend to like benefits once the government passes them, and those benefits then become awfully hard to dislodge.

Paul Starr, a leading U.S. expert who worked on the Clinton plan, wrote two years in the American Prospect that conservatives grasped this fully. Bill Kristol, then advising Capitol Hill Republicans, wrote a memo instructing them of any Clinton proposal: "Sight unseen reject it." Kristol and his allies understood, as Starr wrote, that "if it succeeded, it might renew New Deal beliefs in the efficacy of government, whereas a defeat of the health plan could set liberalism back for years."

We needn't dig too deeply into the policy questions at this point. We'll have all summer to do that. Instead, let's ask what seem to me to be the three important political questions -- three things that will loom as crucial if a major piece of legislation is going to pass.

First, can congressional Democrats agree on a bill? This will be very difficult to pull off. You have some Democrats insisting that they won't support any bill that doesn't have a so-called "public option" -- a government-run insurance plan to force competition on private insurers. You have other Democrats, especially in the Senate (two so far), who say there's no way on earth that they'll back a bill that has a public option.

Second, will Democrats be able to persuade some Republicans to back the bill? There's reason to believe that this isn't necessarily like the stimulus matter from earlier in the year, when the GOP (with three Senate exceptions, one of whom is now a Democrat) put up a united front against Obama. Some Republicans represent districts and states where a major healthcare bill will be popular. Mitch McConnell, the Senate GOP leader, says a public option is a deal-breaker. It's not clear whether he speaks for every single Republican in saying that.

Third, will the powerful lobbies (especially the insurance lobby) put everything they have into killing any legislation, as they did in 1994? Obama had their representatives to the White House for a nice show-and-tell press conference in May. That was taken as a sign at the time that they were resigned to the idea that some kind of healthcare bill will pass, so they might as well play ball and make it something they could live with. But will they stay resigned or decide they have a little fight in them after all? I'd put money on the latter.

The answers to these questions will come down to the political skill of Obama and his team. They have the right idea and have begun with the right approach. Read this piece (especially the first three pages) by Matt Bai from the New York Times magazine last Sunday for interesting detail on the question of how this White House is working Congress (and how different it is from 1994).

But it's one thing to be adroit in the first inning, which is where we are. When it counts is in the ninth inning. Today marks the start of an important process because Obama will clearly hope that by the time the late innings come around, he'll have toured the country and solidified public opinion behind reform.

That's the gamble. The Green Bay event was the first of what will surely be dozens of such events in the coming weeks, during which we'll see if Obama can sustain the kind of enthusiasm he built as a candidate and convert it into capital he can use as president.

Tagged as: democrats, republicans, healthcare, barack obama, universal healthcare, insurance lobby