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

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.