The rest, we could say, is history. But in this historic week for health reform, that history remains contested.
As we mark the law’s second anniversary—even as the Supreme Court hears arguments on its constitutionality—we should pause to consider what the law reveals about the leadership of this president, and about the qualities of strong leadership in general.
At its core, the debate about health care in America is a deeply political and ideological disagreement over the proper role of government. Democrats say the government must remedy what is fundamentally a market failure. Republicans say the solution to our health-care crisis lies in freeing the market further. With the ideological chasm that exists today, how does one govern? How does one lead in such a poisonous political environment?
In answering these questions, we should consider three measures of leadership: approach, resolve and results.
The most important approach a political leader can take is committing to finding common ground with those on the other side of the argument. Good governance is best served by negotiation and compromise. As Senator Henry Clay declared, “all legislation, all government, all society is founded upon the principle of mutual concession.” History is filled with examples, from Clay’s own efforts to preserve the Union to the modern legislative compromises that brought us the Civil Rights Act, Social Security and Medicare.
So how did President Obama do?
While many in his party called for a government-run system like Medicare, or a ‘public option’ insurance plan, President Obama—in the interest of finding common ground and much to the chagrin of his liberal base—agreed early on to a crucial compromise approach originally proposed by the conservative Heritage Foundation. That approach builds on private health-insurance markets to guarantee health-care access for all, with government intervention to make those markets work effectively.
President Obama also strongly encouraged bipartisan cooperation in Congress. The Senate health committee accepted 161 Republican amendments to their health reform bill before final passage. Senate committees held 30 bipartisan hearings, while 6 bipartisan working groups met informally a combined 72 times.
In spite of these efforts, the president was spurned in his efforts to achieve common ground. But his response exemplifies the next quality of leadership: resolve.
Winston Churchill once offered the most famous piece of advice when it comes to resolve: “Never, never, never give up.”
And on this score, I doubt even the president’s bitterest opponents could question his steely resolve in the face of fierce opposition.
I have lost track of the number of times health reform was pronounced “dead,” the number of key White House staff who urged the president to give up, and the countless polls suggesting that the Affordable Care Act still struggles to find broad popular support. It was said that President William McKinley kept his ear so close to the ground that it was full of grasshoppers. Yet if President Obama had done the same, there would be no health-care reform to celebrate today.
In spite of pundits, polls and party discontent, President Obama took Churchill’s admonition to heart. He never gave up. Even in the darkest moments, when many of us had doubts about his determination to see health reform enacted, the president stayed true to what he told me the week he was sworn in. Not because it was easy or popular or politically advantageous, but because he thought it was right. I’ve seen some incredible courage and tenacity in my four decades of public service, but rarely have I seen a better example of resolve from a political leader than this.
But resolve to do what you think is right doesn’t mean anything unless you get results—the ultimate test of leadership.
So on this final, defining test, how did President Obama do?
We are now experiencing the most transformational development in health care in our country’s history. Even though the law will not be fully implemented for many more years, millions of Americans have already benefitted from the sweeping reforms. Over 30 new insurance protections have been implemented, and 73 percent of young adults now have coverage, many for the first time. Today, 105 million Americans no longer face arbitrary lifetime caps on their coverage. Four million seniors have saved more than $2 billion in prescription drug costs in 2011 alone. And nationwide efforts are now underway to initiate meaningful change in both payment and health delivery reform that will reduce costs while improving the quality of care.
Increasingly, the results show the president has delivered—both quality care and quality leadership.
Churchill had one additional relevant thought. “Americans will always do the right thing,” he observed. “But only after they have tried everything else.”
At this momentous time for health-care reform, it is important to remember that many presidents for many decades tried nearly everything else in their collective effort to achieve a most elusive goal, an America in which no one will live in fear for lack of access to health insurance. And history will make one thing quite clear. Barack Obama’s leadership legacy on health reform is that, at long last, Americans did the right thing.
Daschle was one of the longest serving Senate Democratic leaders in history, and the only one to have served twice as both majority and minority leader. He was President Obama’s initial nominee for secretary of Health and Human Services, and currently serves as a senior adviser at DLA Piper.
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