If they rule against health-care reform, the justices might be doing Obama a favor. He never really won the public battle on the issue. So he could take the high ground — disagreeing with the decision but showing respect for the court and for the American people, and vowing to continue the fight for health care for more Americans.
Mitt Romney would also be in a bit of a pickle. As governor of Massachusetts, he was Mr. Mandate; his health-care overhaulthere requires everyone to buy insurance. Would he turn against his own program if the court ruled against such a mandate? Or would that plan stand because a single state enacted it, while the federal government lacked the power to create a national plan? If the Supreme Court overturns Obama’s individual mandate, the Massachusetts mandate could undercut Romney’s credibility on the issue.
In his reelection campaign, Obama could propose that states be incentivized to sign on to a plan like the one in Massachusetts, where most voters favor the plan. He could deal with the issue in the same way states are incentivized to require seat belts. Such a strategy would preserve some state choice and leave much of the financing to them as well. Effectively, Obama could still be for universal health care and yet neutralize the issue for the election.
Part of the problem with the health-care law is that controlling costs and improving quality took a back seat to broadening coverage. A redo would allow Obama to produce a new plan that covers these bases, costs less and has broader support. He should treat an adverse ruling as a political gift, an opportunity to move to the center on health care, more like where he was in 2008.
Universal health care hurt President Bill Clinton and the Democrats in 1994 in part because of the way Republicans and industry interests attacked his plan. Their clever ads capitalized on how government intervention in health care — despite how beloved Medicare and Medicaid are — stirs fear in many Americans. They worry that bureaucrats, not doctors, will make life-and-death decisions. In the 1996 campaign, after his grander ambitions failed, Clinton vowed to protect those federal programs and called for an expansion of health care on a “step by step” basis, only as the country could afford it — and he won back the issue.
Two years ago, Obama faced equally devastating midterm elections, and the health-care law hurt him; 48 percent of voters thought Congress should repeal it, according to CNN exit polls. Going into this election season, Obama had won some converts, but the plan was still a negative with the electorate overall.
Within his campaign, the debate is already underway. If the Supreme Court upholds the individual mandate, Obama’s victory speech will be easy to write. But a different speech will be ready to go if the court strikes down the mandate. And the tone it takes could decide the November election.
If Obama plays it right, a defeat for his health-care reform effort could actually move him closer to reelection — giving him another four years to make major advances in health-care coverage, quality and cost.
served as a pollster and adviser to President Bill Clinton from 1995 to 2000 and as chief strategist to Hillary Rodham Clinton’s 2008 presidential campaign. He is the worldwide chief executive of Burson-Marsteller and Penn Schoen Berland. Follow him on Twitter: @Mark_Penn.
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