On Health Care, Congress Must Navigate Tricky Political Terrain

By Shailagh Murray
Washington Post Staff Writer
Wednesday, June 10, 2009

The new president stood before a joint session of Congress and called for health-care reform in the most urgent terms possible.

"Our families will never be secure, our businesses will never be strong, and our government will never again be fully solvent until we tackle the health-care crisis. We must do it this year," Bill Clinton declared on Feb. 17, 1993.

Less than two years later, "Hillarycare" would become mired on Capitol Hill and would help to send Democrats to a historic 1994 election defeat. Congress would go on to tinker around the edges of health care, including adding a Medicare prescription drug benefit under President George W. Bush, but reform on the grand scale that Clinton imagined fell off the national agenda until President Obama addressed a new Congress on Feb. 24 and outlined goals virtually identical to Clinton's, such as controlling costs while expanding coverage.

"The cost of our health care has weighed down our economy and our conscience long enough," Obama said. "So let there be no doubt: Health-care reform cannot wait, it must not wait, and it will not wait another year."

The great unknown of the health-care debate as it unfolds in the months ahead is whether the current political landscape will prove more hospitable to mandates, cost controls and tax increases -- all measures now on the table that helped doom the Clinton plan.

Even Republicans concede that Obama enjoys some key advantages the last Democratic president did not. The economic crisis has made health-care stakeholders more receptive to change. The broad outlines of the president's blueprint were vetted by voters last year during a protracted series of debates between Obama and Hillary Rodham Clinton in the Democratic primary race, and between Obama and GOP rival John McCain in the general-election campaign.

And unlike President Bill Clinton, who turned to his first lady to craft a plan, largely in secret, this White House is allowing House and Senate committee chairmen to design the legislation with a heavy dose of administration input.

Passage of a health-care bill of the scope Congress is contemplating would be an extraordinary feat, but it is fraught with political peril, win or lose. It may require Obama to backpedal on his campaign pledge not to tax employee health benefits. The Democrats' House and Senate majorities are only slightly larger than 1993 margins and may prove just as illusory, given the large number of Democratic moderates who are trying to hold on to swing seats.

Congress has been riven by increasing partisanship in recent years, and both sides have shown an appetite for tackling policy challenges in incremental bites rather than bold strokes. Big, ambitious bills need big, bipartisan margins not only to pass but also to earn credibility with voters. Republican lawmakers know that the more GOP votes Obama can secure, the more he will shield Democrats from another electoral backlash in 2010.

Given the stakes, Democrats are surprisingly upbeat about their prospects for delivering a bill to Obama this fall, as the president has requested. "It's a given. It's inevitable," said Senate Finance Committee Chairman Max Baucus (Mont.), a lead negotiator. Baucus said yesterday that he expects to unveil a measure next week that would tax employer-provided benefits above a certain threshold.

In the early 1990s, veterans of the earlier battles contend, the status quo on health care was still tolerable. Employer health coverage was often generous; its escalating cost to beneficiaries was more or less hidden. But today, the iconic ads in which the fictional couple Harry and Louise reminisced about the good old days of health care before "government bureaucrats" got involved seem a throwback rather than a threat.

"Harry and Louise are now 58 years old, Harry is a diabetic, needs prescription drugs and has no health insurance," said Sen. Barbara A. Mikulski (D-Md.), a member of the Senate health committee who is helping negotiate a deal. "It's the economics of it, as well as the compelling human need."

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