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Health Reform, Obama's Toughest Sales Pitch, Is Also His Most Critical

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By Michael A. Fletcher
Washington Post Staff Writer
Thursday, July 23, 2009

Since taking office, President Obama has preached the urgency of implementing the big items on his long list of policy priorities. And he has been largely successful at bending public opinion, and Congress, to his will -- on the stimulus package, financial bailouts and his budget, with unprecedented new investments in education and renewable energy.

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But six months into his presidency, as Obama stood in the East Room of the White House on Wednesday night, he faced what is shaping up as his toughest and most critical sales pitch yet: explaining to an increasingly reluctant public that health-care reform is in its best interest.

Obama used his fourth prime-time news conference to directly address the anxiety many Americans feel about emerging plans to revamp health care, plans that are reaching a critical juncture in Congress.

"I understand that people are feeling uncertain about this," he said. "They feel anxious, partly because we've just become so cynical about what government can accomplish that people's attitudes are, you know, 'Even though I don't like this devil, at least I know it, and I like that more than the devil I don't know.' "

Obama cast retooling the U.S. health-care system as crucial to the nation's economic success. Reform would help rein in the national deficit and rebuild the economy, he argued, in a way that would help middle-class workers, whose wages have stagnated in recent years largely because of spiraling health-care costs.

Convincing Americans -- and by extension Congress -- of the value of reform is pivotal to the fate of Obama's broader domestic agenda. Defeat would be a substantial political setback, not unlike the one President Bill Clinton suffered in 1993, when his failure to remake the health-care system caused him to shrink his ambitions.

"Health care will be the key measurement, fairly or not, of the president's success or lack of success this year," said Howard Paster, who worked as a legislative director for Clinton. "That is partly because of how the president has set it up. The stakes are very high."

Few economic policymakers would quarrel with Obama's analysis that health-care costs have hobbled businesses, eroded wages and put an unsustainable burden on state and federal budgets. "The single biggest thing we can do to stabilize our long-term economic situation is to fix health care," said Ellen-Marie Whelan, associate director of health policy at the Center for American Progress, a liberal advocacy group.

Still, Obama faces a tall order selling his health-care vision to an American public that, despite the best efforts of his administration, is still feeling economic pain. The extraordinary federal actions pushed during the early months of Obama's presidency may have averted crisis, but the benefits have yet to show up in the lives of many Americans.

Many economists say the $787 billion economic stimulus is boosting an economy that was near free fall a few months ago. But unemployment has risen to 9.5 percent -- the highest level in more than a quarter-century -- and it is expected to surge higher in coming months.

The stimulus package also included hundreds of billions of dollars in direct aid to struggling states, yet many, led by California, have still been forced to impose draconian service cuts, such as closing parks and limiting health care, to balance budgets devastated by the recession.

A series of financial industry bailouts, meanwhile, may have saved the entire banking system from collapse, but so far there is little evidence that consumer and business lending has picked up substantially, even as four of the nation's largest banks report record quarterly profits and Wall Street executives receive new large bonuses.

A Washington Post-ABC News poll late last month found that, while a majority of Americans agreed that the nation's health-care system is broken, they had little confidence that politicians know how to fix it. Majorities of Americans said they were "very concerned" that changes to the nation's health-care system would reduce the quality of their care, cut their insurance coverage, raise their costs, grow government bureaucracy, limit their choices of doctors or treatments, and sharply increase the federal deficit.

"Folks are skeptical. And that is entirely legitimate because they haven't seen a lot of laws coming out of Washington lately that helped them," Obama said. "But my hope is -- and I'm confident that -- when people look at the cost of doing nothing, they're going to say, 'We can make this happen.' We've made big changes before that end up resulting in a better life for the American people."

Polling director Jon Cohen contributed to this report.


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