Time for Obama to Play Offense on Health Reform
It's true that politics is the art of the possible, but it's also true that great leaders expand the scope of possibility. Barack Obama took office pledging to be a transformational president. The fate of a government-run public health insurance option will be an early test of his ability to end the way Washington's big-money, special-interest politics suffocates true reform.
Without that option, what Obama now calls "health insurance reform" still would be better than no reform at all. But frankly it's becoming hard to tell. So many genuine reforms have been taken off the table -- fully universal coverage, the ability to negotiate prices with the drug companies -- that expectations are ratcheted down almost daily.
Giving up the public option would send many of Obama's progressive supporters into apoplexy, yet the administration has sent clear signals that this is the path of less resistance it's prepared to take.
"The public option, whether we have it or we don't have it, is not the entirety of health-care reform. This is just one sliver of it, one aspect of it," Obama said Saturday at a town hall in Grand Junction, Colo. Kathleen Sebelius, the secretary of health and human services, told CNN that a public option is "not the essential element" of comprehensive reform.
But what is the "essential element"? Where, if anywhere, does Obama draw a line in the sand? For reform to be meaningful, there must be some components that a final package absolutely should include. What on Earth might they be?
Obama was wise to avoid the central mistake of Bill Clinton's failed attempt at health reform, which was to hand Congress a fully elaborated package and say "take it or leave it." Instead, Obama set broad -- and awfully fuzzy -- policy outlines and let Congress fill in the details. He has followed this strategy to a fault, allowing the effort to be hijacked by special-interest lobbies determined to thwart genuine reform.
The let-Congress-do-it approach meant that multiple bills would be written in committees on both sides of the Capitol, which gave the lobbyists for health insurance and drug companies a target-rich environment. They could nibble a little here, gnaw a little there, find the weak points and exploit them. Republicans could find opportunities for demagoguery -- the proposal to have Medicare pay for end-of-life counseling, for example, which was twisted into euthanizing the elderly and infirm. Opponents could write a script for chaos at town-hall meetings, designed to create the impression that Americans love their health-care system just the way it is.
Clearly, the White House feels itself on the defensive. But why?
Consider the political landscape. Democrats control the White House and both houses of Congress. No matter how disciplined Republicans are in opposing any reforms -- even if Republican objections are accommodated -- they don't have the votes to kill a final bill.
If conservative "Blue Dog" Democrats are successful in nixing a public health insurance option and watering down other reforms, progressive voters have a right to ask why they went to such trouble to elect Democratic majorities and a Democratic president. But the Senate can still resort to a parliamentary maneuver that would require only 51 votes, rendering most objections irrelevant. Historical trends indicate that it's unlikely the Democrats will expand their majorities in 2010. Politically, therefore, there's not likely to be a better moment for health reform than right now.
It's also true, politically, that failure to get any health reform measure passed and signed would be a severe blow to Obama -- and a bad omen for the rest of his ambitious agenda to revolutionize U.S. policy on energy and education. It would be understandable if the White House decided that the important thing, at this point, was to get a "win" at all costs. Is this what the apparent retreat on the public option signals?
If so, that would be not only wrong but also -- even at this point -- unnecessary, or at least premature. What the president hasn't done is the obvious: Tell Congress and the American public, clearly and forcefully, what has to be done and why. Take control of the debate. Consult less and insist more. Remind the Blue Dogs who's president and who's not.
Giving up on the public option might be expedient. But we didn't elect Obama to be an expedient president. We elected him to be a great one.