By E.J. Dionne Jr.
Monday, August 31, 2009
President Obama can still secure major health-care legislation this year if he learns from his mistakes in recent months and spends more time reminding Americans why they were once eager for fundamental change.
His White House lost sight of the need to make a strong case that reform would deliver specific benefits to the insured as well as the uninsured. Absent a consistent set of arguments from reformers, advocates of the status quo filled the vacuum -- often with outright lies.
The administration also sent mixed and confusing signals about its position on a public insurance option. This set off a liberal firestorm and increased the role that the public option played in the public debate -- which, paradoxically, is exactly the opposite of what Obama's lieutenants intended.
And his aides did not foresee just how fraught the situation would become in the Senate, where Max Baucus, the Democratic chairman of the Finance Committee, allowed Charles Grassley, the committee's ranking Republican, to string negotiations along indefinitely without making any commitment to voting for a bill.
Senate leaders signaled Obama as early as June that they wanted him to intervene more actively to push Baucus along. The administration held back, hoping it could postpone its most forceful involvement until after both the Senate and the House had passed bills. But Baucus's failure to produce a proposal before the summer recess added to the sense of legislative chaos and bred uncertainty as to what reformers are seeking.
Despite health care's summer of discontent, supporters of change are in better shape than the accounts of recent weeks would suggest. The House is poised to pass a bill in early fall that would achieve most of Obama's major goals. And Obama is a full year ahead of the schedule on which Bill Clinton's administration found itself in the 1990s.
The health battle did not reach its legislative climax until the autumn of Clinton's second year in office. Obama, by contrast, has forced a showdown with plenty of time left before the midterm elections, giving him more maneuvering room.
But backers of reform say that if Obama is to prevail, he will have to be much clearer about what he is fighting for.
Democratic strategists as well as members of Congress argue that for middle-of-the-road voters, the issues that matter are the high cost of insurance, their fears of losing coverage if they have preexisting conditions, and the fact that policies often fail to cover necessary procedures and sometimes cut off benefits.
"They pay their premiums, they pay their co-pays, and then a doctor tells them they need a test and they discover their insurance company won't pay for it," said Anna Greenberg, a Democratic pollster. "That's the kind of thing that people are upset about." John Marttila, another top Democratic adviser, argued in a memo to party leaders that "medical bankruptcies evoke profound empathy, fear and moral outrage" and that reformers should highlight as a central goal "that no American family should be bankrupted by catastrophic health care bills." In the meantime, by failing to make a strong and comprehensible case for the public insurance option, the administration has left many confused about exactly what it is.
Sen. Charles E. Schumer (D-N.Y.) argues that the administration should use a simple analogy to drive home the idea that government has the capacity to expand the choices people have. "In my state and every state, we have excellent private universities and excellent public universities," he said. "People have a choice." Marttila broadly agrees with Schumer's analysis, but he adds that it is a mistake for reformers to lay too much emphasis on the public option. Doing so, he says, leads many to believe that it is the entirety of health reform rather than "only one element" and distracts attention from the most popular ideas Obama is pushing.
In the end, the administration would sacrifice the public option if that were necessary to win major expansions in heath coverage and tough new rules on insurance companies. But the public option's most passionate supporters will not accept such a deal unless the administration first fights hard to get it enacted.
The road to compromise is not paved by offering premature concessions and vagueness. Having held back, the administration now needs to lay out clear and understandable goals, so it can bargain from a position of strength. Dare one say it? That was Ted Kennedy's way.