With Health-Care Reform on the Line, Obama Reframes Critical Debate

By Dan Balz
Washington Post Staff Writer
Thursday, September 10, 2009

After a month of angry town hall meetings and dire predictions about the state of his top domestic priority, President Obama moved forcefully Wednesday night to take the initiative on health care -- and in the process rejuvenate his presidency and unite his fractious Democratic Party.

There was a sense of urgency in Obama's voice -- in apparent recognition of the problems he has encountered through months of congressional dickering, hostile and sometimes false claims hurled by opponents of reform, and the degree to which he has gambled his political fortunes on the outcome.

It is rare for a presidency so young to have so much on the line. No single speech can create consensus on health-care legislation, and in that sense this was not the make-or-break moment described by some commentators. But Obama has staked his presidency on this issue, and his advisers knew it was long past time for him to assert himself in a more demonstrable way or risk seeing the entire enterprise slip away.

"The time for bickering is over," Obama said. "The time for games has passed. Now is the season for action."

Obama may have lost ground over the summer in the health-care fight, but he marshaled the power available to a president -- a nationally televised speech to a joint session of Congress -- to try to reset the debate on more favorable terms as the final legislative push begins. The question is whether the path he outlined -- what he described as a middle ground -- will satisfy the divided wings of the Democratic Party or the few moderate Republicans who may be interested in cooperating with him.

If anything, the speech and the sharply partisan reception in the House chamber served to highlight the work that remains before Obama can make good on his pledge to enact major reform by the end of the year.

The president had two overriding objectives for his speech. First was to reassure and ultimately rally a skeptical public to get behind the drive for comprehensive health-care reform. On this, it was clear he had in mind a pair of audiences whose support is vital: independents and senior citizens. Seeking to appease independents worried that his agenda threatens a fiscal disaster for the country, he promised not to sign a bill that would increase the deficit. Addressing seniors, he looked directly into the cameras and vowed, "I will protect Medicare."

Obama almost certainly will get a boost in the polls from Wednesday's speech, as President Bill Clinton did when he gave a similar address to Congress in the fall of 1993. Obama's key to success is to use the space created by this moment to drive Congress, particularly his Democratic allies, toward consensus and action. The longer the debate continues, the more his gains from the speech will dissipate.

That is why his second objective was to put his imprint on the health-care discussion in a way that will move the legislative debate from its current stalemate to final passage. For weeks, Obama has been pulled and tugged on health care, urged by Republican opponents to abandon his plans for comprehensive reform and to significantly scale back his initiative, and exhorted by many Democrats to return fire and challenge those opponents as aggressively as they have challenged him.

Instead, he followed the instincts that have guided him throughout his political career, calling for a more civil debate and seeking as broad a consensus as possible. He tried to set himself as the midpoint in a debate between a single-payer system run by the government and the abandonment of the existing employer-based system, although neither has been a real option in the discussion this year.

For Republicans, Obama offered some possible concessions as a way to demonstrate his continuing willingness to work across partisan lines. He also invoked the late Sen. Edward M. Kennedy (D-Mass.) to remind some of Kennedy's GOP allies of their cooperation with the liberal lion of the Senate, hoping to cajole them to join the effort to enact a bill. "I still believe we can replace acrimony with civility and gridlock with progress," he said.

But the reality is that the president faces near-universal opposition from the GOP, and there was little in the reaction Wednesday night to suggest any immediate change in that. If he succeeds in his quest for health-care reform, it will be with at best token Republican support. That means binding up a Democratic Party divided between its liberal and moderate wings, between House and Senate, most notably over a public insurance option. On this issue, Obama reiterated his backing but urged progressives not to make that provision the key to their support.

Obama gave liberals enough to cheer about elsewhere in the speech, calling claims about "death panels" "a lie" and vowing to call out those whose only goal is to score political points by opposing reform. And though he may have chosen the only viable political course in signaling his willingness to accept legislation without a public option, Obama faces hard bargaining and further backlash from his Democratic base.

The battle is more than a test for Obama. It represents a challenge to his party, and the degree to which Democrats recognize that truth will determine the fate of health-care legislation this year. Democrats have said throughout the summer that failure is not an option. Now Obama must persuade them to act in their collective interest, rather than their individual interest.

As the 2010 elections loom, the conflict between self-preservation and party unity will grow more acute. The president has limited time to move the Democrats toward a conclusion.

"It's a moment when Democrats need to pull together," said pollster Stan Greenberg, who was Clinton's pollster during the debate of 1993-94.

Obama used all his rhetorical powers Wednesday night to try to jump-start health-care talks. His challenge now will be to use his powers of persuasion in the gritty negotiations in the coming weeks. His hope is to make good on his statement to Congress and the nation: "I am not the first president to take up this cause but I am determined to be the last."

Much work remains.

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