The Sunday Take

Dan Balz's Sunday Take: The political divide over the health-care debate

By Dan Balz
Sunday, February 28, 2010

In the aftermath of President Obama's White House health-care summit, it's clear that both sides are certain they are right on substance. Where they differ is over the politics. Democrats and Republicans believe that, in the end, they can win the political argument. As Obama said at the end of Thursday's gathering, "That's what elections are for."

Thursday's largely civil and intelligent summit underscored the deep philosophical gulf that remains between the two sides over health care (and many other issues). Both agree that the health-care system needs repair but significantly disagree over how to fix it. That is a genuine difference that seven hours of talking did not begin to narrow.

Democrats think more government is the answer; Republicans say the opposite, that market competition is the best antidote to the ailing system. Republicans are focused on cost, both rising premiums and government expenditures. They haven't made universal coverage anything close to a priority. Democrats are more determined to expand coverage to many millions more who lack insurance. But they say they have not ignored costs. Their proposals, they argue, would reduce premiums and the deficit. Republicans say the projected governmental savings will never be realized.

The summit produced a number of notable exchanges, beginning with the sharp dialogue between the president and Sen. Lamar Alexander (R-Tenn.). Often the two sides were dueling with conflicting numbers. Senate Majority Leader Harry M. Reid (D-Nev.) chastised Alexander by saying he had a right to his opinion but not his own facts. But there are enough numbers and studies by reputable organizations to arm both sides, and neither side was prepared to yield to the other's analyses.

Those policy and philosophical differences, backed up by the blizzard of statistics cited throughout the day, are the reason Obama sounded pessimistic at the end of the day that there were grounds for compromise. As he noted, the two sides will go their separate ways in the final legislative battle and then have it out in November. "We have honest disagreements . . . ," he said, "and we'll go ahead and test those out over the next several months till November."

It was politics as much as policy that has kept the two sides from entering into serious negotiations. Republicans read the polls and see overall opposition to the Democrats' proposals. For now, the status quo suits them just fine. Democrats read the polls and see strong support for many of the key elements of their plans. Having come this far, they resist retrenching unless all other paths are blocked. Failure remains unacceptable. They must change the status quo.

The legislative path remains treacherous for the Democrats, as Reid and House Speaker Nancy Pelosi (D-Calif.) try to count the votes and assemble a majority coalition as their nervous lawmakers read the mood of their own constituencies. The White House and congressional leaders now have about a month to pull together majorities in both houses.

Democrats may be forced to use reconciliation to enact health care with a bare majority, believing that in the end the public will not care much about congressional procedures, only outcomes. But if the deal-making from December is any guide, Democrats are taking a risk of looking like they are jamming health care through in the face of public opposition.

When Sen. Scott Brown (R-Mass.) won his surprise victory last month, the anger over health care had as much to do with the process by which Democrats were trying to pass the bill as with the substance. That should be a caution to the Democrats that process can color public opinion.

Whatever happens in Congress, the health-care fight is heading toward a political referendum in November. So far Republicans have been winning the battle for public opinion, but that competition is far from over, as Obama suggested at the end of the summit.

White House officials said months ago that this year would be about jobs and the economy. That may be their hope and intention, but the November elections also will be about health care, which in reality has become a proxy for a bigger debate about the role of government and whether Obama has overreached in his estimation of how much government Americans want or will accept.

The president has tried to frame this debate not on liberal-conservative lines but on common sense: can government work for people, regardless of whether it is big or small. So far he has struggled with that argument. He must hope that health care, if enacted, will allow him to demonstrate that it can.

The success of Obama's presidency, domestically at least, depends on two things. First, can he pull the country out of the recession fast enough and with enough job growth to maintain public confidence in the policies he has advocated? Second, can he convince Americans that his prescription of more government is the way to fix a health-care system that a majority of Americans believe needs repair?

Obama has been reluctant to scale back his health-care ambitions. At different points through the past year, when urged by one adviser or another to consider a more incremental approach, he has balked. That remains his posture, until Democratic congressional leaders show they cannot muster the votes for the kind of comprehensive changes he has sought.

But he can no longer play the role of passive observer of the legislative process, which seemed to be his stance during months of congressional dithering and false starts. If Democrats hope to succeed, Obama must drive the decision-making in a way he has appeared reluctant to do until this past week. If Congress passes legislation, Obama then must lead the effort to explain and sell the plan to the American people.

The health-care debate, at times, has seemed petty and small. But the endgame shapes up both as a major test of leadership for the president and his party and then a big national debate about the consequences of the outcome. If bipartisan compromise is out of the question right now, then a midterm election fought over big ideas and genuine philosophical differences seems entirely appropriate.

© 2010 The Washington Post Company