By Fred Hiatt
Monday, March 1, 2010; A21
President Obama's true nature -- radical or pragmatist, partisan or conciliator -- is a subject of endless debate. No doubt it will be still a century from now.
But for a moment in the health-care summit last week, he offered as clear a view as we are likely to get -- not only of his reasons for sticking with health-care reform but also why he wanted to be president, maybe even why he became a politician. It came in his response to Sen. John Barrasso (R-Wyo.), a physician who had argued (to oversimplify) that the United States already offers the world's best care and that people should have to save and pay for it rather than depend entirely on the government.
"Would you feel the same way if you were making $40,000?" Obama asked. "Because that's the reality for a lot of folks . . . because the truth of the matter, John, is they're not premiers of anyplace, they're not sultans from wherever. They don't fly into [the] Mayo [Clinic] and suddenly decide they're going to spend a couple million dollars on the absolute, best health care. They're folks who are left out.
"And this notion somehow that for them the system was working and that if they just ate a little better and were better health-care consumers they could manage is just not the case," Obama continued. "The vast majority of these 27 million [uninsured] people or 30 million people that we're talking about, they work every day. Some of them work two jobs. But if they're working for a small business, they can't get health care. If they are self-employed, they can't get health care.
"And you know what? It is a scary proposition for them."
That moment of passionate empathy, midway through seven hours of often-dry debate, struck me as a genuine reflection of Obama's primary motivation in this fight.
It also provided a clue to why his effort has bogged down in a flawed and endangered legislative process.
Universal access is such an article of faith in the Democratic Party that during the primary campaign it wasn't a matter of debate. The argument among Democrats was not whether to do it or how to pay for it, but whether everyone should be forced to sign up. (Hillary Clinton said yes; Obama said no but now believes yes.)
As president, however, Obama had to grapple with the reality that extending government-subsidized insurance to the working poor is not all that popular in a country where most people have insurance, from the government or from their employer. That's why through last year we saw an ever-rotating carousel of alternative rationales: Health reform would put the battered economy on a more solid foundation. It would help get the nation on a sustainable fiscal path. It would tame the hated insurance companies with their supposedly fat profits, or lower costs for families and businesses.
Depending on how reform is designed, any of these purposes could be met to greater or lesser degrees. But Obama faced an even more fundamental obstacle. Even less popular among taxpayers than paying for universal insurance are many of the steps needed to control costs. So from the start, his legislation fudged.
Or, to be more accurate, from before the start: The original sins came during the general election campaign, when Obama promised not to raise taxes on anyone but the wealthy and then, placing himself in an even more constricted box, laced into his Republican opponent, Sen. John McCain, for advocating the single most effective reform both for controlling costs and raising revenue: taxing employer-provided benefits.
The result? In helping to shape and reshape the bill, Obama has stayed true to the goal of improving access. But his new entitlement is "paid for" by wishing away costs and wishing into the future taxes and unpopular reforms that he can't bring himself to embrace now. And a public that is confused about reform's purpose is also -- as the Republicans never tired of pointing out on Thursday -- increasingly less enthusiastic.
Could Obama have done better by leveling with Americans about the cost of helping "the folks who are left out"? Probably not, I suppose. But it might have been a strategy more in tune with the true Obama.