The politics of healthcare in America

Obama might be down, but don't count him out just yet

The politics of healthcare in AmericaPresident Obama will be conducting another prime-time television news conference to address healthcare reform. His strategy of letting Congress initiate policy in this sector has encountered some serious snags. As a result, some Democrats, the so-called Blue Dog Democrats, are opposed to the project. We can also expect the Republicans to stay the course and oppose any attempts at reform, though a few moderates might endorse a proposal that includes some GOP initiatives. But it is the Democrats’ support that is crucial to the success of Obama’s healthcare plan. If Obama cannot keep the Democrats onside, then he too will go the way of President Bill Clinton and lose the centerpiece of his potential presidential legacy.

In an earlier blog, I referred to these Blue Dogs as Storm Cloud Democrats because they have been known to ditch the party line when storm clouds start to form and mid-terms are on the horizon. Many of these Democrats are elected in red districts (Conservative Republican areas), which explains their vulnerability around mid-term elections. In Congress, they have been known to join Republican initiatives and block policies from a president of their own party (JFK in the 1960s, Clinton in 1990s). For instance, they were the Democrats that failed to support Hillary Clinton’s healthcare proposals back in the early days of the Clinton presidency.

The Obama White House has done all it can to avoid falling into the Clinton trap. Letting Congress take the lead was part of that strategy. The problem now is that the momentum behind the reforms is beginning to stall as the GOP has joined forces with the Blue Dogs to raise the spectre of out-of-control costs and a government takeover of healthcare, prompting fears the project will result in higher taxes. That Obama has chosen a mid-week July evening to conduct a national press conference is indicative of how much the White House is worried the project is going off the rails.

If the election campaign is any indication, it seems the president performs best when there are others on the playing field. When adversaries push, he pushes back—and push, they have! Ads attacking the healthcare reforms are airing daily, and while some of them are raising legitimate questions, others are dealing in misinformation. The commercial blasting the Canadian healthcare system is especially revealing, in that it shows how conservatives will stop at nothing to prevent any government presence in the reform package. Those who voted for Obama and strongly backed his commitment on healthcare are about to hit a critical point. After all, the goal behind this reform is to cover the 47 million American who are uninsured, and the proposals currently circulating on Capitol Hill may not succeed in doing that. The latest report by the Congressional Budget Office has only fed the panic over costs and coverage.

Congress must continue to play a role in the debate, but presidential leadership involves more than respecting other branches of government. It means pointing the way forward, forcing the compromises, and pushing for results. Unlike much of his initiatives on the economy and on national security, the president seems to have lost the advantage on healthcare. His recent poll numbers show the honeymoon is indeed over and while his personal popularity ratings are still strong, his policies on healthcare no longer have the favor of a majority of the voters.

Obama found himself in a similar situation after his primary losses in Pennsylvania and Ohio, and when dealing with the Pastor Wright controversy. Back then, he appeared to be off his game. Now, it is obvious Obama is reaching back into the playbook for yet another rebound strategy. Expect Obama to shift from the defensive “let Congress do its work” line to one inspired by President Lyndon Johnson and start to show presidential leadership as the latter did in delivering medicare and civil rights legislation in the 1960s.

Restoring America’s image abroad, rediscovering economic stability and growth, dealing with climate change with an eye on global efforts, and reforming healthcare to cover all Americans is what will make this presidency a truly transformative one. So far, healthcare reform is the one priority that has tested the president’s legislative abilities and leadership the most. Success in the healthcare arena would go a long way in setting the tone for his presidency and establishing a template for future legislative initiatives—just like the New Deal did for FDR. Declaring a deadline is a good first step, but his goals must be clearly understood and pursued: lower costs, universal coverage and quality care. A public healthcare option must also be considered or else an important competitive component would be missing. Obama has the numbers. In the days to come, we will see if he has the will.