By Clive Crook
Published: September 6 2009 19:50
The speech that Barack Obama will give to a joint session of Congress on Wednesday could be the most important of his presidency. Mr Obama is fighting to revive his flagging healthcare initiative. But more is at stake than that.
If the healthcare project fails, it will be a serious blow to the president’s power. Mr Obama’s popularity with independent voters has already fallen. He faces opposition from Republicans and anger among many of his own supporters. Pollsters are talking about a big reverse at next year’s mid-term elections. On Wednesday, the success or failure of this presidency may be on the line.
The speech is a gamble, though not because Mr Obama’s rhetorical powers are in doubt. More than once during last year’s election campaign he used a big address to recover from setbacks and vault forward. But one wonders whether high-minded inspiration – Mr Obama’s speciality – will be adequate this time.
The Republicans’ attacks on the Democrats’ healthcare plans have been shamelessly dishonest, but they are right about one thing: more than a failure of presentation is to blame for the proposals’ poor reception. The salesmanship has indeed been pitiful, but substantive issues also need to be resolved.
If on Wednesday Mr Obama goes for spiritual uplift rather than brass tacks, he may confirm a growing, weary feeling that he is all talk. But if he pushes a blueprint that takes sides on divisive details – notably, whether to include the “public option”, a government-run insurance scheme to compete alongside the existing private plans – he will make many people angry. It is hard to see how he extracts a clear win.
His best bet, nonetheless, is to retreat from the public option. The problem is not that the proposal is necessarily a bad idea – though it could be, depending on the details. The problem is that healthcare is an issue where US voters need reassurance. Partly because of the way it is being advocated, and partly because of the people doing the advocating, the public option is a cause of added uncertainty, and hence anxiety.
Supporters of the public option want it for a confusing variety of reasons. Its loudest advocates, who call for any reform without it to be blocked, see a way to destabilise the wider healthcare system and hasten the country towards a government-run single-payer model. Most Americans hearing this get nervous. Reasonably happy with their present arrangements, that is not where they want to go.
The fury of the left is perplexing. A reform without the public option would still be a huge advance. Regulation to stop insurers denying coverage because of medical history, plus subsidies to help the less well-off buy a policy – features of all the plans on the table – address gross failures in the present system. They would widen coverage and ease the insecurity that even insured Americans feel because of the risk that they might lose their cover.
Mr Obama should emphasise those achievable gains and make a virtue of offending the finger-chomping no-compromise types on the Democratic left. He has fallen out with party activists by vacillating on the public option and adopting Bush-lite policies on detention of terrorist suspects and other civil-liberties issues. But his broader political difficulties arise from his leaning left on so many other policies, such as the composition of the fiscal stimulus, his support for a bungled cap-and-trade plan for carbon abatement, his first budget proposal, his soak-the-rich instincts on taxation. This record is why he is losing independents. He can start winning them back by disappointing the left on the public plan.
Despite the heat that the public-option debate is generating, however, resolving it may not be the key to getting moderates behind his healthcare project and back behind his presidency in general. The most important issue in healthcare reform is how to pay for it. Here, Mr Obama has left himself no easy way out.
He has claimed from the outset that cost-control is the principal goal – a disconcerting posture, since all the plans under discussion push total costs higher. The bills do have ideas worth trying for reforming the healthcare delivery system, but they are timid, experimental, and long-term, and the savings are speculative. The substantial extra outlays to pay for wider coverage, on the other hand, are not speculative.
Mr Obama has foolishly promised not to raise middle-class taxes. And he has wisely promised that healthcare reform will not widen the budget deficit. As a result, he and the Democrats have to pay for almost the whole venture by squeezing funds out of Medicare, the government-run programme for the elderly. The elderly, who hitherto had no great stake in this discussion, are now opposed to reform.
At the start, Mr Obama should have said that guaranteed access to affordable health insurance is something all Americans would benefit from, that it would cost something, and that taxes would have to rise to pay for it. He did not make that case when he had the chance, and now it is too late. One way or another, taxes are going up, but Mr Obama will have to keep denying it.
His best course on Wednesday is to desert the left and fudge the rest. That, and his flair for the big speech, might do the trick. US healthcare reform is both desirable and, despite everything, still achievable. Let us hope Mr Obama is on form.
Copyright The Financial Times Limited 2009
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