Saturday, 18 July 2015
02 December 2021
How Obama’s epic victory in pushing forward health reform revitalized his presidency

«Promise delivered»

2010 April 14

On the day before the historic health care reform vote, Barack Obama made his final argument in favor of the bill to the Democratic members of Congress. “I am not bound to win,” he began, quoting Abraham Lincoln, “but I am bound to be true.” The next 45 minutes provided a rare, true, almost private glimpse of American politics. Some said they had never seen the President so passionate — although Obama’s version of passion is much calmer than most. He did many of the things expected in a pep talk. He made the substantive case for the bill. He jabbed the hyperbolic Republicans. But then, in the final 10 minutes, his tone became more intimate.

Obama spoke to the Representatives about why he and they had become politicians, and why they had become Democrats. He talked about all the town meetings and compromises, the long hours, the lumps and brickbats, the time spent away from their families. “And maybe there have been times where you asked yourself, Why did I ever get involved in politics in the first place? … But you know what? Every once in a while, you have a chance to vindicate all those best hopes you had about yourself … And this is one of those moments. This is one of those times where you can honestly say to yourself, Doggone it, this is exactly why I came here.”

It was a perfect balm, after a season of unrelenting scorn and derision. The caucus was frightened and exhausted. The President emphasized a common humanity with his peers, normally an afterthought in the performance art of politics. He appealed to the battered sense of honor and idealism that still resided beneath their scar tissue. He was seeking not only to inspire his colleagues, but to comfort them. I don’t think I’ve ever seen a President do that before.

The votes were undoubtedly there by the time the President spoke, but the speech solidified him in his party’s esteem — just as the vote would anchor him in history. Obama became a very different President in the process. After a first year in office that promised consequence but never quite delivered on it, he had done something huge. The comparisons with Jimmy Carter would abruptly come to an end. He was now a President who didn’t back down, who could herd cats, who was not merely intellectual and idealistic but tough enough to force his way.

This is bound to change the landscape of American politics. It makes significant progress on other issues — financial reform, immigration, perhaps even the reduced use of carbon fuels — more plausible. It may give Obama new stature overseas, in a world that was beginning to wonder about his ability to use power. Of course, if he doesn’t carefully read the lessons of this excruciating passage, it could lead to hubris and overreach. The President’s weaknesses — his isolation, his tendency to mediate rather than lead — are less evident in victory, but it remains to be seen if this experience has mitigated them.

“I know this is a tough vote,” Obama told the House Democrats, and, for many of them, it was — politically. But in another way, it wasn’t: it was ground zero of what being a Democrat has meant for the past 80 years. It rectified an astonishing injustice in American life: most of the nonworking poor are guaranteed health care, through Medicaid, but the working poor are not, unless they’re lucky enough to have an employer who provides it. Another injustice: insurance companies determine who receives coverage and can deny it at will. For Democrats, this represented a gaping hole in the social safety net. Arguments about the details were inevitable, but a yes vote was embedded deep in the party’s DNA.
For Republicans, the issue was more complicated. There was the essential conservative allergy to new government programs. But the existing health care system was an unholy mess, inefficient and costly — especially the segments run by the government, Medicare and Medicaid. It placed an unfair burden on employers, who were assumed to be health-insurance providers of the first resort, and an unfair legal burden on doctors. Substantial numbers of Republicans had always favored reform, even archconservatives: 20 years ago, the Heritage Foundation’s Stuart Butler came up with a plan to provide universal coverage, paying for it by replacing the tax-exempt status of employer-provided health benefits with a system of progressive tax credits.

In 1993 the Republicans, led by Senators John Chafee and Bob Dole, who never forgot that his life was saved by government health care, offered an alternative that many, including me, thought was better than the Clinton Administration’s proposal. It became the basis for the universal health plan passed in Massachusetts by Governor Mitt Romney. Massachusetts, in turn, became the basis for the federal plans offered in the 2008 campaign by Hillary Clinton and later adopted by President Obama. The plan passed by Congress and signed by the President on March 23 was, then, a mongrel; its roots were in the Republican plan of 1993 and in Massachusetts.

But not a single Republican voted for it. Indeed, the Republicans put on a scalding, cynical performance all year, mischaracterizing the bill as “socialism” and a “government takeover” of health care, inventing nonexistent provisions like “death panels” to scare the public. Now that it has passed, Republicans will have to deal with the reality that the bill did not represent “Armageddon,” as their overwrought House leader, John Boehner, claimed — that, in fact, it won’t have much short-term impact at all and that in the long term, the impact is more likely to be benign than tragic.

The Republican stonewall had its roots in a memo that William Kristol wrote in 1993, urging Republicans not to cooperate in any way with Bill Clinton on health care because, among other things, the plan represented “a serious political threat to the Republican Party.” In other words, it would make Clinton and the Democrats more popular. Kristol’s strategy succeeded in 1994, when Republicans won control of the House and Senate — but it failed in 2010, although Republicans, misled by momentary anti-reform polls that mostly reflect public confusion, seem intent on pushing “repeal.” It remains likely that Democrats will lose seats this year, but those losses may not be as extensive now. A good measuring stick would be the 26 House seats lost in 1982, when Ronald Reagan faced a 10.8% unemployment rate.

The profound question for Republicans is whether they continue on the path of intransigence or decide to participate in the government. Intransigence has its pleasures. In the hermetically sealed tornado of right-wing bloviation, the wildest claims have come to seem the most marketable. This was a problem on the left for a long time. When Congressman Randy Neugebauer of Texas screamed “Baby killer!” on the House floor, the epithet resonated — the protesters who screamed those same words at U.S. troops in the 1960s sent the American pendulum swinging back toward conservatism and crippled the Democratic Party for several generations. The Tea Party nativism, paranoia and anti-intellectualism embraced by the Republicans have rarely been a winning hand in American politics.

“It is abnormal for any industry to throw back upon the community the human wreckage due to its wear and tear, and the hazards of sickness … should be provided for through insurance,” said Theodore Roosevelt in 1912, at the dawn of the progressive era. The work of building a social safety net for the industrial age proceeded, in fits and starts, for the next 50 years. The excesses of that effort brought the Reaganite swing in the opposite direction, during which time the protections frayed and the need for a new, more flexible information-age safety net became apparent.

Obama’s health care reform will undoubtedly prove inadequate to the demands of a globalized, warp-speed economy and an aging population. It will have to be modified, and modified again — and one hopes the Republicans, with their natural instinct for efficiency, will participate in that process. But, however flawed, the health care bill is a sign that major, concerted public reforms are once again possible, and that the difficult work of transforming America to compete successfully in a new world of challenges can now begin.


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