Leadership moments in the U.S. healthcare debate

Barack Obama is returning from the ‘Three Amigos’ summit in Mexico to conduct the first of a series of town hall meetings (starting in New Hampshire today) aimed at building support for his plans to reform healthcare. With the polls showing a decided decrease in support for the president’s efforts on this issue, any outreach effort becomes crucial and will probably determine the degree of reform. Despite the boisterous and somewhat staged opposition in the town hall meetings to date, most observers concede that Obama has the numbers in Congress to pass some kind of reform package. The question now is whether it will amount to a transformational change or whether it will it be the result of a transactional or brokered agreement hammered out among legislators which addresses only some of the issues at stake.

We know the context. Obama considers this his number one domestic priority. We also know that the White House has done its best to avoid the top-down approach of the failed Clinton reform effort of 1993 and they are doing this by asking Congress to develop legislation that meets Obama’s objectives. These include universal access to quality care, lower and controlled costs, portability, and health insurance reform to prevent the denial of coverage based on pre-existing conditions. Up to now, Congress has developed as many as five bills. Different versions of the proposed bills have passed the House committees leading the Obama people to claim that healthcare reform has never been closer. But a deeply contentious issue remains—the public nature of the program, which is becoming a divisive factor among Democrats.

Obama is still clinging to the hope that he will get a bipartisan bill which will come with significant Republican support. This desire is upsetting his most liberal backers, who suspect the Obama White House is watering down the reform initiative in order to get the Blue Dog Democrats on side and may end up with only a semblance of reform. Above all, liberals want a public option. The President still appears to want one, too, but cost concerns, the sluggish economy, and the sustained and highly-negative campaign by opponents of reform are generating sense of unease among his most fervent supporters. The arguments favoring reform remain as cogent as ever—America spends more per capita than any other industrial nation on healthcare, but it lags behind in many leading indicators dealing with a healthy populace. And there is a consensus on the need for reform. Very few prefer the status quo according to the polls.

This blog has argued that to achieve any real success, the president needs to find inspiration in the example of LBJ, who pushed through the landmark Medicare and Medicaid legislation in 1965 by doing the arm twisting and the cajoling necessary to convince those who are hesitant. While the circumstances have changed, this current battle represents a leadership moment for Obama and only the president has the moral authority and the electoral clout to make it happen. We should remind ourselves that Obama’s approval numbers are significantly higher than those of Congress, which may explain why he has taken a more hands-on approach in recent weeks. The results are starting to show. Still, he may now be on offense, but he is far from the finish line. The town halls will be an occasion for Obama to make his case one more time, but by September, the president will need to be more specific on the content of his desired reform and move away from his approach of general objectives.

The Blue Dog Democrats have been criticized by liberals in the party and in the media. With good reason, I might add. Healthcare reform was a major issue in the last campaign and the Democrats promised to address it. And yet, the Blue Dogs are essential if this bill is to be credible with the more centrist parts of the electorate, namely the independents. This is a leadership moment for them, too. A failure to back some significant reform project will carry a cost and we could see a repetition of 1994, when the Democrats lost control of Congress. After that moment, President Clinton, who could have been a transformational president, became a transactional president. For many, the Clinton years are still seen as a period of lost opportunity. This is not what people voted for last November.

As for the Republicans, I still believe the best position for them is to steer a moderate conservative course if they are to expand their base beyond the South, Fox News viewers,  and the Rush Limbaugh/Sarah Palin contingent. Republicans missed an opportunity last week with the Sotomayor nomination and Hispanic voters will have long memories come 2010. Significant healthcare reform represents another opportunity for them to be a factor, as they were in 1965 on Medicare, Medicaid and, yes, civil rights. Indeed, it is a leadership moment for them as well.