Will Obama be the last president to tackle healthcare reform?

“I may not be the first president to tackle health care reform,” Barack Obama told Congress on Wednesday, “but I intend to be the last.” Pretty powerful words if you intend to bank your domestic record on one issue. Obama needed to send a message to counter concerns over his ability to lead on this issue. He needed to show determination, clarity and focus. His audience was beyond the walls of Congress. It was independents who have so far declined to support him and have put the reform project in doubt. He also had to convince his own party that it must be united and willing to compromise if it is to produce a much-needed reform bill.

While he made some laudable overtures to the Republicans, their support remains unlikely and will have little impact in the end. Given their performance over recent weeks, there was no better way to show bipartisan spirit than by including some GOP ideas in a primetime national address. To have a Republican congressman hector the president, yelling “you lie,” only made it a sweeter night for Rahm Emmanuel and David Axelrod.

The speech was forceful, well-delivered, and had the right tone of emotion. It was classic Obama—sufficiently pedagogical on the details, but long on the values and the principles underlying his reform proposal. His reference near the end to Teddy Kennedy hit an appropriate emotional note with the Kennedy family members present in the audience. This blog has asserted that this speech was as important to Obama’s presidency as the speech on race was to his campaign for the Democratic nomination. A failure to achieve significant reform will compromise Obama’s promise of transformational change. This is what happened when Bill Clinton failed in his bid back in 1993. Obama has made it clear that he is ready to stake his presidency on getting a meaningful package through Congress.

The Democrats were told to find common ground with the GOP and Obama has shown the way by endorsing a John McCain campaign idea about emergency catastrophic care and by offering the possibility for some malpractice or tort reform, a GOP favourite. It will not appease the Republican party, but it represented some movement. At the same time, Obama stuck to his guns on the public option, proposing to make one available from a pool of insurers within an insurance exchange mechanism. It was short of the expectations of the left, but it kept the idea alive. This was no time for Obama to back off on a proposal that was repudiated from the outset by the Republicans on ideological grounds, but otherwise supported by a majority of Americans. Obama appeared to be subtly conceding that his policies were not the real problem with voters. It has been his handling of the issue that is causing a part of the unease. He also showed a willingness to do battle and counter the swiftboating tactics of the Sarah Palin types. This was long overdue.

Obama will now shift his focus to applying realpolitik principles to the issue and start putting pressure on his party within the halls of Congress. It is time for a modern version of LBJ-style persuasion that produced landmark legislation in the 60’s—a dose of charm mixed with a big heap of tough love. The bully pulpit is still a powerful instrument in a communications world. Early polls may be encouraging, but it is premature to predict the outcome of this debate. My take is that the big loser last night was the status quo. Change is back on the agenda and there will be some significant reform this fall. It will have to be if Obama is indeed the last president to tackle health care reform.

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