The Politics of Health Care

President Obama outlined the process for health insurance reform at a Democratic National Committee function on Thursday, and it's pretty interesting, pretty shrewd. It also illuminates for me what conclusions he's drawn from the debacle in MA.

Immediately after the unthinkable (and unthinkably embarrassing) loss of the 60th Senate seat in a solidly Democratic state--the seat held by John and Edward Kennedy for a half century--Obama announced that he wasn't going to try to rush the healthcare bill out of conference and through the House and Senate before the Dems lost their filibuster-proof 60 (which coincidentally happened officially on Thursday.) This upset some people, because it seemed a kind of surrender. He also seemed to step back from the process, letting congressional leaders hash out how to accomplish the final bill, and some feared he was abandoning health care completely.

But in his State of the Union and in every forum since, he's made clear that he's still committed to healthcare reform. But why he backed off a bit became
clearer today. Apart from the complacency that allowed the Senate seat to slip away (and Obama addressed that immediately by bringing David Plouffe back to ride herd over all the congressional races this year), Obama clearly saw that the GOPers had succeeded in distorting the healthcare package enough so it didn't have the support it should. And the lack of public support was showing up in declining support among Democrats in Congress.

So his plan is to organize a meeting of legislators--Dems and GOPers--along with the relevant experts, make it public--televise it--and hash out the plans that were passed, and what should go into the final bill. Then put it to a vote. The process, he indicated, should take only a few weeks, and might be the next order of business after the jobs bill he says is his first priority right now.

“What I’d like to do is have a meeting whereby I am sitting with the Republicans, sitting with the Democrats, sitting with health care experts and let’s just go through these bills,” Mr. Obama said. “Their ideas, our ideas. Let’s walk through them in a methodical way, so that the American people can see and compare what makes the most sense. And then I think that we have got to move forward on a vote. We have got to move forward on a vote.”

Part of what Obama clearly wants to do is clear the air of distortions, and focus public attention on what the bill will really do, and what it won't.

Mr. Obama said that Americans were apprehensive about the health care legislation because there was too much misinformation that he would now work to clear up.
“They are certain that they would have to go onto a government plan, which isn’t true,” the president said. “But that’s still a perception a lot of people have. They are still pretty sure that they would have to give up their doctor. They are still pretty sure that if they are happy with their health care plan, that it’s bad for them. They are still positive that this is going to add to the deficit. So there is a lot of information out there that people understandably are concerned about.”

He presented the rest of the process in a matter-of-fact manner: He continued, “That’s why I think it’s very important for us to have a methodical, open process over the next several weeks and then let’s go ahead and make a decision. And it may be that if Congress decides, if Congress decides we’re not going to do it, even after all the facts are laid out, all the options are clear, then the American people can make a judgment as to whether this Congress has done the right thing for them or not. And that’s how democracy works, and there will be elections coming up and they will be able to make a determination and register their concerns one way or another during election time.”

But there was a more aggressive message under the calm. Because clearly he believes this is an argument he can win, and once the actual undistorted plan is clarified for the public, there will be a political price to pay for not passing it.

It's a gamble, but you have to like his chances. GOPers are still reeling from his dismantling of them and their arguments at the Republican House caucus. The other very powerful element in his favor is the fact that both the House and Senate have already passed comprehensive health care bills, 90% of them (the President says) the same. So all the painful months of this process so far may not have been wasted. It still will take some heavy lifting, but the process that Obama outlined is both rational and politically shrewd. GOPers have been crying that nobody is listening to their ideas, and they've criticized Obama for not conducting a more public--and televised--process. After the televised caucus Q&A, they may not be as eager for that--but if it's handled right, they're going to get it.

If it works, the process will be persuasive, polls will reflect increasing public support for reform, and legislators will have to decide which side of history to be on, and what they want to face the voters having done or not done.

At one point, as the president insisted that he would continue to fight for the health care bill, the crowd chanted, “Yes, we can! Yes, we can!”