Sixteen years ago this month, a youthful Democratic president with a job-approval rating hovering around 50 percent stood before Congress to make an impassioned plea for health care reform. As Bill Clinton mounted the rostrum and looked out over the House chamber, he discovered to his horror that a seven-month-old speech on the economy was whirling through the teleprompter instead of the health care text. For the next seven minutes, until the correct floppy disk was inserted into the teleprompter, Clinton confidently vamped before Congress and the nation as if all were going rhetorically exactly as planned.
When Barack Obama goes before Congress Wednesday night at 8:00 Eastern to make his own prime-time appeal for reform, he already knows that nothing – absolutely nothing – in the quest for landmark health care legislation goes exactly as planned. Gone are the gravity-defying popularity ratings that accompanied Obama's inauguration. All but vanished are White House dreams of Republican cooperation, with Maine GOP moderate Sen. Olympia Snowe virtually Obama's last across-the-aisle negotiating partner. And despite hefty Democratic majorities in both the House and the Senate, centrists in Obama's party have balked at the president's proposal to create a public health care plan to compete with private insurers.
Part of the challenge that accompanies health care reform is the Rube Goldberg complexity of all proposed legislation. The result is myths like Medicare death panels (a canard recently popularized by Sarah Palin) and exaggerated fears of government bureaucrats slashing benefits (a major theme of the Harry and Louise TV ads
that upended Clinton) that complicate presidential salesmanship. As Obama put it in his Labor Day speech to the AFL-CIO, "Because we're so close to real reform, the special interests are doing what they always do – trying to scare the American people and preserve the status quo."
Obama partly owes his election to the Great Financial Collapse of 2008, but the economic meltdown also requires the president to make a persuasive why-now case for a dramatic expansion of the medical safety net. As a result, Obama has been constantly singing a downbeat chorus about the burden of rapidly escalating health care costs. "If we do not control these costs, we will not be able to control our deficit," Obama said in his introductory remarks at his late July prime-time news conference. "If we do not reform health care, your premiums and out-of-pocket costs will continue to skyrocket."
In this economically strapped period, Obama has been forced by circumstance to pledge that health care reform will not increase the Red Sea of the deficit. In contrast, when George W. Bush and Congress created the Medicare prescription drug benefit in 2003, they blithely assumed that never-ending American prosperity would pay for it somehow. But Obama is also hamstrung by his campaign pledge to never increase taxes on anyone earning less than $250,000 a year. Where Clinton in his 1993 speech to Congress candidly admitted that "some will be asked to pay more" for health insurance, Obama is promising to expand coverage and reduce costs without adding to the deficit or burdening middle-class Americans in any way.
Although Obama's quest may prove quixotic, the president is, in many ways, in a stronger political position than Clinton was in 1993. Obama came into the White House with a true electoral mandate while Clinton was a 43-percent minority president elected with the aid of Ross Perot's third-party candidacy. In the early 1990s, House Democrats boasted the independence and arrogance that comes with having been in the majority for four decades. This time around – having endured the Gingrich Revolution and GOP control of the Senate – congressional Democrats seem far more schooled in the art of the possible.
There are commentators on the left who believe that Obama should try to ram health care reform through Congress in a naked display of political power that would put Lyndon Johnson (or Tom DeLay) to shame. While Republicans have become elephantine in their stubbornness and recalcitrant in their resistance, Obama almost certainly can only achieve permanent reform by playing to the center.
The rationale for moderation is embedded in the details
of the health care bills being considered in Congress. Even if Congress followed Obama's latest timetable and passed legislation by the end of the year, many key provisions would not take effect until after the next presidential election. For example, the latest draft
circulating around the Senate Finance Committee mandates that insurance companies – beginning in 2013 – cannot refuse coverage based on pre-existing conditions. What this time lag means in practice is that health care legislation could be radically revamped by a future Congress (or a future president) before it takes effect.
That is why Obama's true audience is not really the members of Congress who, depending on their party affiliation, will either applaud wildly or sit stonily through the presidential address. Instead, the president will presumably be talking to the voters who make up the Muddled Middle -- the 24 percent of the electorate in a recent Gallup Poll
, who have no opinion on whether Congress should pass health care reform.
There is an idealistic case to be made that health care is a basic human right – and there is something antediluvian about 47 million citizens lacking any form of insurance coverage in 21st century America. Obama must also reassure voters whose approach to reform is a naked what-is-in-it-for-me calculus.
It is a daunting rhetorical challenger even for the Orator President. But after a State of the Union-style address to Congress in February and four prime-time press conferences, Wednesday night's address represents Barack Obama's last, best hope to succeed where Bill Clinton failed in creating a national majority for health care reform.
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