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Obama on Health: Stunning Arrogance or the Edmund Burke Theory of Leadership?

5 years ago
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Why would President Obama and his party press onward to pass a landmark health bill in the face of polls that suggest it's risky to do so? Senate Republican Leader Mitch McConnell calls it "stunning" and says they are projecting arrogance. "Every election in America this fall will be a referendum on this issue," McConnell says.

That's one way to look at it this seemingly endless tussle over health care, health insurance and health costs. Another is to imagine the political consequences for Democrats and Obama if they were to fail after calling health care a major problem and spending a year trying to solve it.

Yet a third prism would be through the words of Edmund Burke, the member of Parliament who in 1774 offered a classic definition of his role. He said he would give great weight to his constituents' wishes, high respect to their opinions and "unremitted attention" to their business, but would not abandon his conscience or independence: "Your representative owes you, not his industry only, but his judgment; and he betrays, instead of serving you, if he sacrifices it to your opinion."

Obama took the Burkian approach on Wednesday in the East Room, joined at the lectern and in the audience by applauding medical personnel in white jackets. "How will this play?" the president said. "What will happen with the polls? I will leave it to others to sift through the politics, because that's not what this is about. That's not why we're here." We are here, he said, "to lead." He dismissed any potential political consequences with a simple "I know it's right." He finished with an ad-lib: "Let's get it done."

There are two tentative deadlines for action within Obama's time frame of a few weeks -- March 18, when he is scheduled to leave for Indonesia and Australia, and another slightly more realistic one on March 29, when a two-week congressional recess begins. "Whether we can meet that or not remains to be seen," said a Democratic aide on Capitol Hill, referring to the latter date.

The House and Senate first need to finalize changes to the Senate bill and have the Congressional Budget Office assess the cost of the revised package. When that work is done, the plan is for the House to pass the Senate bill and the bill containing the fixes. Then the Senate will pass the fixes, if necessary using the majority-vote reconciliation process to avoid a filibuster.

Democrats, who don't want to face unruly town meetings during their recess and would rather talk about jobs than health care, are highly motivated at this point to keep things moving. "Language is being negotiated on the Hill as we speak," a health policy expert with close ties to the White House told me Wednesday. "Everyone realizes the pressure of the clock and is trying to do that expeditiously. Everybody on the Hill wants to move on."

Obama's speech came between last week's seven-hour health summit and the health reform sales trips he plans next week to Philadelphia and St. Louis. They are all belated signals to the public and to Congress that he is deeply committed to seeing this through.

It's far from the first time a president has flouted public opinion, McConnell's shock notwithstanding. Had polls guided policy, we would not have had civil rights laws in the 1960s and we would have been out of Iraq long ago. There were, of course, political costs in both cases. George W. Bush endured rock-bottom approval ratings and his party lost control of Congress and the White House. After Lyndon Johnson signed the 1964 Civil Rights Act, he reportedly said that "we have lost the South for a generation." He underestimated the damage to Democrats; we're now into the third generation of Republican dominance in the South.

Yet these things sometimes work out in the end. At a breakfast this week at Third Way, a moderate Democratic think tank, polling analyst Bill Schneider and other capital pundits came up with three issues that met with a wary, disapproving public, and ended up with wide popular acceptance: Bill Clinton's 1994 crime bill (which banned assault weapons and put 100,000 new cops on the street), Bush's 2003 Medicare prescription drug program (which I've written about here), and Johnson's legislative crusade for civil rights, woven into the fabric of a nation that just elected a black president.

The national polling on health reform is mixed. The country is split at best over the package pending in Congress, and they don't like the process. But majorities say they support a number of its major components. Polls in Massachusetts following Republican Scott Brown's election to the Senate in January were also mixed. Among the results: A majority of people whose top issue was health reform chose the Democrat, who supported it.

There are aspects of the Democrats' health plan that Obama didn't mention and that cause concern for many -- the requirement that most people buy health insurance, for instance, and the phase-out of expensive private Medicare Advantage plans within the traditional Medicare program. There is also the natural resistance to change among those who have decent coverage they can afford, at least for now.

But the hard fact is there will always be many, many more people with jobs, health insurance and reasonably good health than people enduring medical hardships, tragedies and bankruptcies. Someone has to think about the health have-nots, as well as the big picture on costs, prevention, insurance regulation and the impact of our Swiss cheese insurance system on job mobility and entrepreneurship. It's not going to be individual voters worried about themselves, or inexpert poll respondents caught on the fly. It's got to be our national politicians, led by the president.
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