Time for Obama to Step In?

From the outset, President Barack Obama’s strategy on health-care reform has been to study everything the Clinton Administration did in 1993 and ’94–and do the opposite. Where Bill and Hillary Clinton delivered a byzantine bill of more than 1,300 pages to Capitol Hill, only to see it shredded once it got there, Obama has kept his distance from the fine print. He set forth a few ambitious goals: expanding coverage, reining in health-care spending, improving medical quality. And then he left it to Congress to develop a plan that could win the votes necessary to pass.

Until quite recently, that flexible approach appeared to be working pretty well. Congressional chairmen usually prefer having control to being told what to do by the White House. And interest groups and political adversaries that had been on opposite sides of past health-care battles were at the negotiating table, in no small part because Obama had convinced them that reform was really going to happen this time. As a result, the legislative process is already further along than it ever got under Clinton.

But new fault lines are opening up everywhere you look. Liberals are worried that Obama is going squishy on including a strong, government-run “public option” among the health-care choices available to Americans. Conservatives are warning that the legislation won’t do enough to control health costs. Rural lawmakers are complaining that proposed Medicare cuts will fall too hard on their states. The two sides of the abortion debate are tussling over whether the procedure should be covered under the plan. And those are just the arguments going on among Democrats.

It’s all a sign that the season for hard decisions has arrived. Obama continues to project an air of confidence about the most audacious undertaking of his presidency. “For those naysayers and cynics who think that this is not going to happen,” he said on July 13, “don’t bet against us.” The next hurdle is to get a bill through the House and Senate by the time Congress adjourns for its August break. White House officials concede that missing that deadline could throw the entire exercise off track, because it would give opponents a month to undermine it. Says one: “If we don’t get it done before the August recess, it will be subject to a lot of attack” when lawmakers are home among their constituents.

If the President wants to accelerate the process, he may have to abandon his original hands-off strategy and start getting more deeply involved. Growing numbers of Democrats are arguing behind closed doors that Obama could ease their qualms if he were clearer about where his red lines are for health-care reform. While the President insists, for instance, that he wants to see a public plan in the legislation, he has refused to spell out in detail what it should look like. Meanwhile, White House chief of staff Rahm Emanuel has been talking up the possibility of setting up a public plan only as a fallback if the private-insurance industry fails to create a robust and competitive market for health coverage. “The goal is to have a means and a mechanism to keep the private insurers honest,” Emanuel told the Wall Street Journal. “The goal is nonnegotiable; the path is” negotiable.

On the Senate side of the Capitol, this comment sounds like a bow to political reality. Whereas the Health Committee has passed a bill with a strong public plan, the Finance Committee is looking at a number of weaker versions, including one that would operate as a cooperative. But over in the House–where three key committee chairmen unveiled a health measure that has a public plan and puts new taxes on the wealthy–Emanuel’s words stirred up painful memories from the early Clinton years. In 1993, House Democrats backed the President on an unpopular energy tax–based on the heat content of fuels, measured in British thermal units (BTUs)–then watched in shock as Clinton retreated from them when the Senate balked. That vote was one of the major factors behind the massive defeat House Democrats suffered in 1994, and some Representatives are wondering whether they might “get BTU’d” again if they stick their necks out for an ambitious health-care-reform bill that gets watered down in the Senate. “We all like Rahm,” a Democratic House member told me. “But we also remember where he was in 1993.” Back then, Emanuel was a top Clinton White House strategist.

Administration officials predict that Obama will not weigh in on many of the more contentious issues until a health-care bill passes both houses and reaches a conference committee this fall, much as he has done with other big bills. There are areas where Obama will be needed to help cut a final deal: determining which taxes will be raised and which programs will be cut to pay for the legislation; defining the shape and size of a public plan; deciding what businesses and individuals will be required to do. Between now and then, White House officials say, don’t be surprised to see rough spots and bumps along the road. “Everybody wants to rush the process and jump to conclusions,” sighs an aide. “The process will play itself out.” The question is, Will there be health-care reform at the end of it?