Obama's Healthcare Reform on Hold

Back in August 1993, as Congress was preparing to break for summer recess, President Bill Clinton was trying to drum up support for his healthcare plan, even though most of its details were still under wraps. For months his special White House healthcare task force, spearheaded by first lady Hillary Clinton, had been huddling behind closed doors, calling in experts, wading through proposals, promising to have something for the country to examine. Attacks from special interest groups were growing. Speculation about the proposal's contents trickled through the nightly news. Congressional committees were waiting to see legislation.

It wasn't until late September that the president appeared before a joint session of Congress and revealed his proposal. It was another year before its fate—failure—was decided.

Last week, the Senate left for August recess, and President Obama, like Clinton 16 years ago, is throwing himself behind healthcare reform. His effort also is in legislative purgatory, although one of a completely different sort. Four of the five committees that must approve a healthcare bill have already signed off. The holdout is the Senate Finance Committee, typically one of the more conservative committees. Though Obama failed to get a congressional vote by August as he promised, he clearly learned from Clinton's failure that quick action is key.

Still, his attempt is not sailing boldly ahead. It's caught up in a political fight, a philosophical fight, and a messaging fight, all swirling around what experts say is arguably the most ambitious effort by the federal government in decades. "This really makes or breaks the Obama presidency," says James Morone, a political science professor at Brown University and coauthor of a new book, The Heart of Power: Health and Politics in the Oval Office. "Every Democratic president—Roosevelt, Truman, Kennedy, Carter, Clinton, every Democrat except Johnson—tried this in one way or the other, and they've all come up short." So far, Democrats have managed to broker compromises to keep their party in agreement. So the question now is perhaps as much, "Will healthcare reform happen?" as it is, "What will it look like if and when it does?"

Part of the answer will come in September, when lawmakers who went home and met with constituents at town halls or coffee klatches to hear gripes or praise come back to Washington and report back to Democratic leaders. Thanks to a hard-fought compromise late last month between liberals and conservative "blue dog" Democrats, the House could hold a vote as soon as it returns and merges the different versions of its bill, assuming the deal holds. It's no wonder that some Republicans are delighted by the intensity of the protests breaking out at town meetings across the country. "The huge thing is the first week back," says Morone. "If the blue dogs start to talk about dumping the public option, if the deal they went home with falls apart in the House, Obama is in big trouble."

To keep healthcare reform moving, the White House has been forced to take a trial-and-error approach to reading the nation's pulse. For decades, Democrats have talked about the plight of the uninsured as a moral imperative. To that President Obama this spring added the issue of cost: Healthcare is really, really expensive, is getting more expensive, and is eventually going to bankrupt the country, he argued. But as the administration has learned, these arguments don't excite Americans. So the White House is adapting. "It was clear that neither of those messages were reaching the middle class," says David Kendall, a health policy expert for the progressive think tank Third Way. "What we have seen in just the last month and a half is a shift toward the question, 'What's in it for me?' " Now, the White House talks about reform less as a scary if sterile economic problem and more in terms of personal "stability," promising Americans that reform will help them keep insurance if they lose a job or develop expensive medical conditions. In other words, it's social security for the body.

Of course, "What's in it for me?" raises another question: "What's actually in the bill?" It's there that the desire to fix healthcare can get snuffed out by the massively technical nature of healthcare itself and by the easy distortions that can accompany it.

So far, the debate centers on two levels: political and technical. Politically, what's gotten the most attention is the dispute over the role of government in health insurance, an ideological fight played out in the battle over a public option. The issue, put simply, is whether the federal government should sell health insurance and compete with private insurance companies, which in theory could make insurance cheaper. This gets a rise out of people, and it also tends to provoke caricature and exaggeration. In fact, as far back as 1948, when President Truman proposed healthcare reform, Republican critics retaliated with cries of "Communist!"