THE TREATMENT DECEMBER 27, 2009
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Harold Pollack is a professor at the University of Chicago School of Social Service Administration and Special Correspondent for The Treatment.

As we enter health reform’s final lap, critical details remain uncertain. Blue dogs and progressives must both be appeased. Critical financing issues must be resolved. House and Senate bills must be reconciled. Lots could still go wrong, but it seems likely that a 2,000 page behemoth will be thwonked onto the President’s desk. However President Obama manages the endgame to reach that point, he should roll that grand presidential desk onto Air Force One and fly it to Hope, Arkansas where he should sign that final bill.
Some of my fellow early Obama supporters may be appalled at my last sentence. You may remember the Democrats' tough nomination fight. I certainly do. I supported Barack Obama from the beginning because I was done with Bill Clinton after his lapses of personal integrity cost the nation so dearly. I was furious with both Clintons at various points in the 2008 campaign. Politics is a tough business. It could hardly be otherwise.
These disputes provide all the more reason to bring Democrats together for what promises to be a genuine historic achievement. Fifteen years ago, the Clintons took a big gamble that they could send a big package to Congress and get the thing passed. They lost, but their effort was more substantive, skillful, and worthy than is commonly remembered.
The Clintons made serious mistakes, but maybe that effort was needed to reach this point. President Obama and his lieutenants--including a conspicuous number of old Clinton hands--have learned from these mistakes, even as they made new ones of their own. The American public learned something, too. Harry and Louise helped the insurance industry own a conspicuous win. As our health system visibly continued to struggle, that hasn’t worn well.
Liberals have thrown much anger and condescension Hillary Clinton’s way. Such circular firing squad-ing itself made the political wound even worse. As James Morone smartly notes, Democrats walked away from the failure, and thereby allowed Republicans to impose their own storyline, evading accountability for what they had done. It became a story of over-reaching HillaryCare big-government rather than a narrative of special interests and conservatives defeating a worthy effort to improve our health system while covering the uninsured. If the past months have taught us anything, it is the monumental difficulty of passing major reforms. As Senator Ron Wyden phrases things, the Status Quo Caucus is the most powerful in Congress.
If President Obama succeeds where President Clinton failed in beating that caucus, it won’t be because of any difference in general intellect, political skills, or determination between these two gifted men. President Obama attacked the current process with advantages his predecessor didn’t have: a more solid Democratic majority, higher personal popularity, a damaged Republican opposition. President Obama also has President Clinton’s experience to build on.
This is an exhilarating victory, not withstanding many disappointments and unpalatable compromises required along the way. Smart politicians share ownership of their victories, not least because they may need co-owners of later painful defeats. That’s one reason President Obama was wise to make Hillary Clinton Secretary of State. If health reform passes, people will notice which President signs the bill.
Historians remembered that Lyndon Johnson passed Medicare and Medicaid, aided by those huge Senate and House majorities after the 1964 election. Large ego and all, Johnson himself remembered that he was not the only person to make this happen. He signed the bill at the Truman Library in Independence, Missouri to honor Truman’s fight for health care 20 years earlier. Johnson gave Harry and Bess Truman the first two Medicare cards.
Sometimes Democrats fight so much among ourselves that we forget how much we share common values. Health reform is bigger than any one person or administration. By embracing this fact, President Obama can salve an open wound. He can also bring his party together as he begins to make this thing work. He’ll need all the help he can get.
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3 comments
"President Obama attacked the current process with advantages his predecessor didn’t have" while I don't dispute the list, Obama also has had some disadvantages Clinton didn't. Namely the Republican party hell bent on stopping the reform in hopes of replicating the 94 Congressional races. Of course, since they have been so relentlessly upfront about that, that also might have helped Democrats who knew the cost of failure. As to his flying down to Hope, eh, whatever. Ideologically, the Obama wing and the Clinton wing are pretty much the same, how else could Obama have stocked his cabinet so full of them? so I don't really see any upside to reaching out to the same wing. If Obama wants to share the spotlight with Bill and Hillary, it is fine by me, I simply don't see it as any kind of grand gesture. At most it is a nice touch. I would say the same thing if he went to Ted Kennedy's old office and signed it on his desk.
- blackton
December 27, 2009 at 7:08pm
Insuring an additional 30 million people is a great achievement, but I can't celebrate. Cementing the role of for profit insurance with mandates and no public option will be chilling. The main reason we pay 17% of our GDP to health care, while other industrialized countries pay 8 to 10 % on average is that they rely on single, not-for-profit systems. We'd be spending a trillion less a year if that was our percentage, and covering everyone without underinsurance. Might a state experiment with a single payer system by asking for Medicare and other waivers under the Senate health care bill? Yes - in 2017. But for the next seven years, that's not one of the states' rights.
- bsemple
December 28, 2009 at 12:09am
Wasn't one of the provisions that health insurance companies spend upwards of 85% of revenues on care, the way some states mandate auto insurance pricing? Also, that they can't deny anyone coverage for pre-existing conditions, or drop sick people, starting around 2014? I supposed if the 1st has been dropped without the latter then yes, score more for the health insurance industry.
- Juniper
December 28, 2009 at 11:57am