The Happy Talk Is Great. Don't Expect It To Last.

by Jonathan Cohn | March 6, 2009

Thursday's White House summit on health care was all about cooperation and optimism. Republicans promised to work with Democrats. Corporate lobbyists pledged to find common ground with liberal activists. If you support comprehensive reform to make health care affordable for all, it was hard to walk away without feeling enthusiastic--about both President Obama and what he's trying to do.

But at least one forum participant, West Virginia Senator Jay Rockefeller, wasn't feeling so cheery.

Rockefeller is no enemy of reform. On the contrary, his record on health care issues belongs right up there with Henry Waxman's and Ted Kennedy's.

But in the last few months, Rocekefeller has on more than one occasion pierced the prevailing mood of optimism with warnings about what's possible--and what isn't--in this legislative environment. On Thursday, he was at it again:

I want to issue a warning …There’s all this talk of, "It’s all going to work, we’ve finally reached it, with the president behind it, people want it." And I go back to the Clinton bill. Every single poll they took showed 72 percent of Americans said they’d be willing to pay two dollars more for universal healthcare. They didn’t mean it. They didn’t mean it. They didn’t want to do it. … There are a lot of people who have an interest, and let this be said bluntly, in keeping costs high, in making sure that medical companies make money. That leads me directly to the rudest thing I am going to say, which is the power of lobbyists.

Rockefeller is making two separate points here--one is about the fickle nature of public opinion on health care, particularly when the public is still pretty uninformed about the debate; the other is about the power of lobbyists to block reform, so that they can hold onto their profits. On both countrs, unfortunately, Rockefeller is making sense--and I say that as a well-known optimist myself.

Go back to the clips from 1993 and, sure enough, you'll read about conservative lobbyists and Republicans promising to cooperate with then-president Bill Clinton in his effort to revamp the health care system. But the support they pledged never materialized. Insurers, business lobbies, the medical profession--they either fought Clinton directly or sat out the debate out altogether.

And the Republicans? After some initial bursts of enthusiasm for Clintoncare, they quickly turned against it and any viable alternatives, adopting the strategy--first suggested by strategist Bill Kristol--of opposing any Democratic reform "sight unseen."

The public mood changed, too. Until the very end, polls showed that voters supported most elements of the Clinton reform agenda. But they didn't like the package as a whole. While to some extent that reflected confusion over what Clinton was actually proposing, it also reflected the fact that public enthusiasm for reform was never as strong--or deeply held--as the original polling numbers suggested. 

None of which is to say that history must repeat itself. The situation on the ground is demonstrably worse than it was during the Clinton health care fight. More people lack health insurance, the cost of care is straining business and government, and there's no realistic option in the private sector for arresting these trends. (Back in the 1990s, businesses felt they could control costs on their own--without government--simply by adopting managed care.) 

The political moment is a lot different, too. Obama won a larger mandate in 2008 for change than Clinton did in 1992, plus he has a more liberal Congress as his governing partner. The economic crisis, meanwhile, has fostered an environment where sweeping legislative change seems possible.

But that's still not enough to win the reform battle. At the end of the day, at least some of the people who were in the room on Thursday, saying all of those nice things, are going to decide they have more to lose from health care reform than they have to gain.

Maybe it will be the drug lobby. Maybe it will be the insurers. Maybe it will be small business. Maybe it will be all of them. But whatever the array of reform's adversaries, they will have a good shot at winning--unless they are confronted with a public that not just accepts comprehensive health care reform but insists upon it.

Obama can help that process along, by using his position to educate voters and unleashing the grassroots machine he built during the campaign. But he can't do it alone. He'll need the help of groups like the Service Empoyees International Union, Health Care for America Now, Moveon.org, and other liberal groups that can organize supporters and rally them upon command.

Rockefeller's statement was a warning to Obama, but it was a warning to these groups as well. Don't be fooled by the pleasantries on Thursday. There's going to be a big fight. And liberals will lose it if they don't prepare now.

Note: For more on what Obama actually said--and what it means--see my previous dispatch

--Jonathan Cohn 

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