Obama and Health Care: Time to Hit 'Reset'

In his speech, the President must be clear about his reform priorities and why they're vital even to those who have insurance

Can he do it?

That's the only question anyone has been focused on all week in Washington, as Senators and Representatives, thousands of staffers, and the hordes of lobbyists looking ahead to the fall agenda have piled back into town to await the next, and near-final, round of the health-care debate.

With his much anticipated prime-time speech on Sept. 9 before both houses of Congress—a speech that has attracted more kibitzing, opinions, and advice, both heartily sought and entirely unsolicited, than any Presidential address in recent memory—the issue is whether Barack Obama can restart the health-care debate and turn momentum back in his favor.

It certainly won't be easy. Despite months of trying, Obama has yet to present a clear, coherent vision of what he wants out of health-care reform and why Americans should be convinced they will be better off going along with his plans. In part, that's because they—not to mention the congressional leaders trying to draft the various bills—still don't know exactly what he will support, what he won't, and why.

"Everyone knows the potential costs and the risks of a growing bureaucracy," says Stan Collender, a partner at Qorvis Communications, a public affairs consultancy in Washington. "But no one has heard him say 'these are the benefits; this is what I'm trying to get done for you.' That's what has to happen tonight."

Simple Terms Necessary

So the President's first, and really only, task tonight will be to lay out a clear vision—in compelling, nonwonky language—why health-care reform should move ahead and how it will help the average American. The public will come away from the speech tonight "knowing exactly where the President stands," says White House Press Secretary Robert Gibbs.

Many in Obama's party have been frustrated by his willingness to leave the debate open for so long at such a high political cost. "He's got to get off of his heels and focus on the benefits, as well as the costs of failing to act," says one key Democratic strategist.

Chris Jennings, a former health-care adviser to President Bill Clinton who recently helped author a bipartisan reform plan backed by former Senators Tom Daschle and Bob Dole, argues that the President will have to do a more effective job of showing how leaving the status quo in place will have a negative impact on average citizens in the form of higher premiums, more co-pays, and the rising cost to pay for treatment of the uninsured. "He needs to talk about the things that working Americans get, and move away from the talk of 'bending the cost curve' or bringing down the deficit," says Jennings.

Jennings also argues that the President has to address the underlying fears people have of losing their coverage—the negative consequences of current policies and how they lock people into jobs because "that's the only place they can get health care. Or how, if you're in your 50s and you try to get health care, good luck. That's the kind of conversation the Administration needs to have more of."

The Public-Option Problem

But another question is who, if anyone, among his potential supporters Obama will be willing to anger. The two wings of the President's party are divided over the so-called "public option" for health care. Progressives in the House say they won't vote for a bill that doesn't include a public option—that is, a government-backed competitor to private insurance—while moderates in the Senate say including it will doom any bill there.

So far, the President has avoided signaling which side he will come down on. Liberal supporters like soon-to-be AFL-CIO President Richard Trumka have made clear they'll be watching Obama's speech to see how strongly the President affirms his support for the public option, while congressional Blue Dogs will look for a tamer proposal that signals his intent to ease their concerns about the program's costs and excess government involvement.

They, like Republicans, will look for signals that he's willing to jettison the public option.

"No one knows yet what approach he will take. Does he signal he will settle for something smaller that will keep Republicans at the table, or does he throw down the gauntlet?" asks Jade West, the head of government affairs for the National Association of Wholesaler-Distributors, which had fought hard against the public option and higher taxes for business to pay for the plan. Either way, she adds, "it's an extremely risky choice for the President."

Gibbs and other advisers have signaled that he's unlikely to abandon the public option tonight. While the President will probably emphasize the parts of reform that most in his party and some Republicans agree on, such as eliminating insurers' ability to deny coverage due to pre-existing conditions or to cancel coverage in the face of an illness, he's expected to continue to argue for the public option. But don't look for him to insist that he won't sign a bill that doesn't include it. Given the likely impossibility of getting legislation with a public option through the Senate, many analysts now believe retaining the option is largely a negotiating ploy. Obama needs to demonstrate to his base that he's fought long and hard for what they want, both to keep them on board and to gain the most leverage for his trade-off when he is ultimately forced to give up the public option, as now looks inevitable.

"He's trying to hold on to the coalitions he needs among the Democrats," says Thomas Mann, a congressional scholar at the Brookings Institution. "There's something to be said for holding out; it may be the best way of obtaining a solution if he's forced to compromise later, as he almost certainly will be."

Yet for all its difficulties, Obama's task Wednesday night will be much easier than the one that follows: turning whatever momentum he might gain tonight into a concrete legislative victory by yearend. After more than five years of watching Obama on the national stage, particularly during the many ups and downs of the campaign, we know the man can give a speech that resets the entire terms of debate. But so far there's less evidence that Obama the master campaigner can turn into Obama the master—or even moderately competent—legislator.

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