A Presidency Restored to Health

The success or failure of President Barack Obama's sweeping overhaul of the American health-care system will be clear soon enough. The measure will be revised and amended in successive Congresses. If, over the next decade, it curbs costs and improves outcomes, health care will supersede any other possible legislative accomplishment as Obama's great legacy.

Not that you'll hear Obama insiders talking much about that. They've been careful to keep the historical dimensions of this victory quiet, fearing any recognition would make the President look pretentious. "To the extent he considers history, it's only as a reaffirmation of our capacity to govern ourselves in a real way," says top Obama adviser David Axelrod.

Still, the victory is historic, one that eluded Presidents from Harry Truman through Richard Nixon and Bill Clinton. At several critical junctures it appeared likely to elude Obama, too. Yet even when close associates wavered, his resolve did not. "A lot of Presidents would have concluded it's too risky; maybe get safely reelected and take up health care in year five," says historian Michael Beschloss. "Obama said the rewards were so high, it was worth gambling his Presidency."

Scarlet Letter?

Republicans, from House leaders through Senator John McCain, insist the way Democrats pushed the legislation through without a single GOP vote will poison the environment and doom anything else this year, except Republicans' own electoral chances. "Every Democrat who sided with party leaders and liberal special interest groups at the expense of their constituents is going to wear their vote like a scarlet letter," said House Minority Leader John Boehner.

Democrats, who control the House 253-178 and the Senate 59-41, will lose seats this autumn, and possibly even control of one chamber; that's the rhythm of American midterm elections, especially with majorities of this size. It's unlikely health care will be the primary factor in this outcome. Republicans are overplaying their hand by painting reform as a socialistic grab that turns 17% of the economy over to big government. In reality, a government-run scheme—the now infamous public option—like those that exist in many other Western countries was rejected. The closest precedents for Obamacare are the 1974 Richard Nixon health-care initiative, the proposal that Republican Senate Majority Leader Bob Dole floated in 1994, and the Mitt Romney-enacted Massachusetts health-care plan of 2006.

To date, public support for the President's plan has been thin. You can blame the weakness of the Obama message machine or the shrewd actors in the Tea Party for that. Now that the bill is law, that support may grow. There are numerous provisions likely to be popular that take effect this year: a prohibition on insurance companies dropping people from coverage when they get sick or refusing coverage to children with preexisting conditions; a tax credit of up to 35% of premiums for small businesses to make employee coverage more affordable; and more generous prescription drug benefits for Medicare recipients.

Eclipsed by the Economy

Although most Republicans, including the major Presidential hopefuls, are signing pledges to repeal Obamacare, it will be revealing whether this issue is emphasized by Republicans in a few months. Already privately some are saying they should get off it. Republican strategist Ken Khachigian, a former Ronald Reagan aide and now adviser to Carly Fiorina's California Senate quest, suspects that the health-care issue "will fade" as the November election becomes dominated by the economy.

Democratic strategist Paul Begala agrees with Khachigian and has little doubt his party will suffer November losses. Nevertheless, he's convinced the health-care bill will "mitigate" the numbers, because, he argues, the benefits of the measure will become more apparent and misinformation—the creation of "death panels"—will be rectified. The real disaster would have been if Obama hadn't passed health care: "Failure … would have depressed the Democratic vote and disgusted Independents, who would have concluded Democrats can't run the government."

George Mason University historian Richard Norton Smith adds that if the measure had been defeated, history would have seen Obama as enormously gifted and well-intentioned but ultimately labeled his a "failed Presidency." Instead, he says: "It's a rejuvenated, energized, and in many ways vindicated Presidency."

    Before it's here, it's on the Bloomberg Terminal.