E. J. Dionne: Iron will needed on health care
Every general studies the mistakes of the last war, and President Obama’s style has been much influenced by the difficulties of Bill Clinton’s presidency.
In particular, Obama has shied away from handing Congress his own plans on “stone tablets,” a phrase much loved by senior adviser David Axelrod, and instead allowed it room to legislate. The president has won a lot, including a decent stimulus bill and laws on children’s health coverage, tobacco regulation and employment discrimination that, in less exciting times, would have been seen as landmarks.
But the stimulus bill was neither as good as nor as large as it might have been, and there was a legislative train wreck on Obama’s effort to close Guantanamo prison. And then there’s his centerpiece campaign to reform the health care system. Obama’s initial approach of laying out principles and giving Congress latitude was the right response to Clinton’s mistake of offering an immensely detailed proposal, only to see it mocked and rejected. Yet two big problems now confront health care reform that only Obama’s intervention can solve.
The first is the absence of substantial Republican support for comprehensive change. Max Baucus, the Democratic chairman of the Senate Finance Committee, has done practically everything short of making ethanol a reimbursable prescription drug in order to win the heart of his good Republican friend from Iowa, Chuck Grassley. I’m told that Grassley, under immense pressure from Republican colleagues not to deal at all, has informed Baucus that he cannot sign on to a bill if it is supported by only one other Republican, the sensible Olympia Snowe of Maine.
This creates a terrible dynamic in which Baucus is pushed toward one concession after another. It’s a setup for a sellout.
In the meantime, Democrats are divided among themselves on two central issues. The first is how to pay for expanded coverage. During the presidential campaign, Obama stoutly opposed paying for new health care proposals by taxing existing health care benefits. The Democrats’ allies in the unions are prepared to go to war if Obama backs off this pledge. The unions argue plausibly that their members gave up wages in exchange for high-end health plans. Reform, they say, should not come at the expense of middle class workers.
But other liberals see taxing generous health care packages as a logical extension of the idea that the better off should assist the less privileged. Some liberals also worry that if health care is paid for by more general tax increases, those levies will be unavailable later when it comes time to control the deficit without slashing programs.
Then there is the issue of offering a government-run health plan as one alternative in a reformed insurance market. Obama was right to offer a sturdy defense of the public plan. “If private insurers say that the marketplace provides the best quality health care,” he said, “why is it that the government—which they say can’t run anything — suddenly is going to drive them out of business?”
And those who call themselves fiscal conservatives should be the public option’s strongest supporters, since it provides the best hope of holding down the costs of universal coverage.
There are progressives who would trade the public plan for a strong universal coverage bill if it included tough rules on the insurance companies. What should be avoided above all is a fake public plan hemmed in by so many restrictions that it would be doomed to failure.
The key is that no compromise should be allowed to undermine the long-term goals of covering everybody and containing costs. Concessions made for purely political reasons could produce an unworkable monstrosity of a bill. Obama needs to weigh in now. He doesn’t need stone tablets, just an iron will.
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