The Political Calculus of Health Care Reform


What’s the riskier political move for Obama: pushing for an ambitious health care overhaul, even if this entails a drawn out process that shifts his attention from other pressing issues (i.e., the economy, climate change)? Or trying to get a bill—any bill—passed quickly?

Former Clinton advisor William Galston has suggested the president’s best bet is the latter. In a blog item on Friday, he encouraged Obama to take “what he can get on health care” so he can “focus more on the economy over the next three years, and persuade average Americans that the economy is as central to his concerns as is it to theirs.” There may be political consequences if he doesn’t, Galston warned:

A jobless recovery helped undermine George H. W. Bush’s reelection prospects in 1992. Its continuation weakened support for Bill Clinton’s economic program and contributed to the Democratic Party’s rout in 1994.

Galston surely hopes to see Obama avoid the same fate as his former boss, but the problem with his advice is that the political terrain is markedly different today than it was 15 years ago. Unlike the disorganized, top-down reform attempt in 1993, there is presently a broad coalition of non-profits, businesses, and citizens who are behind some form of substantive health care reform. While conservatives, along with the powerful health insurance and pharmaceutical lobbies, have lined up against reform efforts, pursuing real change remains both possible and politically savvy. As Clinton predicted last week at the Netroots Nation conference, “The minute the president signs [the health care] bill, his approval will go up. Within a year, when the good things begin to happen, and the bad things they’re saying will happen don’t happen, approval will explode.”

The real danger is that Obama will be too eager to sign a weak bill and call it “health care reform.” Which is why the administration’s move this weekend to distance itself from the divisive “public option” in favor of the more anodyne if equally undefined health insurance co-ops was so discouraging to many liberal Democrats. As the Wall Street Journal noted today, “it is unlikely that the co-ops would bring prices down as significantly as the government could.” If Obama tries to rush reform through Congress, he risks signing into law a bill that could validate the Republicans’ fearmongering about its spiraling costs and limited benefits, potentially jeopardizing what could be a core legislative accomplishment on which to base his reelection campaign.

Galston is right that creating jobs and rebuilding the economy are vitally important both to the success of the nation and the Obama administration. But health care reform has become Obama’s flagship issue, and a misstep could cost him. As Clinton noted, recalling his own thwarted attempt, “If you go out there and then you fail, then the victors get to re-write history.”

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