Obama's Health-Care Challenge: Keeping the Focus on the Larger Goals

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Jim Young / Reuters

President Obama shakes hands after delivering a speech on health-care reform before a joint session of Congress on Sept. 9, 2009

The early returns look good. On the morning after Barack Obama's dramatic bid to push the most ambitious undertaking of his presidency toward a goal line that is in sight and yet still out of reach, the instant polls suggested he had indeed made some headway. In a national survey by CNN, 2 out of 3 of those watching said they might favor his health-care proposal, which was a 14-point jump from before the President gave the address on Sept. 9 to a packed House chamber. But as Bill Clinton — or his wife, the Secretary of State, who was sitting in the front row — could tell Obama, it's best not to get too euphoric at the way a speech can make the numbers jump. After all, Clinton got virtually the identical result the day after he gave a similar speech on his own health-care plan in that same spot 16 years ago. It turned out to be the high-water mark for an initiative that spent the next year in a drawn-out death spiral and that proved to be a failure that helped cost the Democrats control of Congress in the 1994 elections.

Obama White House officials know that too. So while they are sounding confident at this stage that the President will have some kind of health-care bill by the end of the year, they are watching carefully to see if there are more signs that they have arrested what they acknowledge has been a slide in public support. What concerns them, they say, is not what happened in August — the near riots at congressional town halls or the lies about "death panels." Instead, it is a quieter and growing public unease that they began seeing in their own polls and in public ones starting early in the summer.

In an interview with TIME in late July, Obama acknowledged that problem with surprising candor. "This has been the most difficult test for me so far in public life," he said. "When I see polls saying that it's 50-50 and people are still worried about whether this is going to somehow increase their costs when every bill that's out there would lower them, or that this is going to mean that they lose their doctors, or their health care is rationed, or, you know, all the other things that they're worried about, it leads me to spend a lot of time thinking about how can I describe this in clearer terms so that we can get the health care that the American people deserve."

In part, his advisers have since concluded, the difficulty stems from the natural give-and-take of the legislative process and how it plays out in the media. The larger goals, they say, get lost in the politics and the arguments over individual aspects of the bills. What Obama and his strategists concluded — paradoxically — was that the spotlight of a presidential address could take the public's attention off the politicians (including a President whose approval ratings have been edging down) and put it back on the larger goals that Obama is trying to achieve. As a senior White House official explained a few hours before the speech, "When you ask people, 'Do you support the President's health-care plan?' you get something from [even] to slightly negative. When you describe what the President is proposing, you get solid support by a margin of 20 points or more."

Another goal of the speech, officials say, was to install a circuit breaker — not only to the mythology and false claims about the legislation but also to the wars that have been waged between the left and the right over actual provisions. Chief among them: the "public option," a government-run alternative like Medicare to cover the uninsured. "What's happened is that has become sort of a Rorschach test for the left and the right," the White House official said. "There are those on the left who believe this would be the nose under the tent for single-payer. There are those on the right who suspect that this could be the nose under the tent for single-payer. The left and the right love to do that kind of minuet. I don't want to denigrate those views so much as to say that it is an unproductive sideshow to the major debate here."

So even as Obama expressed his support for the public option, he downplayed its significance, calling it "only a means to [the] end'' and noting that just 5% of Americans were likely to sign up. (Indeed, one factor often overlooked in all the shouting is that under most of the versions of the bill that have been proposed, as well as Obama's own, the majority of Americans who get health coverage through their employer would not be eligible to buy into a public option, or any of the private ones that would be offered under the newly established state marketplaces; some critics on the left say that would actually lessen its potential cost-saving impact.) Obama said more explicitly than he has before that he is open to watering down the public option. "Some have suggested that the public option go into effect only in those markets where insurance companies are not providing affordable policies. Others have proposed a co-op or another nonprofit entity to administer the plan," he said. "These are all constructive ideas worth exploring."

The challenge for Obama going forward, however, will be twofold — and in some ways contradictory. While he will have to immerse himself even more in the details and in the legislative back-and-forth in the weeks to come, he will also have to rededicate himself to making the larger case that will reassure the public that the whole exercise is worth it. How well he achieves that balancing act may determine the shape of the bill that finally reaches his desk — or whether he gets one at all.