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After a summer of setbacks, President Barack Obama has a clear roadmap for salvaging health care reform:
Convince skeptical Americans that a new system would actually help them, not limit their choices and care. Strike a compromise between liberals who demand a public option and cost-conscious centrists who call it a deal-breaker. Win over Sen. Ben Nelson (D-Neb.), an inscrutable moderate. And avoid Death Panels II, a rerun of the potent Republican attacks.
But what’s got to make the White House nervous this week: That’s the same basic roadmap they started out with in February, and it failed to get Obama where he had hoped to be by Labor Day — much closer to a final compromise.
So the White House is sending Obama out to do what they believe he does best — talk to the nation, in a grand setting of a joint session of Congress on Wednesday, where he’ll address a public anxious about overreach, a Democratic Party divided and a Republican Party feeling like they have the upper hand.
Over the Labor Day weekend, the public saw the outlines of a solution for Obama. He previewed his speech with a Democratic call to arms and a challenge to Republicans during a union picnic Monday in Ohio, while Senate Finance Committee Chairman Max Baucus (D-Mont.) released a plan that could form the blueprint for a bipartisan deal.
After months of trying to rise above it all, the president is about to descend into a gritty debate on Capitol Hill.
“The president is personally going to have to be more FDR and LBJ over the next four months in terms of being the lead negotiator telling people exactly what he wants,” said Ralph Neas, head of the National Coalition on Health Care and a veteran of Capitol Hill deal-making. “He is the one who is going to have to put together the votes that get to 60 in the Senate and 218 in the House and that produce the eventual bill that becomes law.”
Here’s what Obama needs to do:
Make peace with the progressives. This will truly test Obama’s abilities as the leader of the Democratic Party.
Liberals want a public insurance option and say they will not support a bill without it. Moderate Democrats say they couldn’t vote for a bill with it. At some point, Obama will need to go with one faction or the other — but so far has been reluctant to definitively pick sides, something that appears unlikely to change in Wednesday’s address.
He appears intent on threading the needle of voicing support for a public option, while making clear he’ll sign a bill without it.
Still, that will likely embolden liberals to hang on to the public option until the president unequivocally tells them no — which could prolong the agony for Democrats, and the weeks needed to get a final deal.
“[The late Massachusetts Sen.] Ted Kennedy could tell the left, ‘This is as far as we can go,’” Neas said. “I am not sure there is anyone else who can do that except Barack Obama.”
If it gets to that point, the White House will argue that progressives can get most of what they want — coverage for tens of millions of uninsured Americans, insurance market reforms and affordable coverage for those who already have coverage.
The alternative, Democrats say, means almost-certain defeat next year and possibly in 2012, as well. The White House is preparing to rally wavering Democrats by invoking a bitter memory most in the party would rather forget: then-President Bill Clinton’s failed health reform effort in the 1990s. The party lost Congress in 1994, aides said, not by trying to do too much on Clinton-style health care but by failing to get any reforms done at all — drawing a parallel to the dangers of inaction this year.
Neutralize the extremes. It has become almost impossible for the president to do anything without facing severe skepticism from the right. The angry town halls may not have been representative of all the August gatherings, many of which no doubt went down without incident. But for better or worse, the showdowns draw the most media attention — and for that reason, Obama has to hope he doesn’t get thrown off balance again by a new death-panel-style argument from the right.
Experts say Obama’s best hope of doing this is by replacing the Republican narrative — with talk of government-funded abortions and health care for illegal immigrants — with one of his own. And he was clearly testing those themes in his Labor Day speech in Cincinnati on Monday, where he said to critics of his plans for reform, “I’ve got a question for them. What’s your solution?”
“The truth is, they don’t have one. And we know what that future looks like. ... More families pushed into bankruptcy. More businesses cutting more jobs. More Americans losing their health insurance —14,000 every day. And it means more Americans dying every day just because they don’t have insurance,” Obama said.
Win over Ben Nelson. The Nebraska Democrat is the hardest of the Senate moderates to please, but if the president hopes to avoid using reconciliation, he quickly needs to soften up Nelson — and a band of moderates whose support for Obama’s approach has been elusive.
“Ben Nelson is the weathervane,” a health care industry insider said.
This group, which numbers about 10 or 12, hasn’t drawn the same amount of attention as Sens. Chuck Grassley (R-Iowa), Mike Enzi (R-Wyo.) and Olympia Snowe (R-Maine), or progressives in the House and the Senate who have made the most noise on the public option. But given the long odds of Baucus striking a deal among the bipartisan Group of Six, the president and Democratic leaders will soon be clamoring for the wish lists of these moderate Democrats.
“They are more powerful than the Republicans,” the source said. “If you don’t get Ben Nelson and the two Arkansans and Joe Lieberman and Evan Bayh, then you can’t get to 60. Period.”
Start with the public option — as long as it remains part of the package, these moderates are unlikely to go for it. Nelson suggested during an interview with the Lincoln (Neb.) Journal-Star that a “governmental approach” could cause reform to “implode.”
But this group is generally more concerned about cost than expanding coverage. They want a deficit-neutral bill — a real plan to rein in health care costs over time and no major tax increases.
Watch Sen. George Voinovich (R-Ohio). No, really, keep an eye on this retiring senator. Don’t get hung up on Snowe and Sen. Susan Collins (R-Maine) as the only possible Republican votes.
Voinovich has bucked his party in the past, and Democrats are hoping retirement may liberate him to vote for a package in the end. Unlike Snowe and Collins, Voinovich wouldn’t have to worry about blowback from his Republican colleagues.
“If he wants NASA moved to Cleveland, Ohio, he could get it done,” the health care insider said.
Just get it to conference: This is the rallying cry for people on all sides of the debate, with the goal of all to pass the strongest bill they can out of the House and Senate, so they have a strong position heading into the conference committee that will create the final compromise.
That’s why the bill that Baucus floated over the weekend is so important. The Montana Democrat clearly tried to strike a balance — his plan doesn’t include a public option, but consumer-owned insurance cooperatives that some Democrats are trying to position as a “public option-lite.” That’s designed to entice moderate Democrats and maybe a Republican or two.
But Baucus has included a few things that would be hard for liberals to resist. One is a new tax on insurance companies that offer the so-called “Cadillac” plans of high-cost insurance. The other is a fee on insurance companies to help pay for the reform efforts, designed to raise $6 billion a year starting in 2010. The big test of his bill will come as early as Tuesday, when the six bipartisan negotiators will meet to see if it’s worth continuing their talks, with the Baucus idea as the template.