Obama’s Health Speech Stops the Bleeding, For Now

Momentum, whether in physics, sports or politics, is a diminishing force. And its power is particularly fleeting when it comes to major presidential addresses. 

So let’s go ahead and stipulate that the health care reform address that President Obama just delivered to a joint session of Congress will be well received by Americans. The Big Speech, after all, is an Obama trademark, and he certainly didn’t disappoint on Wednesday, particularly with a closing passage that combined a touching political eulogy for Ted Kennedy with a rousing appeal to the nation’s basic decency. 

And if history is any guide, the public will now respond with newfound enthusiasm for Obama’s health care agenda. Just before the speech, an A.P. poll found an outright majority of Americans—52 percent—disapproving of Obama’s handling of the issue. That number should drop measurably in the days ahead. 

But history also suggests that this support won’t last long. When the sausage factory that is Congress begins grinding its gears again, the broad, unifying principles that Obama presented will be largely forgotten, replaced by the usual emotionally charged incoherence of a thousand screaming politicians, activists, radio hosts, and television talking heads. 

This is, lest we forget, what happened the last time a president made a serious effort to reform the health care system. On Sept. 22, 1993—nearly 16 years ago to the day—Bill Clinton stood exactly where Obama stood tonight, held up a prototype of a new national health insurance card, and presented a plan that would guarantee coverage for all Americans. 

The public rallied around him. Clinton delivered his address after a rough first eight months in office, but in its aftermath, a poll found voters approving of his plan by a wide 56 to 24 percent margin. “Clinton Health Care Plan Is Alive On Arrival,” a New York Times story declared a week later, when Congressional committees began diving into the plan. Richard Gephardt, then the House majority leader, gushed that “the launch couldn’t have gone any better.” 

But we all know how that turned out. A year later, with even reform supporters in Congress deeply divided and with the public flummoxed by an endless stream of claims and counterclaims, the Clinton plan—and the idea of health care reform in general—was dead. 

It was that episode, in part, that Obama had in mind when he told Congress on Wednesday that “I am not the first president to take up this cause, but I am determined to be the last.” For Obama to avoid Clinton’s health care fate, the momentum generated by his speech to Congress will have to be worth more than that which Clinton’s generated. 

The good news for the White House is that there’s some reason to believe this will be the case. The tedious, poll-killing Congressional process is already much further along than it ever got when Clinton proposed reform. All three committees of jurisdiction in the House are poised to pass a similar bill, and a compromise between the two committees in the Senate may not be far off.  

As Obama noted, “There is agreement in this chamber on about 80 percent of what needs to be done, putting us closer to reform than we’ve ever been.” 

There are several outstanding issues, but the biggest, it seems, is whether the final bill will include a public insurance option. House Democrats (and the Democratic Party base) badly want one. Senate Democratic leaders, who want to come up with 60 votes to kill a Republican filibuster (and who don’t want to resort to the tricky, filibuster-bypassing reconciliation process), seem ready to compromise it away—especially with Maine Republican Olympia Snowe now dropping strong hints she’ll support reform without it. 

Obama finessed the issue in his speech, paying extensive lip service to the obvious policy benefits of a public option, giving liberals in the audience (and at home) their first opportunity ever to cheer a president arguing for such a proposal. If there’s a public option in the final bill, he made it clear, he’ll happily sign that bill. But he quickly followed up by making it equally clear that the public option is not a bottom-line issue for him. 

“We should be open to other ideas that help us meet our goal,” he told Congress. 

This leaves the door wide open for the most likely Congressional compromise on the public option—the “trigger” proposal that Snowe is pushing, which would table the public option for several years, after which time it would only be activated if private insurers have failed to meet certain coverage and cost benchmarks. Significantly, some liberals in the House who have previously said they won’t back anything short of a “robust” public option, have this week voiced openness to this idea.  

So it’s actually not that hard to see Obama’s speech succeeding where Clinton’s, which was delivered before Congress actually took up reform, couldn’t.  

In some ways this should validate the White House’s political strategy. For months, Obama and his team have taken heat for farming out too much work to Congress and for not engaging the president in a more direct, specific way. But after tonight, you could argue that they were just saving their ammo for the right moment—that a speech to Congress delivered near the finish line will be far more helpful than one given at the starting gate. Already, a CNN instant poll shows support for Obama's plan rising to 67 percent after the speech.

That said, there is an unmistakable price for getting a bill through Congress this way. Especially if it’s stripped of a real public option (does anyone really think the public option trigger would ever be pulled, even if private insurers don’t live up to their promises?), the final bill figures to be too watered down to solve the country’s health care woes.  

That doesn’t mean it won’t be helpful to Americans, or that it won’t be a political victory for the White House. But it also doesn’t mean that Obama will achieve his goal of being the last president ever to have to address health care reform.  Obama’s Health Speech Stops the Bleeding, For Now