Obama’s Long View on the Health Care Bill

President Obama’s just-get-me-a-bill-dammit approach to health care reform is rooted in the calculation that a signing ceremony would be a major political winner for the White House in the 2010 elections.

In his latest “60 Minutes” sit-down on Sunday night, the president offered a preview of the triumphant spin we can expect if he is able to put his signature on a bill.

“Seven presidents have tried to reform a health care system that everyone acknowledges is broken,” Obama said. “Seven presidents have failed up until this point. We are now that close to having a bill that does all the things that I said and most experts said need to be done when we started this process.”

At a certain level, the White House’s political reasoning makes sense. In 1994, the thinking goes, Bill Clinton and the Democrats paid dearly by claiming health care as their signature issue-and then failing to deliver any reform at all. Voters took the refusal of Congress to pass legislation as validation of the Republican attacks on “Hillary Care.”

To avoid a repeat, then, Obama needs to be able to sign something-anything-called “health care reform.” This is why, for example, the White House has offered only lip service on the public option. Sure, Obama would sign a bill with a public option, but if it’s going to cause too much trouble in Congress, well, then forget it. This is their thinking, at least.

But there’s a problem with it: Obama and the Democrats are going to pay a price next year for their health care push no matter what. The reason is simple: Even if reform passes, no voters will feel its positive effects by next fall.

Let’s assume that a bill does make it through Congress (hardly a guarantee right now-especially with a certain Connecticut senator’s latest declaration). We don’t need to know the exact dimensions of the final deal to recognize that its major components won’t begin to go into effect until several years from now. Subsidies to help individuals secure coverage, for instance, probably won’t start being paid until 2013 or 2014.

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And for most Americans, there won’t even be much change on the horizon, since Congress-again, assuming it passes anything-is poised to bar anyone who is now covered by group insurance from participating in the new insurance exchanges that would be set up. As The New York Times noted in a Sunday editorial, “[T]he vast majority of Americans, those covered by employer-sponsored insurance, would see little change or a modest decline in their average premiums under the Senate bill.”

This is a recipe for a continuation into 2010 of the same health care debate we’re having now- with Republicans free to make all of the hysterical, rejectionist claims they want, and a large chunk of voters (in the absence of direct evidence in their own lives that “ObamaCare” is working) receptive to it. The fact that Obama actually signed legislation won’t move these voters; their lives won’t feel any different-all they’ll know is that Obama signed something very expensive and very flawed.

In a way, health care will be to the 2010 political debate what the stimulus has been to 2009’s.

It’s possible to make an academic argument that the $787 billion package passed last winter has been successful. The facts may well support such a claim. But it’s much easier to make the emotional case against it, since the economy is still rotten and the administration (unwisely) forecast that the stimulus would keep unemployment below eight percent. It is now 10 percent. Most people do not feel that the stimulus has impacted their life in any way. All they know is that it cost lots of money.

This is how they will view health care in 2010. Democrats can talk over and over on the campaign trail about the historic bill they passed. The Republican argument will be more emotionally compelling: in the middle of an economic crisis, they wasted your money on a bill that won’t help anyone. Given the economic climate and the nature of midterm elections, voters will be in the mood to hear the Republican argument-not the Democratic one.

So does this mean Obama was wrong to tackle health care in his first year? Not at all. Big domestic achievements come at a great political cost, but what’s the point of being president-especially in a time like this-if you’re not willing to reach for them? And no president should be cowed by the prospect of an ugly midterm: They’re almost unavoidable and-as evidenced by Reagan and Clinton-they don’t mean that much.

Sure, any bill that might pass Congress at this point will be a flawed compromise, one that will deeply disappoint the Democratic base-and one that will leave unaddressed major flaws in the health system.

But it will be a start, and the opportunity will be there for subsequent Congresses to improve on it. Social Security and Medicare had to be reformed after they became law. It took three passes to finally get the Civil Rights Act of 1964. Socially transformative legislation doesn’t happen at once. It evolves.

The fact that they will take a bath in next year’s elections should, in a way, be liberating for the White House. They are right to accept some compromise on health care; otherwise, no bill will ever get through. But they need to make sure that the bill that emerges has a framework that can be adapted and expanded in the years ahead-something that will pay dividends for Democrats well into the future. Just not in 2010.

More from Steve Kornacki:

That Grand Health Care Compromise? Jerry Nadler Has His Doubts

Time for the Lieberman Rule

Obama and the Reagan Trajectory Obama’s Long View on the Health Care Bill