Obama’s approach: the drawbacks
Krugman spells out the difficulties of trying to take a middle path in the current political context:
I’ve been alerted to an interesting Boston Globe article about Barack Obama’s role, when he was in the Illinois legislature, in the attempt to get the state committed to universal health care. It turns out that the story very much prefigures the debates we’re having right now.
Obama later watered down the bill after hearing from insurers and after a legal precedent surfaced during the debate indicating that it would be unconstitutional for one legislative assembly to pass a law requiring a future legislative assembly to craft a healthcare plan.
During debate on the bill on May 19, 2004, Obama portrayed himself as a conciliatory figure. He acknowledged that he had “worked diligently with the insurance industry,” as well as Republicans, to limit the legislation’s reach and noted that the bill had undergone a “complete restructuring” after industry representatives “legitimately” raised fears that it would result in a single-payer system.
“The original presentation of the bill was the House version that we radically changed – we radically changed – and we changed in response to concerns that were raised by the insurance industry,” Obama said, according to the session transcript.
To be fair, the piece also says this:
During debate over the Health Care Justice Act, Obama also attacked the insurers, accusing the industry of “fear-mongering” by claiming, even after he made changes they wanted, that the bill would lead to a government takeover.
This story gives a lot of context to the debate over health reform now. Obama clearly sees himself playing the same role as president that he did as a state legislator — as a broker among groups, including the insurance industry, as someone who can find a compromise solution that’s acceptable to a wide range of opinion.
My thoughts: being president isn’t at all like being a state legislator, Illinois Republicans aren’t like the national Republican party, 2009 won’t be 2003, and the insurance industry’s opposition to national health reform — which must, if it is to mean anything, strike deep at the industry’s fundamental business — will be much harsher than its opposition to a basically quite mild state-level reform effort.
The point is that if national health reform is going to happen, it will be as the result of a no-holds-barred fight of an entirely different order from what Obama saw in Illinois. The president’s role will have to be far more confrontational, involve far more twisting of arms and rallying of the public against the special interests, than Obama’s role as a state legislator in the Illinois case. And it will take place against a backdrop of fierce attacks not just from the industry but from Republicans who fear, rightly, that any kind of reform will move the country in a more liberal direction.
My worries about Obama are that he doesn’t seem to understand this — that he thinks that in 2009, as president, he can broker a national health care reform the same way that as a state legislator, in 2003, he brokered a deal that mollified the insurance industry. That’s a recipe for getting nowhere.
I have to agree: getting a good national health insurance plan is going to be a fight every step of the way, and Big Pharma and the insurance companies are not going to give an inch. The only way it will happen is with a strong and combative president and a solid Democratic majority in Congress.