Fineman: Will Obama Wipe Out on Health Care?

Barack Obama has a knack for riding political waves. I put that down to his upbringing in Hawaii, where surfing is second nature. He also yearns to make history. I put that down to his time as editor of the Harvard Law Review, where it dawned on him that a son of a Kenyan and Kansan could be president, and a path-breaker in the process. But now the president's skill at riding well-timed waves into history is being tested. In fact, he's in danger of wiping out. The reason is health-care reform. Why? Because his timing isn't good and his plan, at least what we've seen so far, isn't "reform." 

Obama and his aides, fearing a loss of momentum, are trying to stoke a sense of urgency in hopes that the Senate will feel compelled to pass a 1,000-page-plus measure before its August recess. I asked a very plugged-in Hill Democrat whether the Senate would do so. "Less and less likely," he said. That doesn't mean that health-care reform is dead. It does mean at best that the fall is going to be dominated by a ferocious national debate, and that the outcome is far from clear.

Obama's timing is bad because of the recession, which puts more strain and focus on the federal budget, even as it makes devising a health-care plan that moves toward erasing deficits in the decades ahead—what's known as "bending the curve"—more difficult. The president knows that he needs to sell health-care reform both as a matter of morals and of money: that we can only avoid irreversible national bankruptcy by controlling health-care costs.

But every one of the three proposals put forth so far on the Hill would, as written, add to federal deficits, not ease them. What would have been a tough sell in the best of circumstances is now all the more difficult in the face of deepening worries, especially among independent voters, about the long-term federal debt.

Robert Gibbs, the White House press secretary, told me that there are "curve-bending" provisions scattered through the three bills, but that those provisions need to be consolidated into a final bill for the whole thing to work. Here's another political problem: most of Gibbs's so-far-unaccounted-for curve-bending would be derived not from additional cuts in spending, but from raising taxes to generate revenue. 

The president has vowed to make sure that his final plan is paid for, meaning that it won't add to long-term deficits, but that's far short of what he and his budget director, Peter Orszag, originally said they were aiming for. It's not a curve—at least not a downward one. If Obama is going to argue that we can't not afford to do this, the numbers have to show the chance for radical savings. So far, they don't.

The second reason why the health-care wave is fading is this: so far, this isn't "reform" in any thoroughgoing sense. The original idea was to rethink the entire convoluted and overly complex system, and to find ways to truly change the way we think about health care to both improve care and save money. There ought to be ways to do that. But the three bills to emerge so far seem like more of an attempt to buy off existing constituencies than a real rethinking of the mess.  

Insurance companies are a good example. Yes, they would be required to sell coverage to people with preexisting conditions, but they would get something monumental in exchange for tighter regulation: a government mandate that everyone buy their product. No wonder an industry group has released an ad praising what Congress is doing. Yes, there would be tighter regulation of hospitals, doctors, and other caregivers, and cuts in Medicare and Medicaid spending, but all of the players would stay in place in pretty much the same relation to each other that they now have. So, yes, millions of people would get subsidized coverage at taxpayer expense, but we would be sending them into a system that everyone admits is dysfunctional and unsustainable now.

And why is Obama keeping his surfboard on this weakening wave? For one, he thinks that he can broker a deal among Democrats, which, in theory, would be enough. He believes that his powers of persuasion and patience for detail will prevail. He also wants to be able to proclaim that he's has made health care "available" to all.

But that's not technically what the bills do. They don't contain an entitlement in the strict sense; they don't directly state that every American is entitled to health care. But by forcing people to buy—and forcing companies to sell—insurance, and by offering assistance to those who can't afford coverage, the measure comes closer than we ever have to the vision of a national health-insurance program that President Harry Truman put forth more than a half century ago.

Obama wants to say, "I've redeemed the Truman promise." In other words, "I've made history." But this president is a long way from the beach, and no one knows which way the tide is running.

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