Dingell's Long Fight for Universal Health Care

President Obama offered few clues in his Wednesday evening press conference about what kinds of taxes he will support beyond a millionaires' surcharge to pay for health-care reform. The prime-time event was supposed to mark an end to Obama's hands-off approach to the sausage-making on Capitol Hill, but he is still floating above the fray. Whether that will prove a smart strategy, or will lead his party over the cliff once again on this issue, brings to mind the classic Dickens quote, "It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness …"

Obama is playing this right, or he isn't, and we'll know soon enough. Forget the Republicans. This has devolved into a contest among Democrats, and the challenge is for Obama to show some muscle. The White House had lost control of the debate, forcing the president to publicly sort through the bickering within his own party. That's the problem with a purchased Congress: members are more beholden to the special interests that contribute to their campaigns than they are to the national interest, or to their president.

Getting to this point has been a long march. Michigan Rep. John Dingell, the longest-serving member of Congress, is living proof of health-care reform's thwarted history. Dwight Eisenhower was president when Dingell assumed the seat that was held by his father before him. The senior Dingell began the fight for universal health care with FDR in 1935 when it was seen as a humanitarian cause, long before cost became an issue. Dingell, speaking at a breakfast Wednesday morning attended by health-care activists and lobbyists, noted that FDR passed Social Security at the height of the Depression and would have done national health insurance but was deterred by war, further economic woes, and political adversity (the president's failed attempt to stack the Supreme Court with friendly justices).

President Truman took up the fight, addressing Congress just seven months after taking office to propose a new national health-care program, calling the health of the nation's children as definite a public responsibility as their education. John D. Dingell Sr. was one of three Democratic cosponsors of the legislation, which would have created what is known today as a single-payer system. His son, who is now 83 years old and gets around with the aid of crutches, has introduced the bill every year in Congress since 1956—that's 53 years. "I am what you call a single-payer freak," he says. Yet "Big John" Dingell is fully onboard with the bill currently churning through the Energy and Commerce Committee that he once headed, and by implication with whatever the Democrats can build enough coalitions to pass. He quotes the late Chinese leader and economic reformer Deng Xiaoping, who said, "It doesn't matter whether the cat is black or white as long as it catches mice." (The saying resonates with me, as I've got an infestation of mice in my home, and my cat, who is black and white, is getting the job done, mouse by mouse.)

Every special pleader in Washington knows that the time-honored way to kill legislation is through delay. Obama can afford to let the August deadline slip, but he's right to push for legislation to sign by the end of the year. Compromising isn't pretty. Putting together the votes to win means building coalitions, and they're built by trading away pieces of what you want and sprinkling what's left with goodies. The health industry, led by insurance companies and pharmaceuticals, is collectively spending $1.4 million a day to preserve what it sees as its livelihood. Yet Obama has kept a fragile coalition together. At a meeting in Washington under the auspices of the Institute for Healthcare Improvement, Nancy Nielsen, former president of the AMA and only the second woman to lead the venerable organization, said doctors are 'dispirited and angry … they don't like government, they don't like health plans, they don't like each other very much, but the country is in pain and needs us, every one of us."

There's no certainty the AMA will be there in the end, but it's not an implacable foe of reform the way it's been in the past. Listening to Nielsen's emotional statement, a representative with an organization that documents disparities in health resources compared the coalition Obama has assembled to riders inside a Humvee on the road in Baghdad: they're safe for now, but they're taking fire from all sides.

Republicans are calling defeat of health care Obama's Waterloo, a way to destroy him politically. This is war, and if anything will bring Democrats together, it's the knowledge that if they don't pass the Affordable Health Choices Act, or some semblance thereof, the rest of Obama's legislative agenda could fall like dominoes, along with his presidency.