Obama's Mistakes on Health-Care Reform

Many armchair analysts agree President Obama shouldn't have tackled comprehensive health-care reform in his first year, that he should have focused on the economy and creating jobs. That's easy to say now that we've seen what a hash Congress made of the reform effort. But if Obama had walked away from universal health care, it would have been seen as a colossal betrayal of the Democratic dream and the liberal lion whose endorsement helped propel him to the White House.

Obama's nomination was far from a sure thing when Sen. Ted Kennedy, with Caroline Kennedy at his side, took the stage at American University a week before Super Tuesday and endorsed Obama. It was one of those moments in politics when the ground shifted, when liberals and feminists and African-Americans—the Democratic base—got the OK from their first family of politics to back Obama, an upstart in the party, over Hillary Clinton, who had assumed this would be her base, as it had been during her husband's presidency.

As it turned out, Kennedy's endorsement wasn't enough for Obama to carry Massachusetts, an inkling perhaps of what would follow with this year's loss of Kennedy's seat to Republican Scott Brown. Hillary's feistiness was more popular with working-class Democrats in the state than Obama's cool intellectualism. The Kennedy mystique took a minor hit, but the national momentum had shifted to Obama, generationally and culturally, and Kennedy made it happen.

Even before Kennedy became ill with a brain tumor, he was looking ahead to a Democratic president and a renewed push for what he called "the cause of my life," health care as a right, not a privilege. After being diagnosed with a brain tumor in May 2008, Kennedy let it be known he was orchestrating meetings with lobbyists and lawmakers so Democrats would be ready to go with legislation once the election formalities were over. A Democratic victory seemed certain with historical forces favoring the Democrats, and Republicans less than enthusiastic about their nominee, John McCain.

Obama took office with two agendas—the one that he ran on, which included health-care reform, education reform, and energy independence—and the one he inherited, rescuing the economy, bailing out the banks, and filling the huge hole created by the collapse of private investment with government spending. The much-maligned stimulus bill didn't save or create as many jobs as promised, but it pulled the economy back from the brink, allowing Obama to soldier on with health care, fulfilling the commitment of the campaign. This time, building on the lessons of the past, he would do it differently.

The last big push for health-care reform had ended in failure when Hillary Clinton crafted a bill in the White House and congressional leaders treated it like an anthrax letter. Sen. Daniel Patrick Moynihan, then chair of the Senate Finance Committee, held the Clinton bill aloft, all 1,342 pages, and let it drop to the floor with a thud, signaling what he thought of it.

Obama, taking the opposite tack, turned over the drafting of legislation to Congress on the assumption that powerful committee chairmen would have a vested interest in its passage. Now we know the opposite of an error is another error, and that Obama was too passive in his relationship with Congress. He didn't provide leadership to his allies on Capitol Hill, and the result was an extended period of stumbling that allowed reform opponents to gain the upper hand.

Kennedy died in late August, and when Obama appeared before a joint session of Congress on Sept. 9 to urge for health care's passage, commentators wondered if Kennedy's death would provide the last push to get the bill done. Republicans Orrin Hatch and John McCain spoke movingly at the Kennedy funeral mass about their friendship with the liberal lion, but Kennedy nostalgia did not dislodge a single Republican vote.

Disillusioned Democrats concluded Obama spent too much time chasing bipartisanship, and the yearlong horse trading and backroom dealmaking squandered the mandate he had from the voters. The fractious Democratic majority would only have acted on its own if Obama had cracked the whip. But he signaled early on that he could be rolled when he ceded too much power to Nancy Pelosi and Harry Reid in putting together the stimulus bill.

If Hillary had been elected, would she have done things differently? Having been burned once with health-care reform, she probably would have approached it more gingerly, and she wouldn't have felt indebted to Kennedy. Those who know her say she would never have given up that much control to Congress, not so much for ideological or philosophical reasons, but simply because she's a more controlling personality than Obama. And she certainly wouldn't have wasted any time seeking bipartisanship. She would have accepted today's polarizing politics as a fact of life, something to be conquered, not changed.