"Obama’s in the ER but he’ll get his reforms"

Andrew Sullivan:

The right’s healthcare scare tactics are hitting home – but to little purpose---The media love drama, and the prospect of a sudden, Icarian fall to earth by the dashing new president is too good a story to miss. The summer has been crammed with YouTube clips and television news reports featuring the angrier members of the Republican right railing against Barack Obama’s plans to inflict euthanasia on their grandmothers, abort their children and put them in concentration camps.

No, I’m not kidding. One of the most popular far-right websites, WorldNetDaily (with 5m readers a month), has argued that Obama’s healthcare reforms appear designed “to create the type of detention centre” that people “fear” could be used as “concentration camps for political dissidents, such as occurred in Nazi Germany”.

Last week, in a fracas at a town hall meeting, an elderly man had his little finger bitten off. Not quite the storming of the Bastille, but not nothing either.

This is a circus, but circuses get ratings, and they also shift the mood. Behind the theatrics, there is little doubt that worries about overhauling an industry as big as the entire British economy have deepened. The majority of Americans, with great healthcare, are understandably wary of change. The uninsured are a small minority and not as politically involved as elderly voters terrified by Republican claims that they are all about to be denied treatment. Obama’s hang-back strategy — designed to avoid a repetition of Hillary Clinton’s hands-on failure in 1993-4 — has allowed opponents to define the issue negatively.

There has been a political cost for the president. His approval ratings have slid from close to 70% to around 50%. That’s not as steep a slide as Bill Clinton managed in the same period, but it’s still worrying. His decline among independent voters is a bad sign and his pragmatism has weakened the passion of his own party base to support him. On Wednesday the president will give a speech to Congress on the reforms. He will need to be on good form.

Nonetheless, I remain convinced Obama will win this fight. Not totally; not without political cost; but win it he shall. And the strategy is really very simple. The most popular elements of the bill will be kept in and the most contentious left out.

The fundamental issue of costs will be deferred. A bill that prevents insurance companies from denying coverage to people with pre-existing illnesses; that creates healthcare exchanges, where people can buy their own insurance policy subsidised by the government; that brings agreed price reductions by the drug companies in return for all these new, previously uninsured clients: this will pass and be popular. How could it not? The option of a government-run insurance plan to compete with private ones will be either dispensed with or held in reserve. If, after a few years, health costs keep soaring and the private companies have not mended their free-spending ways, it could be brought back.

Obama has a solid majority and can achieve all this with Democratic votes alone. So why is he in such trouble? Partly it is that this kind of reform rightly stirs scepticism, and Obama has allowed a hapless and divided Congress to take the lead, muddying the message. Partly it is that the hard right is becoming more and more extreme and its fears have eclipsed the hopes of Obama’s supporters. But the most critical part, in my view, is the public understanding that after two massive bank bailouts and a vast stimulus package, with two still-intractable wars, the US cannot afford even the modest 10-year trilliondollar package Obama is proposing. And Obama’s inability to cut spending while the economy is so fragile means he is constrained from offering fiscal reassurance.

So, tactically, Obama is on the defensive. Strategically? Again, he is stronger than he now appears. When the health insurance bill is passed and elderly Americans are not rounded up into concentration camps and granny isn’t subjected to euthanasia, and when many uninsured people gain a peace of mind they have never felt before, and people become able to change job without fearing loss of insurance, the Republican scare tactics may come to seem absurd.

Moreover, the Republicans have failed to lay out their proposals for dealing with the same problems. There are some worthwhile ideas out there: guaranteeing insurance only for catastrophic or chronic illness, vouchers for free check-ups and tax-free health savings accounts to pay for medicines and routine treatment. These proposals go largely unheard, though, drowned out by anti-Obama scaremongering. A party that has tried to kill what may well become a popular measure and has offered no alternative is not thinking strategically.

Imagine next year. Obama has a healthcare plan and a carbon emissions scheme in place, both of which duck some core difficult questions but are still big moves away from the era of George W Bush. His stimulus, designed to kick in with more force in 2010, helps to push an already recovering economy into growth. The troops begin to come back from Iraq in larger numbers. Stocks maintain momentum; banks keep paying back their bailout money, giving the government a profit; and Obama calls a fiscal-responsibility summit to begin to chart a path back to budget sanity.

It won’t turn out that easily, but it’s a plausible scenario. The strategy of pushing much of the stimulus money into an election year was, in retrospect, a shrewd if cynical ploy from Rahm Emanuel, the White House chief of staff. The Democrats will almost certainly lose seats in the Senate in the 2010 mid-term elections, as incumbent parties do, but even in the worst-case (and highly unlikely) scenario, a Republican takeover of the House, Obama’s options are no worse than Clinton’s were in 1994. Clinton, you may recall, failed to get healthcare and yet was re-elected handsomely.

And what will the Republicans be saying then? At some point, they need ideas — yet no ideological heavy lifting is currently being done. Worse, their most credible candidate for 2012, Mitt Romney, enacted a healthcare reform in Massachusetts very similar to Obama’s national plan. How does a party attack a healthcare reform when its own candidate endorsed just such a scheme in his own state?

Well, I guess they can run Sarah Palin or Dick Cheney. But Obama has already defeated both of them. He took his time this summer, hung back and let his enemies do their worst. They did. He took a beating. But, as with the Clintons and John McCain during the election campaign, he survived their tactical hits by retaining a strategic cunning. He still has it. Whether he can retain it is what the next year will tell us.