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Moment of truth on health care

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David Broder
October 4, 2009
— Barack Obama has reached the moment of truth for answering the persistent question about his core beliefs and political priorities. The coming votes in the House and Senate on his signature health care reform effort will tell us more about the president than anything so far in his White House tenure.

The challenge is not one he invited. All during last year’s campaign, Obama skillfully skirted the question of whether he was a moderate, consensus-seeking pragmatist, as his words suggested, or a faithful adherent to the liberal agenda, as his voting record demonstrated.


In stylistic terms, he cultivated the pragmatic image. On issues, he was alternately one or the other—lining up with the liberals on Iraq and civil liberties, for example, but joining the hard-liners on Afghanistan and the budget.


In the campaign, he took the moderate side of the health care debate—disagreeing with Hillary Clinton on the necessity for an individual mandate to buy health insurance and suggesting he would be satisfied with incremental progress toward covering all the uninsured.


But now, factors have combined to strip him of the camouflage he once enjoyed when it comes to health care policy.


His effort to craft a bipartisan package with significant Republican support has failed, as GOP leaders in Congress have chosen to take their chances on handing him a costly defeat rather than opting to claim a share of the credit for success. With Sen. Olympia Snowe of Maine apparently the only Republican who might vote for the evolving legislation, Obama will have to find virtually all the votes he needs among his fellow Democrats.


Also, the debates inside the five House and Senate committees that have shared in drafting the bills have dramatized the deep ideological splits on the Democratic side of the aisle. The symbolic issue has been the public option—the proposal for a Medicare-like insurance plan competing with those offered by private companies.


Four of the five committees have included that proposal; the fifth, the Senate Finance Committee, has explicitly rejected it.


Beyond that much-hyped dispute are multiple disagreements on the cost and financing of the overall reform, with no consensus between the more conservative Democratic Blue Dogs and the more numerous liberals, especially in the House.


The first imperative for House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid is to find a formula that will produce 218 Democratic votes in the House and 59 of the needed 60 votes in the Senate.


Obama will have to be an active player in that process. But in addition, he will have to negotiate something that will be workable in the real world. As he contemplates a re-election race in 2012, he needs at least three years when his most important domestic initiative has not blown up in his face.


What are his chances of pulling it off? It will not be easy. In the House, Pelosi and a clear majority of the Democratic caucus members want a liberal bill, including the public option. They might have to offer some cosmetic concessions to the Blue Dogs, but they are unlikely to yield on the main points.


In the Senate, on the other hand, while liberals may prevail on floor amendments to install the public option, they cannot by themselves deliver 60 votes for passage. At this point, the leverage swings to the handful of more conservative, small-state Democratic senators who, with Republicans, might be able to force substantive changes.


As this plays out—finally, in a House-Senate conference committee—the political cost of the Republican decision to be simply a blocking force will become clear. Had the GOP furnished even a few votes in return for seeing some of their concerns addressed, chances are that Obama and the Democratic congressional leaders would not have felt the necessity to keep all the liberals in line. This would have given the president more room to maneuver.


As it is, his main leverage point is the realization among nearly all Democrats that nothing would be as costly to them, in their individual 2010 races, as the failure of this Congress, with its heavy Democratic majorities, to pass a substantive health reform bill.


That might be enough in the end for Obama to succeed. But the task of getting there will really test him—and expose his core values.


David Broder is a columnist for The Washington Post. Readers may write to him via e-mail at davidbroder@washpost.com.

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