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Sep 10, 2009

Health care evokes passionate debate because so much is at stake—which makes the possibility of failure all the more tragic.

By Alan Stoga

The passions, real and staged, that President Barack Obama’s health care proposals have ignited should not have surprised anyone.

It’s partly the dollars: health care spending is expected to account for almost 18 percent of the economy this year. That translates into $2.5 trillion, more than $8,000 per person. The Centers for Medicare and Medicaid Services forecast that spending will hit at least $4.3 trillion within ten years. That’s before the $900 billion President Obama says his reform plan would cost.

Everyone on the receiving end of that bounty—from doctors, health care professionals and hospitals to drug, insurance and biomedical companies—has a stake in stopping reform, or at least in trying to ensure they are winners and not losers.

With so much money at stake, there is no incentive to fight fair.

Even more importantly, health care, almost by definition, affects every one of us in ways that no other issue possibly can. The urgency of war in Afghanistan or coping with climate change or managing a runaway deficit spending disappears if your child is suddenly rushed to a hospital or if your aging parents can’t afford to die with dignity or if an insurance company refuses to pay for treatment.

The fact that health care is so personal means we should be passionate—maybe even angry—when politicians begin tinkering with what amount to life and death questions.

Change is always frightening, even more so when you don’t trust the people making the changes. And Americans don’t trust their politicians.  

The irony is that anyone who has dealt with America’s health care system knows it is broken. Almost 50 million uninsured. Absurd costs and spiraling inflation, partially caused by endless paperwork and mind-numbing bureaucracy. Ingrained bias to overtreat, and too much liability-driven medicine. Too many doctors and nurses where we don’t need them and too few where we do.

Americans deserve better and they deserve cheaper. But can President Obama deliver either?

The short answer is no—at least not the way the story has unfolded so far. Notwithstanding the President Obama’s inspired rhetoric, the political reality is stacked against him.

On the one hand, Congressional Republicans seem to be channeling Nancy Reagan’s advice to “Just Say No.” On the other, Congressional Democrats are showing their party’s legendary ability to turn victory into defeat.  

President Obama has been too soft, too accommodating and too mindful of the lessons of President Bill Clinton’s failed reform effort. No one in Washington seems to fear him, which may have been one of the bigger takeaways from his recent speech to Congress: even at the depths of the Vietnam War protests, no Congressman ever dared call LBJ or Nixon a liar, at least not within earshot.

Reform isn’t dead yet, but it’s on life support. And its vital signs are fading.


Viewpoints: Obama needs to channel his internal LBJ

By Steven Hill, New America Foundation


Following President Barack Obama’s speech on health care, several pundits compared his performance to President Harry “Give ‘Em Hell” Truman. Following his election, they compared him to Presidents Abraham Lincoln and Franklin Roosevelt.

For the upcoming health care battle, Obama needs to step into the shoes of President Lyndon Johnson. Especially when it comes to lining up votes from recalcitrant members of his own party, LBJ’s brawling, southern style of trench politics is best suited for Obama’s challenge.

LBJ was one of America’s most underrated presidents. He was president during most of the 1960s, one of the most tumultuous decades in modern American
history. The nation was torn by race riots and a deadly struggle for basic civil rights on behalf of its racial minorities. Despite the obstacles of backward attitudes and stubbornly discriminatory institutions, the hardnosed southerner was able to deliver more on the nation’s urgent civil rights agenda than his predecessor, President John F. Kennedy, an Irish Catholic from Massachusetts, ever could have done.

Stories of LBJ’s toughness are legendary. He was willing to twist arms and step on the toes of his narrowly tribal colleagues in the South. He knew how to stare down some of his former Senate associates, calling them into his office, rolling up his sleeves, poking them in the chest and getting nose to nose, eyeball to eyeball. He could curse, bully and hound like a redneck thug when he needed to.

But he could sweet-talk and horse-trade, too, as well as log-roll, pork barrel and use all the tools of legal bribery and persuasion that a president possesses. It wasn’t pretty, but it sure was effective.

LBJ got the job done by having a clear compass on what could be bargained away while still maintaining his objectives. And what resulted was the greatest civil rights legislation since the abolition of slavery—The Civil Rights Act of 1964 and the Voting Rights Act of 1965—that significantly reduced discrimination and started America down a path that ultimately led to the election of the first black president.

Besides channeling his internal LBJ, if necessary Obama needs to tear a page from the playbook of two other southerners who knew how to put on the brass knuckles. Former GOP operatives Karl Rove and Tom Delay made it clear that any Republican representatives who crossed their agenda would face a well-funded conservative opponent in their next party primary. That sent a shiver through the ranks, and the back benchers fell in line.

Obama should let any Democratic foot-draggers know that if they don’t get with the program, he will un-elect them and put in Democrats more in tune with his priorities. His threat would be credible, since Obama is one of the great campaigners of modern political history. He still enjoys popularity—though it’s dwindling—among the broad coalition that mobilized to elect him. Obama could convincingly threaten to fund candidates to run against uncooperative Senators in the Democratic primary, and to campaign on behalf of his slate of candidates.

But to make that threat, Obama has to mean it. He has to show a quality that the nation has not seen in him since the presidential election ended last November. Some glimpses of it were present in his powerful speech on health care, but now he needs to show that a new LBJ is in town.

Lyndon Johnson made mistakes—the escalation in Vietnam being his gravest (Obama take note)—but more than any president in the last half century, he passed landmark legislation that remade this country into a better place. And he did it fighting against the same barriers that Obama now faces—outdated attitudes, fear of change and vested interests defending the status quo—not only across the nation, but within the Senate, indeed within his own party.

Like civil rights in the 1960s, health care reform is one of the defining policy debates of our time that will set the stage for the next generation. The United States remains the only advanced economy that has failed to figure out how to provide affordable health care for all of its people.

To win this battle, Obama needs to retire the photos of Lincoln and FDR into his desk drawer in the Oval Office, and hang on his wall a large portrait of President Lyndon Johnson, the Texas brawler who knew how to drag his former Senate colleagues across the finish line.

Steven Hill is director of the Political Reform Program of the New America Foundation and author of 10 Steps to Repair American Democracy.

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