Obama secures his place in history
Published: March 22 2010 20:01 | Last updated: March 22 2010 20:01
Barack Obama and his allies in Congress have succeeded where previous Democratic administrations have failed. They have passed a healthcare reformthat guarantees health insurance for almost all Americans and ensures that bankruptcy will no longer be a consequence of serious illness. It has taken the US much too long to do what other rich countries did decades ago. Better late than never.
Mr Obama, Senate leader Harry Reid, and House speaker Nancy Pelosi have secured their places in history. However, the reform they have passed is unfinished, flawed and, for the moment, unpopular. Republicans are promising to repeal it, and hope to regain the majority in the House in November’s mid-term elections. The Democrats have made history, but will they come to regret it?
In the long term, this seems unlikely. Whatever problems and complications intervene, the entitlements enshrined in this legislation are so basic that they will come to be seen as inalienable – just as Social Security and Medicare, the country’s other landmark social-welfare provisions, now are. Come what may, the principals will look back on this as their proudest moment in politics.
In the short term, though, the Democrats have taken an enormous gamble. For the past year, they have been intent on their own internal debate over the reform. Neither the party’s leaders in Congress nor the president himself have troubled to make the case for this particular policy to the public. They have rightly said that the present US healthcare system is a disgrace – which is true – but they have done far too little to defend their specific proposals.
Instead, the selling of this reform has concentrated on populist bashing of health insurance companies, around which the US healthcare system will continue to be organised. It has also been based on the claim that extending insurance to 32m Americans, at a gross cost of $1,000bn over 10 years, will yield a net reduction in the budget deficit.
This arithmetic is hardly plausible. The reform does call for experiments to improve efficiency. These could yield significant long-term benefits, but to do so they would have to be pursued far more aggressively. Proposed cuts in Medicare, intended to pay for roughly half the gross outlays, will be politically challenging.
The independent Congressional Budget Office has endorsed the deficit-reduction claim, but this office operates within strict limits: it must assume what Congress tells it to. The public is sceptical about the figures, and is right to be.
The Democrats mismanaged the process in another way. To their credit, they have ended up with a centrist, moderate reform – similar to the plan introduced in Massachusetts by Mitt Romney, a Republican governor. Yet they got there reluctantly, approving the measure after months of roiling argument and bitter opposition from their own progressive wing. Belied as it may be by the outcome, they have left an impression of a party intent on moving the US farther to the left than its voters wish to go. Mr Obama’s tanking approval ratings tell the story.
A genuinely bipartisan effort – like the ones that created Social Security and Medicare – could have shaped a national consensus, and a far better basis for the repairs and course corrections that will be necessary as the reform proceeds. For this inability to reach cross-party agreement Mr Obama can fairly criticise the Republicans, who were never open to co-operation. Their unanimous opposition to the reform is wholly indefensible. But this does not excuse the president’s failure to lead his own party to a moderate consensus, which could then have been presented, early and often, to the country. Instead, he had moderation forced upon him by conservative Democratic dissidents.
Despite all this, the public could come round to the reform, as the Democrats hope, and perhaps soon enough to avoid a rout in November. The party may get a lift from its achievement, and press the rest of its agenda with renewed energy. But do not bet on it. Bitter wrangling over healthcare will continue as the Senate debates further action this week. Beyond that, legal challenges will be pressed, and problems with the legislation, real and imagined, will come to light.
A setback in November, and the crushing of their other policy ambitions, may be the price Democrats must pay for this reform and the way they pursued it. An avoidable sacrifice, would then be the verdict, but a worthy one nonetheless.
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