Dan Balz's Take
On Health Care, the Messenger Changes, But Questions Remain the Same
By Dan Balz
The repeated applause President Obama received from members of the American Medical Association as he laid out his case for health care reform today illustrated anew why many people believe the political climate for action has rarely been better.
But as the president was speaking in Chicago, a leading Democratic polling firm was releasing the details of a new survey that underscored how divided the country remains over some of the basic choices in the reform package and why the president will need to do more before he can expect to see legislation on his desk for signature.
Though congressional committees have been working steadily for months on health care, Obama's speech marked the true opening of this health care debate. The speech represented his most comprehensive argument for acting now to reform the health care system.
At its heart, the speech was a rallying cry for political leaders to come together to fix a system whose costs continue to spiral upward and which leaves 46 million people without insurance. The current system is an unsustainable burden on the U.S. economy and, as Obama put it, "a ticking time bomb for the federal budget.
The president used the address not only to advance his case for change but to answer specific charges by critics, foremost among them his advocacy for a public health insurance plan as an option for consumers, a potential deal-breaker on Capitol Hill.
Obama cited repeated past failures by previous presidents and Congresses. Teddy Roosevelt, Harry Truman, Richard Nixon, Jimmy Carter and Bill Clinton all called for comprehensive reform. Though there seemed to be public support for previous efforts to reform the system, particularly in 1993, strong opposition and effective lobbying by many of the stakeholders and infighting among the advocates helped sink those previous efforts.
Obama said he believes this year can be different. As evidence he cited the Senate passage of legislation to allow the Food and Drug Administration to regulate the tobacco industry, a measure that died a quick death when proponents pushed it forward a decade ago.
"What makes this moment different is that this time -- for the first time -- key stakeholders are aligning not against but in favor of reform," he said. "They are coming together out of a recognition that while reform will take everyone in our health care community doing their part, ultimately, everyone will benefit."
There certainly appears to be a different mood among the stakeholders this year than there was when Bill and Hillary Clinton tried to reform the system in the early 1990s. One sign of change came last month when leaders of the health care industry visited the White House to pledge $2 trillion in reductions in the cost of care.
While the pledges may prove illusory and lack any enforcement mechanism, as political theater, the event suggested that, for now, major players are reluctant to look like they're leading the effort to deep-six this president's effort to change the system.
At the same time, public opinion appears to strongly favor reform. Public dissatisfaction with the current health insurance system is high and sizable majorities believe the system needs either a total overhaul or significant reforms. But there are important caveats to the conclusion that the conditions today are significantly better for health care reform than they were in 1993.
The Democratic firm of Greenberg Quinlan Rosner Research, it its new survey, found that public opinion appears almost identical to where it was in that period, both in the overall support for reform and the reservations that Americans still have about just how reform might be accomplished. Some of the findings were summarized in a New Republic article.
Obama makes the case that the costs of health care threaten the economy and the budget. But roughly as many Americans are concerned that the government will make changes that reduce the quality of care, raise taxes, hurt small business or limit choices as worry about whether rising costs will cause even more people to lose insurance.
In other words, the debate over change versus status quo has not yet been decided. People see as much risk in change as in maintaining the current system. They worry as much about the federal government assuming too much control over health care as much as they worry that, without change, insurance companies will have too much control.
The Greenberg survey found support for Obama's plan, but not a majority behind it, and when broken down by parties, only Democrats offered strong backing. Two in three Republicans said they opposed the plan and among independents, 49 percent said they opposed it (to 32 percent who favored it). The survey also found a significant difference among age groups, with those over 65 far more opposed than those under 65.
The survey then tested arguments for and against the broad principles at the heart of Obama's plan and the authors of the poll asserted that, after real debate, support for the plan increases, though not dramatically. Their conclusion was that advocates for reform must make the case for change more effectively than they have.
Obama began the public side of the campaign Monday in Chicago and effectively marshaled the arguments in his favor. But the path to success will require a continuous campaign of public advocacy by the president, attention to legislative details and a willingness to cut some deals. The climate may look favorable, but if the past is any guide, Obama still has a difficult fight on his hands.
Posted at 2:51 PM ET on Jun 15, 2009
Dan Balz's Take
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