Dan Balz's Take
The Hard Sell Begins
By Dan Balz
President Obama had two audiences in mind throughout his prime-time news conference Wednesday night: Americans who are increasingly skeptical about his effort to reform the health care system and members of Congress looking for guidance as they near politically difficult votes on such a package.
For the public, Obama needed to allay fears that the unknown is worse than the status quo in the hope that they will rally behind reform. For those in Congress, particularly his fellow Democrats, Obama needed to make the case that the failure to act on health care will be politically more risky than acting.
In the past two weeks, as the health-care debate has intensified, the president has felt growing pressure from two directions. Public polls have shown declining confidence in his performance in the health care fight, which in turn has caused more nervousness in Congress. On Capitol Hill, he has been urged to get more directly involved in helping to develop a consensus, rather than leaving the sausage-making, and the tough choices, to Congress. Obama scheduled his news conference as a way to answer his critics and reassure the public.
Much of the session was a tutorial by the president that included long answers to some fairly pointed questions. The length of those answers highlighted the complexities of the problem and underscored how difficult it is to explain in simple terms what it will take to provide nearly every American with health insurance and, at the same time, constrain medical care inflation so that an expanded system doesn't bust the budget.
Obama tried to portray health-care reform in the rosiest possible terms--better care at less cost. That is a tall order and one that slides too easily past the problems any overhaul of this size and scope inevitably will bring. His more compelling argument may have been to describe what he said are the consequences of inaction: higher costs, bigger deficits, and more people losing their insurance. It is that reality that has produced a climate for action this year that has been, until now, far more favorable than in the past.
Obama was characteristically defiant in the face of critics who doubt that he will be successful, continuing the posture he has taken since returning from his overseas trip earlier this month. "We will pass reform that lowers cost, promotes choice and provides coverage that every American can count on, and we will do it this year," he declared in his opening statement.
At the same time, he was conscious of shifting public opinion and also respectful of the concerns that many Americans have about whether they'll be better or worse off under a new system. "Folks are skeptical," he said. "And that is entirely legitimate because they haven't seen a lot of laws coming out of Washington lately that helped them."
The president, however, was also uncharacteristically defensive Wednesday night. He was clearly mindful that he has hit a rough patch exactly six months into his presidency and felt the need to justify what his administration has done to deal with a set of monumental problems. He recounted the economic and budgetary problems he inherited and the steps his administration has taken to stabilize the financial industry and enact a stimulus package. He repeated his claim that the administration has reduced the 10-year projected deficit by $2.2 trillion, a figure that has been debunked by many budget experts.
A new poll from the Kaiser Family Foundation, released Thursday morning, illustrated exactly what Obama was talking about. "Criticisms and doubts seem to be registering," said the release accompanying the poll.
Fifty-six percent said reform is more important than ever and more Americans think they will be better off, rather than worse off, if Congress passes a bill. But more Americans said they fear Congress and Obama will enact legislation that is bad for their family than said they are worried that Congress won't act this year.
The real test of the president's leadership will continue to be how well he can push Congress toward consensus. On Wednesday, he began to provide some clarity--or perhaps reinforced with stronger language the direction he has been pointing toward throughout this debate. In one case, he leaned left, in the other he leaned right, a conscious recognition of the fissures within the Democratic coalition that have cast doubt on the ability of Congress to pass a bill.
He was explicit, again, in resisting any taxes on the middle class to pay for the cost of reform. He tried again to promote his idea of limiting the value of charitable deductions for the wealthiest Americans, an idea that has met significant resistance in Congress. But, notably, he gave a tentative endorsement to the approach liberal House leaders are taking, which is to add a surcharge on the income taxes of wealthy Americans.
House Speaker Nancy Pelosi verbally amended the House bill earlier this week in an interview with Politico, saying she would like to see the threshold for triggering the surcharge raised to families with incomes of $1 million or more. Obama said, "To me, that meets my principle that it's not being shouldered by families who are already having a tough time."
He has continued to resist proposals that would significant limit the tax exclusion on employer-paid health insurance. But did he leave the door open a bit for some form of that revenue-raiser, which the Senate Finance Committee has been examining? Here's what he said: "While they're currently working through proposals to finance the remaining costs, I continue to insist that health reform not be paid for on the backs of middle-class families."
Obama was even more explicit about health care reform and the deficit. "I've also pledged that health insurance reform will not add to our deficit over the next decade, and I mean it," he said. "In the past eight years, we saw the enactment of two tax cuts -- primarily for the wealthiest Americans -- and a Medicare prescription program, none of which were paid for. That's partly why I inherited a $1.3 trillion deficit. That will not happen with health insurance reform. It will be paid for."
That was another warning to Congress--and a nod to moderate Democrats and those few Republicans still engaged in negotiations in the Senate. Obama has seen the tendency of Congress to slip away from this requirement of not adding to the deficit. He knows Congress will take the path of least resistance on deficit questions, even in the name of deficit reduction.
Obama has now made it as explicit as he can that health reform must include meaningful cost containment, saying he will not sign a bill that doesn't work. Will he, in the end, hold to that line?
The president will need a sustained public campaign of rhetoric and persuasion to prevent public opinion from sliding farther in the coming weeks and perhaps months of this battle. He will continue to make the public case for health care reform Thursday when he travels to the Cleveland Clinic. As he's done on most days the past two weeks, he will be looking for ways to use the bully pulpit to counteract the growing assertiveness of his Republican critics that no reform is better than what Congress may be brewing.
But he will need to do more as well to push the process forward in Congress. Right now, it's not clear where he is placing his real bets. Is it with the Senate Finance Committee bill that is not yet fully formed but that holds out the possibility of some semblance of bipartisanship? Or will it be with a Democrats-only strategy that forces a bill through with a bare majority, using in the Senate the reconciliation process that would amount to a declaration of war with the Republicans?
Obama wants success above everything else. But he has now begun to put down some more explicit markers about what constitutes success. The question is whether, through public advocacy and legislative diplomacy, he can now pull off a victory that has eluded so many other presidents.
Posted at 8:54 AM ET on Jul 23, 2009
Dan Balz's Take
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