RECALLING HOW Ted Kennedy had seen healthcare reform as the cause of his own life, President Barack Obama, in a powerful speech to Congress on Wednesday night, staked his own reputation on the signature initiative of his presidency, a 10-year $900 billion plan that would provide near-universal cover. Eloquently appealing to a public growing sceptical on the issue and for whom the new president’s lustre is beginning to fade, he described reform as an economic and moral imperative: “I am not the first president to take up this cause, but I am determined to be the last.”
Ultimately the speech was also about more than healthcare. It was an attempt to demonstrate decisively that Mr Obama is a political leader, a commander-in- chief able to produce, to run the country, no longer just a candidate with a vision and a good turn of phrase.
Mr Obama’s challenge now is to use the “bully pulpit” of the presidency, which itself has no legislative power, to marshal, broker, cajole, and arm-twist a divided party and Congress into taking concrete action. To that end, anxious to avoid antagonising either Democratic left or right – the Republicans are a lost cause – his speech was notable in avoiding specifics on some contentious issues. Most crucially, he didn’t detail plans for a state-funded insurance scheme to compete with the private sector, and, according to the industry, steal its patients. He was also short on details of cutbacks in programmes for the elderly and of the source of resources to pay for reform.
“The public plan is only a means to that end,” the president pleaded, “and we should be open to other ideas that accomplish our ultimate goal.” But the reality he faces is that the House will not pass a healthcare bill that does not include the public plan, and the Senate will not pass a Bill that does. For Mr Obama the critical test of his authority will come when these issues reach a “conference committee” where the two chambers’ representatives negotiate in private to reconcile their differences.
But what marks out Mr Obama’s speech from those of previous presidential attempts to tackle the healthcare morass is that he is, remarkably for a presidency still in its early days, already facing into the endgame. Much of the heavy lifting has been done, and on a series of critical elements of his healthcare proposal there is broad agreement in the ranks of the Democrats who control both chambers. In the Senate, however, they have only barely the 60 seats needed to prevent a filibuster, and defections on the left could mean needing to rely on one or more centrist Republicans, adding to the delicacy of finding a compromise formula.
But four of the five congressional committees considering healthcare have already passed legislation on which there is broad agreement. All require all Americans to have insurance – today 46 million are without cover – and provide government subsidies for those who can’t afford it. And each would prohibit insurance companies from refusing cover for pre-existing conditions, imposing lifetime ceilings on coverage, or from dropping people when they get sick. But there’s still many a slip between cup and lip. Success is still all to play for.