Rupert Cornwell: Fine words, but a hard slog ahead

He laid out America's healthcare debate in its hideously complicated reality
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The Independent Online

In terms of exposition and exegesis, it was a masterpiece. In the space of 45 minutes on Wednesday evening, Barack Obama laid out America's health care debate in its entire, dysfunctional and hideously complicated reality, in a way almost anyone could understand.

He set out what is wrong with the existing system, both morally and economically. He explained his plan to put it right, steering clear of extremes – the government-run single payer arrangement favoured by liberals and the right's dream of replacing today's predominantly employer-based system by one in which people buy their own coverage on the private market.

And in his speech to Congress, he lambasted the scaremongers and "the bogus claims spread by those whose only agenda is to kill reform at any cost."

But then everyone knew that this President was the most gifted explainer to occupy the White House in modern times, with a talent for making complex issues simple that even Ronald Reagan or Bill Clinton might envy. The real question of the evening was whether Mr Obama had regained his grip of a debate that in the course of hundreds of heated town hall meetings during the summer had seemed to be slipping beyond his, and anyone's, control. And here the jury is still out.

In immediate political terms, Mr Obama undoubtedly made progress – helped by the "You lie!" outburst of Republican congressman Joe Wilson which only bore out the President's criticism of opponents whose policy consists solely of saying no. The reaction of other senior Republicans, mostly ranging from dismissal to scorn, may also have backfired. "What the American people got was not another plan, but another lecture," John Boehner, the House minority leader, sneered yesterday.

His colleagues meanwhile continued their familiar tactic of erecting and demolishing straw men. The government must not intervene in the relationship between patients and their doctors, insisted Eric Cantor – completely ignoring the fact that Mr Obama had assured that such intervention was precisely what would not happen.

But in a sense the Republicans are irrelevant. Not only has the party all but slammed the door on bi-partisan reform. In the House of Representatives Democrats command far more than enough votes to pass a measure on their own. In the Senate, on paper at least, they have a comfortable simple majority to enact a law, under a 'reconciliation' procedure that sidesteps the hurdle of 60 voters needed to defeat a filibuster. However, here too the omens are mixed.

A snap poll by CNN suggested the President made headway with people who watched his speech on television. But even the network admitted that those who tuned in were more likely to be Democrats. And those with longer memories recalled that an equivalent speech by Mr Clinton was greeted by a similarly positive reaction from an equally Democratic congress in 1993, as he launched the last comparably ambitious plan to reshape the country's health care system. Yet within 12 months his grand scheme had collapsed, contributing mightily to the Democratic rout at the 1994 mid-term elections.

Mr Obama, of course, is much further along than was Mr Clinton 16 years ago. This time, four of the five Congressional committees with jurisdiction on health care have produced bills, and the fifth – the Senate Finance Committee – has promised to do so by next week. No Clinton bill, by contrast, ever made it out of committee. And 16 years ago the US health care crisis, though grave, was nowhere near as acute as now.

But there is no guarantee his speech, however masterful, will bridge divisions within his own party, between liberals and the conservative "Blue Dog" Democrats, who occupy the position once held by moderate Republicans – a breed facing extinction on Capitol Hill as their party has become ever more extreme.

For Mr Obama and both proponents and adversaries of reform, it is going to be a long, hot autumn.