Leading article: Healthcare reform enters its endgame

Failure will not break his presidency, but could alter the political calculus

Share
Related Topics

No one can reasonably accuse Barack Obama of faintheartedness. Whatever the enterprise in hand, he tries, tries and tries again to implement the policies he was elected on. We saw the months and the attention he applied to remaking US policy in Afghanistan, to the point where he was reproached with over-intellectual dithering. We are now witnessing, one more time, his Herculean efforts to persuade Congress to pass a healthcare reform that will really help uninsured, or underinsured, Americans.

Mr Obama's decision to postpone a planned visit to Indonesia and Australia, so as to oversee a new stratagem for passing the necessary legislation, is the latest proof of his commitment to this cause. But his readiness to risk a certain amount of diplomatic damage in Asia also hints at how much else is at stake. The passage of healthcare reform may not be quite the make-or-break moment for his entire presidency that some, not least his Republican opponents, would like it to be, but its fate will convey a message about his strength – or weakness.

He needs the reforms to pass; just as much, though, he needs them to be more than a formality. As Hillary Clinton could have told him, any change to US healthcare designed to benefit those excluded from the established system calls forth a ferocious and variegated alliance. There is the majority of Americans who have acceptable health insurance at present; there are pensioners who (though they are loath to admit it) benefit from a generous state-funded system, and there is a host of well-funded interest groups, from doctors to insurance companies.

All of them fear a loss of benefits or remuneration if insurance is extended to people who – as they see it – are poorer, less healthy and less responsible than they are. The social justice argument does not sway them; it is dismissed as European-style socialism that will come back to bite the hard-working majority in their taxes.

Mr Obama has had particularly bad luck with healthcare reform, the death of Senator Edward Kennedy last August being a particular blow. No sooner had the Senate passed its bill – paving the way for the two Houses to reconcile their versions into a law for the President to sign – than the Democrats lost their legislative majority in the upper chamber, by dint of losing the late Senator Kennedy's seat to the Republicans. That reflected extraordinary carelessness on the part of Massachusetts Democrats. With mid-term elections looming later this year, the decision of Senate Republicans to press their unexpected advantage was entirely predictable.

While bad luck played its part, however, the troubled healthcare saga has also exposed some of Mr Obama's weaknesses. Not as adept at backroom Congressional politics as either Bill Clinton became or George Bush already was, he has struggled to get his way with the legislature. Nor, for all the rhetorical gifts he displayed on the campaign trail, has he been able to use the President's bully pulpit to optimum effect.

There is no reason why, with time, Mr Obama should not manage Congress as effectively as his two predecessors. What is more, he goes into what it must be hoped is the healthcare endgame this weekend, with an additional argument. Backed by the Congressional Budget Office, he says that the Democrats' plan will also cut the budget deficit, thereby delivering a double benefit. This should make it harder for Congressional Republicans to resist – but, by itself, probably not hard enough.

React Now

iJobs Job Widget
iJobs General

Business Analyst Consultant (Financial Services)

£60000 - £75000 per annum: Harrington Starr: Business Analyst Consultant (Fina...

Systems Administrator - Linux / Unix / Windows / TCP/IP / SAN

£60000 per annum: Harrington Starr: A leading provider in investment managemen...

AVS, JVS Openlink Endur Developer

£600 - £700 per day: Harrington Starr: AVS, JVS Openlink Endur Developer JVS, ...

E-Commerce Developer

£45000 - £60000 per annum + competitive: Progressive Recruitment: Exciting opp...

Day In a Page

Read Next
 

Letter from the Political Editor: Phone and data laws to be passed in haste

Andrew Grice
The first lesson of today is... don't treat women unequally?  

Yvette Cooper is right: The classroom is the best place to start teaching men about feminism

Chris Maume
A History of the First World War in 100 Moments: Peace without magnanimity - the summit in a railway siding that ended the fighting

A History of the First World War in 100 Moments

Peace without magnanimity - the summit in a railway siding that ended the fighting
Scottish independence: How the Commonwealth Games could swing the vote

Scottish independence: How the Commonwealth Games could swing the vote

In the final part of our series, Chris Green arrives in Glasgow - a host city struggling to keep the politics out of its celebration of sport
Out in the cold: A writer spends a night on the streets and hears the stories of the homeless

A writer spends a night on the streets

Rough sleepers - the homeless, the destitute and the drunk - exist in every city. Will Nicoll meets those whose luck has run out
Striking new stations, high-speed links and (whisper it) better services - the UK's railways are entering a new golden age

UK's railways are entering a new golden age

New stations are opening across the country and our railways appear to be entering an era not seen in Britain since the early 1950s
Conchita Wurst becomes a 'bride' on the Paris catwalk - and proves there is life after Eurovision

Conchita becomes a 'bride' on Paris catwalk

Alexander Fury salutes the Eurovision Song Contest winner's latest triumph
Pétanque World Championship in Marseilles hit by

Pétanque 'world cup' hit by death threats

This year's most acrimonious sporting event took place in France, not Brazil. How did pétanque get so passionate?
Whelks are healthy, versatile and sustainable - so why did we stop eating them in the UK?

Why did we stop eating whelks?

Whelks were the Victorian equivalent of the donor kebab and our stocks are abundant. So why do we now export them all to the Far East?
10 best women's sunglasses

In the shade: 10 best women's sunglasses

From luxury bespoke eyewear to fun festival sunnies, we round up the shades to be seen in this summer
Germany vs Argentina World Cup 2014: Lionel Messi? Javier Mascherano is key for Argentina...

World Cup final: Messi? Mascherano is key for Argentina...

No 10 is always centre of attention but Barça team-mate is just as crucial to finalists’ hopes
Siobhan-Marie O’Connor: Swimmer knows she needs Glasgow joy on road to Rio

Siobhan-Marie O’Connor: Swimmer needs Glasgow joy on road to Rio

18-year-old says this month’s Commonwealth Games are a key staging post in her career before time slips away
The true Gaza back-story that the Israelis aren’t telling this week

The true Gaza back-story that the Israelis aren’t telling this week

A future Palestine state will have no borders and be an enclave within Israel, surrounded on all sides by Israeli-held territory, says Robert Fisk
A History of the First World War in 100 Moments: The German people demand an end to the fighting

A History of the First World War in 100 Moments

The German people demand an end to the fighting
New play by Oscar Wilde's grandson reveals what the Irish wit said at his trials

New play reveals what Oscar Wilde said at trials

For a century, what Wilde actually said at his trials was a mystery. But the recent discovery of shorthand notes changed that. Now his grandson Merlin Holland has turned them into a play
Can scientists save the world's sea life from

Can scientists save our sea life?

By the end of the century, the only living things left in our oceans could be plankton and jellyfish. Alex Renton meets the scientists who are trying to turn the tide
Richard III, Trafalgar Studios, review: Martin Freeman gives highly intelligent performance

Richard III review

Martin Freeman’s psychotic monarch is big on mockery but wanting in malice