Is Obama Losing Health Care Reform?

It is easy for Democrats to fear the sky is falling in. Grim headlines proclaim that voters are nervous and Democrats are fighting among themselves over health care. National public opinion surveys reveal a 10 percentage point decline in voter confidence in President Barack Obama’s overall leadership. There are unresolved policy questions about health funding mechanisms, a public option, and an employer mandate. All this evokes flashbacks to the spectacular collapse of Bill Clinton’s reform efforts in 1994.

But Obama already has demonstrated much greater political effectiveness than Clinton. The new president is more popular than Clinton was at the six-month point. In mid-July, 1993, for example, Clinton had a 41 percent approval rating in the Gallup poll, much lower than Obama’s most recent rating of 56 percent.

Four of the five relevant congressional committees actually have passed health care reform, which is not something Clinton was able to achieve. Obama’s leadership style of delegating specific policy decisions to Congress has led to committee approvals and given himself maximum room for bargaining and negotiation at the end of the legislative process.

When you look at public opinion polls, there is little evidence that opposition scare tactics are working. Sixty-six percent of Americans in a recent CBS News/New York Times survey favored a “government administered” public health insurance option. This is despite private insurance industry anguish over a public option. And 55 percent believe the federal government should guarantee health insurance for all Americans. Critics who claim America should not expand the role of the government are losing that argument with the general public.

Even more striking are poll numbers revealing that voters have much greater confidence in Obama on health care than congressional Republicans. For example, 55 percent of Americans say Obama has better ideas about reforming health care, compared to only 26 percent who think that of congressional Republicans.

Obama’s greatest challenge is determining how to pay for reform. House members worried about costs made changes that scaled back the original program by 10 percent. This saved around $100 billion and kept the overall price tag under $1 trillion. This is not exactly a bargain price, but it helps make the argument back home that legislators are doing something about reform costs.

Ultimately, Democrats will succeed in passing health care reform because the risks of failure are too high. When the 1994 Clinton effort collapsed, conservatives were emboldened and liberals alienated. The result was a spectacular GOP comeback in that year’s election that gave Republicans control of the House and Senate.

If Democrats lose health care reform, the biggest victims will be Blue Dog Democrats. Since many of them represent conservative areas, they will be the ones swept out of office if liberals are disillusioned by failure and stay home in the 2010 elections. Moderate members who oppose health care reform because they worry about specific provisions should understand they have more to fear from failure than success in passing comprehensive reform.

Victory in passing a bill will give them a major platform to brag that they did something no American president has done in 50 years. In the end, the Democrats’ October surprise may turn out to be congressional passage of health care reform.