Can Obama recover on healthcare?

It’s been a bad month for Barack Obama. His popularity has fallen from once-dazzling highs to a merely respectable 53%, about where George W. Bush was at this point in his presidency.

The causes aren’t hard to find. People are impatient for economic recovery and frustrated that Obama’s stimulus hasn’t done the trick. And now, bombarded by Republican warnings about big government, they’re losing their appetite for Obama’s top domestic priority: healthcare reform.

In a Wall Street Journal-NBC News poll released last week, only 36% of respondents said they thought Obama’s healthcare plan was a good idea; 42% said they thought it was a bad idea. Only a month ago, that question yielded an even split. Americans, polls have found, think Obama’s plan is likely to raise the cost of healthcare and restrict patients’ freedom of choice. It’s no wonder they’re not enthusiastic.

And both sides know that the stakes go well beyond fixing our inefficient, haphazard medical system. Republicans would love to cut the high-flying president down to size and show that the Democrats’ mandate for change has reached an end. Democrats worry that the Republicans might just succeed.


One reason the public shows so little support for the Obama healthcare plan is that there is, in fact, no Obama healthcare plan. To avoid the mistakes Bill and Hillary Clinton made in their abortive healthcare initiative in 1993, Obama left the work of drafting a plan to Congress. But Congress has largely failed him. The congressional committees behaved like committees and drafted three competing proposals, none of them yet complete.

Nobody expected either house to produce a perfect bill. But without an Obama-endorsed proposal on the table, opponents have been free to attack anything they choose -- from Canada’s “single-payer” system to federally promoted euthanasia -- as a likely result of the president’s phantom plan. (Neither single-payer nor euthanasia is under serious consideration.) Obama, a politician who has been brilliant at framing challenging ideas in soothing language, has lost control of the framing of this issue.

Until recently, Obama and his healthcare aides have mostly been playing an inside game. They’ve made deals with groups that opposed the Clinton healthcare proposals in 1993: insurance companies, drug companies, the American Medical Assn. It hasn’t been pretty; the AMA endorsed the House bill explicitly because it included a promise not to cut doctors’ Medicare payments. The White House trumpeted every deal as evidence of progress, but it wasn’t clear to ordinary people what they were getting out of them.

And when Obama talked to the public about his broader goals, he often let his inner wonk take control. More than once, our formerly eloquent president has promised voters that his reforms would “bend the curve” on future spending. Don’t get me wrong: Bending the curve -- diminishing the rate at which the deficit would otherwise increase -- is exactly the right goal. But as a rallying cry, it doesn’t quite rank with “end the war,” “yes, we can” or “change you can believe in.”

There’s still a broad base of support for the overall goal of healthcare reform, but the support is soft. Most Americans say they are happy with their insurance and don’t think reform will benefit them personally. But they still want to improve a patchwork system that leaves millions uninsured, allows insurers to cancel policies when people get sick and costs far too much for what it delivers.

Obama and his aides know they need to win this debate; they’ve known that all along. So what can they do?

First, reframe the issue -- not as an arid fiscal question of “bending the curve” but as a moral and economic imperative to provide reliable coverage to those who have insurance as well as those who don’t. Obama began to do this last week when he unveiled an eight-point “bill of rights” for health insurance consumers and promised “stability and security.”

Second, endorse a specific plan -- even though that means making someone unhappy. Obama hamstrung himself by allowing centrists in the Senate to attempt to fashion a genuinely bipartisan proposal. The goal was to see whether an earnest show of bipartisanship could win a few Republican votes. As long as Montana Democrat Max Baucus and Iowa Republican Chuck Grassley were negotiating -- and it has been a very long time -- Obama didn’t want to get too specific with his own “red lines,” lest he drive Grassley away. The time to jettison Grassley is near.


Third, mobilize Obama’s Democratic supporters. That won’t be as easy as it sounds. Many liberal Democrats would prefer the single-payer model that was never seriously debated in Congress this year. Many more will find fault with parts of whatever plan Obama finally settles on -- for example, if he accedes to the Senate centrists’ proposal for health cooperatives instead of a single federally administered “public option” insurance plan. But the president can explain to the faithful that the Republicans would love to “break him” and that liberals shouldn’t make the perfect the enemy of the good.

And that’s what this August is going to be about. Which side wins is likely to come down to who can best frame the debate over the most important legislation Congress will consider this year. It will depend partly on who’s better at mobilizing supporters, Obama’s untested “Organizing for America” or grass-roots conservatives and the Chamber of Commerce. It will be a critical moment for Obama’s presidency -- a test of whether he can turn his 2008 mandate for “change” into something durable and real.