Four years ago, after a hard-fought election campaign, a president tried to use his newly won mandate to reform a program that touched every American family: Social Security. President George W. Bush soon discovered that his mandate wasn't nearly as powerful as he thought. Even though Bush promised that current pensioners' benefits wouldn't be cut, senior citizens were nervous about any change. In effect, they told the federal government to keep its hands off their Social Security. Bush stumped the country explaining and defending his proposals, but they died without Congress ever taking a vote.
President Obama has run into much the same problem with healthcare reform. Public backing for Obama's ideas has been broad but tepid; it's hard to rally support when the president hasn't said exactly what he's seeking. Meanwhile, a small but vocal opposition has been ferocious -- and it includes not only hard-core Obama-haters but also a significant number of senior citizens, the nation's most powerful voting bloc.
In public opinion polls, young people generally support Obama's proposals, but people over 65 do not. That generation gap mirrors last year's election returns: Senior citizens were the only age group Obama didn't win. But it also reflects fear among the elderly that Obama's drive to make Medicare more cost-efficient could eventually limit their medical choices -- as indeed, it probably would. A poll released last week by the Kaiser Family Foundation found that 37% of the elderly believe that Obama's proposals will harm Medicare, while only 20% said they thought Obama would make their healthcare better. When angry octogenarians tell congressmen to keep the government's hands off Medicare, they're saying exactly what they mean. (And, yes, they know it's a government program.)
The skittishness of older voters was only one of several danger signs for Obama in polls taken after the Republicans' summer offensive against his healthcare proposals. An NBC poll found that more people now think Obama's proposals are a bad idea than a good idea, 42% to 36%. (That question was a dead heat in June.) The same poll found that 55% believed that Obama's proposals were likely to provide health insurance to illegal immigrants (they won't).
Still, despite all that bad news for Obama, there are several ways his healthcare venture is different from Bush's 2005 attempt to remake Social Security -- contrasts that suggest how he can still succeed where Bush failed.
One is contained in that poll question about illegal immigrants: Some of the opposition to "Obama-care" stems from the wild misinformation his opponents have spread. The administration has slowly succeeded in rebutting Sarah Palin's charge that its plan calls for "death panels"; given time, it can handle the other whoppers as well.
A second strength Obama holds is his ability, often displayed in last year's campaign, to improve his sales pitch over time. The president began his healthcare campaign with a wonky insider message about "bending the cost curve," which we now know means reducing the rate of growth in future spending. But in his most recent town hall meetings, Obama emphasized a new, more family-friendly (and less ambitious) message: consumer protection for the middle class. If you already have an insurance policy, he said, his plan will make sure your coverage won't be canceled when you need it. "Most Americans have health insurance," he said last week. "The most important thing to describe to them is: This will be a set of consumer protections that provide you more safety and security."
Finally, the most important difference between Obama's healthcare proposals and Bush's Social Security idea is this: Obama has left himself plenty of room to downsize his plan. Too many voters think end-of-life counseling sounds like a "death panel"? Out it goes. Too many senators think a government-run "public option" insurance plan would crowd private firms out of the market? Tell them you can live with something less, like regional cooperatives -- even as you tell your dispirited progressive supporters that you'd still prefer the public option.
All that ambiguity has been frustrating, but it's left Obama in a position where he's still likely to get some kind of healthcare reform through Congress. Even if it's less ambitious than he once wanted, he will still be able to claim a victory.
"Health reform has survived the August town-meeting wars with just enough public support to move forward," said Drew Altman, president of the Kaiser Family Foundation, whose organization has conducted the most detailed polling on the issue. "The town meetings took a toll, they created more public anxiety about the proposals, but they were not fatal.
"The summer debate focused on issues that were controversial on Capitol Hill, but it strayed from the issues that people care about," he said. "The critical question for most people is: What is this going to do for me and my family, and is there something here I'm afraid of?"
Those are the questions that will determine the outcome of the battle once Congress returns to Washington on Sept. 8. The fight that starts then will make August's town meetings look like a sideshow.