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Obama, Progressives and Health Care Reform

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In the last few weeks, a variety of groups have been more forthright in expressing criticisms of the Obama administration now that it is more than half a year old, and disquiet in particular about the direction of the health care reform debate and legislation. The right has risen up with increasing virulence, and its ability to turn out some loud shouters at town hall meetings around the country came in recent days to dominate the media narrative about health care reform. It's far from likely that their angry rejectionism, resonating with ridiculous charges of socialism, communism, fascism, you name the -ism, and tinged in too many places with the familiar -ism of racism, will carry the day, that it represents more than a vocal disaffected fringe, or that it won't boomerang against them, as so much of the right's reaction to candidate and President Obama has. But at the moment it seems to have left a mark, and shifted the story line to "health care in trouble."

The left is increasingly worried that the President is too quick to compromise and insufficiently directive about what he wants in a final bill. Many don't like the deal he struck with the drug companies, which at the time it was announced some weeks ago produced a bit of grumbling, but was mostly seen as a deft move to bring a big and potentially disruptive player into the health care reform tent. They worry that the public option, which has somehow come to seem -- wrongly, in my view -- as the only meaningful measure of significant reform, as opposed to the best but not the only means of checking the insurance companies, is about to be thrown over the side of the leaky ship.

Some call the President naïve for thinking he could ever rise above partisanship and bitter division, and want him to be more fiery, leading progressive forces into intense battle with enemies to whom no quarter should be given. This criticism dogged Obama during the campaign, and he ignored it, going steadily on his way. When things are looking good it is muted. Not so much at times like the last few weeks. In addition, whatever their personal admiration for the President, many influential voices on the left have never seen him as a sufficiently ideological figure, and since his inauguration have been lamenting his failure to seize the Rooseveltian moment to forge transformational change, particularly with respect to the financial system. Paul Krugman's op-ed in today's New York Times is the quintessential expression of this concern (though outrageously framed in terms of whether Obama can be "trusted," raising to the level of a character issue what is a legitimate set of differences on strategy, if not ideology).

The center, at least that part of the population that is engaged in political life but not sharply ideological or partisan, also seems restive. They seem to think that the mistake the President has made is in deferring to liberals in Congress, particularly Speaker Pelosi and the House, and that he is wrong in relying on his strong November vote and personal popularity, exploiting the economic crisis and the desire for corrective action, to push a much-too-bold agenda, expanding the social welfare net in a way that further mortgages the nation's future with excessive spending. You get a bit of this from David Brooks, and also from slightly right-of-center European outlets like The Economist and The Financial Times.

The President and the people around him could be forgiven some frustration over these mirror-image critiques, since the advice they get with increasing decibel intensity - expected and moreover welcome in a democracy -- is often contradictory, and in some cases at odds with the known record. (For instance, remarks over the weekend by the President and Secretary Sebelius reaffirming support for the public option but refusing to declare it non-negotiable varied not a bit from what the administration has been saying for months, but in the more intense media environment were portrayed as a concession, sending already-unsettled liberals into panic mode. At the same time, I heard a prominent Democratic fundraiser and investor, an Obama supporter, complain in a small gathering recently that the President needed to argue for health care in terms of the unsustainable cost to the economy of continuing the status quo; those of us listening to him were at some pains to gently remind him that this has been a central and consistent tenet of Obama's message since the Presidential debates.)

Many across the political spectrum, at least from center to left, have had a tendency since Barack Obama first appeared on the scene a few years ago, to read into him their own views and aspirations. While pandering and triangulating less than any politician in memory - for instance, maintaining boldness and integrity on a range of foreign policy issues from Cuba to the Middle East -- Obama has somehow managed a pretty long run of keeping these disparate actors satisfied. (For example, at a dinner a few months into the administration, when our host went around the table asking for ratings, all gave high marks to the President, from Peace Now types to hardline Israel supporters, from those like myself perturbed at the insufficiency of financial reforms to libertarians upset that he might restrict executive compensation.)

This balancing act - which says more about us than Obama, I think - is getting harder to sustain, but if expectations are hitting reality, perhaps they were unrealistic from the start. If you look carefully at what Obama has been saying all along, he has never believed his own hype, and indeed has warned, correctly, that there will be very tough times when his political capital will be low. As he told Richard Wolffe, who chronicled his Presidential campaign in the recent Renegade,

"...you're always more popular before you're actually in charge of things. And then, once you're responsible, then you're going to make some people unhappy. That's just the nature of politics. And these things go in cycles. Even during the course of this campaign, there have been months where I'm a genius and there are months when I'm an idiot. At least, if you read the newspapers."

Unfortunately, few progressives have as wide a frame as Obama, or as steady a constitution. When things get rough, as they inevitably have with health care - was anyone naïve enough at the start of this to think the increasingly base-bound Republican Party would lie down and play dead? That Max Baucus and Ben Nelson and Kent Conrad and the like would simply take marching orders from the White House? That the 24-7 gladiatorial media culture would not break out in a frenzy at signs of conflict? -- progressives too often start pointing fingers at one another, badmouthing their allies, and second-guessing their leaders. If that behavior, of which we've seen too much in the last difficult days, does not change, we won't deserve to get health care reform, though it won't be Beltway denizens and the blogosphere that will pay the price, it will be millions of Americans praying not to be plunged into bankruptcy by sudden illness or unemployment.

Nothing succeeds like success, what seems brilliant (how masterfully Obama has staffed the White House with experienced Congressional hands, how smart to let Congress take the lead, rather than ram a bill down the throats of the old bulls, like the Clintons are said to have done!) when things are going well has a thousand critics when the going gets rocky.

The fact is, we did not expect, and until late in his Presidential campaign had no reason to expect, that Barack Obama would stake his Presidency on achieving the health care reform that has eluded every President since the first Roosevelt. He had every excuse, once the economy went into tailspin, to treat health care as a desirable thing that could not be afforded given the mess the country is in, an item on a wish-list that must be deferred to another day. But he did not. He has continually doubled down on it, and there is no way on earth we would be in the middle of an encompassing national debate on health care, with the prospect for significant legislative action still much better than even, if Barack Obama hadn't led and if he didn't continue to lead. The organizing and public education done over the last year by Health Care for America Now, by the unions, by the Center for Community Change and myriad organizing and issue groups was critical in setting the table for Obama's leadership. But if he had not been receptive to it, and made it his signature issue, we would not be anywhere close to the likelihood of a health care bill today.

Let's do a reality check here: four of the five committees of the Congress that need to pass a health care bill have done so, and all four to date are strong reform bills including a public option. In the same week that the White House rattled progressives by reiterating strong support for the public option while refusing to declare it non-negotiable, it also made clear that it was ready to give up on the holy grail of a bipartisan bill - something that will hurt the Administration with its centrist supporters, but you would never know that from the dominant chatter on the left this week. In the 1994 Clinton Administration health care push, no bill ever made it out of committee.

Nevertheless it is healthy to keep expectations of politicians in check and grassroots action intense. Whether it is because the President has too much of a penchant for compromise, certainly for take-no-prisoners liberals who have never been able to elect a pure populist firebrand President and never will; because the Constitution and the minority-favoring Senate rules amplify the power of Max Baucus, Kent Conrad and a few others small-state big guys, despite the "filibuster-proof" majority in the Democratic Senate; or because the country is - I know this will shock many -- well to the right of the Hyde Park/Park Slope/Berkeley/Brookline/Dupont Circle universe in which I dwell and whose general policy preferences I share, let's assume we are going to have to work like hell to get anything close to the kind of health care reform and society we want, no matter who is President.

We have have only a matter of months, maybe weeks, to determine the fate of health care reform and with it, any chance of success on other hard battles like immigration and tax reform. We can spend our time working to win support for a positive vision of change, creating a stronger climate for President Obama and potential allies in Congress to rise to their best, or we can complain and attack. The choice is ours. There won't be another opportunity, I am fairly certain.

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