When President Obama takes his case for health care to the American people tonight, his job is this: re-energize the large base of Americans who were adamant about the issue a year ago.
Senator Harry Reid and Rep. Nancy Pelosi can talk about health care until they are blue in the face, but only a contract between the President and the people will lead to meaningful reform. As the Congressional Budget Office spelled out last Friday, Congress isn't there yet in drafting cost-effective legislation. Perhaps the numerous groups with a vested interest in turning a profit have too much influence. Or perhaps Congress isn't thinking outside of the box. One thing is for sure: if the legislation is as ambitious as the 1993 Clinton legislation, a backlash will occur. That was a primary reason for the 1994 GOP takeover of Congress after Democrats ruled the Hill for 40 years.
But Democratic proposals on the Hill don't show the fiscal discipline or push-back against the powerful forces that make up the current non-system of unlimited corporate profits on the backs of people seeking care. Republicans don't want the same scale of reform as Democrats, but have a vested interested in passing some form of health care legislation: they can't go home to their constituents empty-handed and expect to get re-elected in 2010 and 2012. Most Americans want cheaper, better coverage, and do not want to be part of the 60% of people whose personal bankruptcy occurs because of an uncovered illness or accident.
Independents are a good test of whether legislation goes too far. Washington Post-ABC and Gallup polls show a clear pattern here: The bills on the Hill are not refined or targeted enough. They need a red pen and clear priorities. An emergency stimulus bill may not have created a huge public outcry, but health care entitlement with long-term unfunded costs like Medicare, Medicaid and Social Security is a prescription for trouble. As it is, Medicare becomes insolvent in 2050.
Republicans can't get traction so far on gridlock. Public appetite for a party of no isn't there. Stimulus bills and Sotomayor are evidence of that. But health care is different. The best way for the Administration to achieve its goals on health care is to give Congress unambiguous guidance on what the legislation should include, and what should be left out. That requires tough choices and guts. It requires what Obama promised in the campaign: standing up to lobbyists and special interest groups to work the best interest of the only folks who should count on this issue: a health care system that benefits citizens at the cost of any other interest.
As Obama also said in his campaign, change comes from the people. He can't do it alone. If he loses this battle, it will be easy but wrong to blame Washington. If Americans want health care reform, they have to ask for it loudly. Demonstrations, letters, petitions, and visibility is the way Americans have ended wars, created civil rights legislation, and had their voices heard on issues of every type. Without that kind of civic action, meaningful reform will be defined by the powers in Washington, not the power of the people.