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Jerome Karabel Headshot

Obama, FDR, and the Politics of Health Care Reform

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"I agree with you, I want to do it, now make me do it."
-- Franklin Delano Roosevelt

Facing what is likely to be the defining political struggle of his presidency -- the battle for health care reform -- President Obama emphasized in a town-hall meeting earlier this month that the "lobbyists and special interests are what is going to end up carrying the day" unless "ordinary Americans... stand up and say, 'Now is the time.'" With the deep-pocketed health care industry reportedly spending $1.4 million a day to oppose any fundamental change, the need for a countervailing popular movement could not be more urgent.

Yet shortly after this eloquent call for public pressure, President Obama then moved to undermine it, telling Congressional leaders that grass roots groups such as the Service Employees International Union, MoveOn, and Democracy for America should stop pressuring wavering Senate Democrats to support more robust reform. While continuing to express support for a public plan, President Obama has conspicuously refused to draw a line in the sand on the issue. At the same time, White House Chief of Staff Rahm Emanuel has repeatedly communicated that the Administration might be willing to support health care legislation that abandons the public option altogether.

Obama's awkward attempt to deflect grassroots pressure could not be more different from the stance taken by Franklin Delano Roosevelt, who famously said after his election in 1932 to a group of labor leaders pressing for favorable legislation, "I agree with you, I want to do it, now make me do it." What Roosevelt understood was that demands from below -- even clamorous ones -- were a resource for a president who aspired to be the architect of major social reform.

FDR's steadfastness of purpose and his ability to capitalize on grassroots pressure were nowhere more visible than in the battle over the Social Security Act -- the piece of legislation that, more than any other, defined his domestic legacy. In an eerie echo of the problems Obama is facing today, Roosevelt faced Senate opposition from within his own party . The leader of the opposition was a conservative Democrat from Missouri, Bennett "Champ" Clark, who sponsored an amendment that would have allowed employers to opt out of Social Security. The amendment enjoyed widespread support, passing in the Senate with over half the Democrats voting for it as well as all but three Republicans.

But Roosevelt and his supporters stood firm, recognizing that the Clark amendment would fatally undermine Social Security by narrowing the contribution base, limiting universality, and destroying portability (the ability to carry the pension from job to job). Promising to veto any legislation that included the amendment, the Roosevelt administration -- crucially assisted by its allies in the more liberal House of Representatives -- kept it out of the final legislation, the landmark Social Security Act of 1935. In the words of political scientist Jacob Hacker, a leading expert on the history of public and private social benefits in the United States, "Social Security passed not because Congress wanted it but because Roosevelt demanded it."

By unwaveringly insisting on a vigorous public plan and promising to veto any legislation that does not include it, President Obama could play a role similar to that of President Roosevelt in protecting the integrity of the Social Security Act. Certainly, the President is an able and articulate defender of a public plan. In a powerful critique of the logic of those who claim that a public option would drive private insurance out of business, he has pointedly asked: "If private insurers say that the marketplace provides the best quality health care; if they tell us that they're offering a good deal, then why is it that the government, which they say can't run anything, suddenly is going to drive them out of business? That's not logical." And, as he rightly notes, a public plan can keep down administrative costs, provide more options, and -- most critically -- force the insurance companies to compete.

It is precisely because a public plan is likely to bring down costs that private insurance companies oppose it so vehemently. Their fierce opposition unquestionably poses a formidable political problem for the President. But this is a battle that can be won, especially if a substantial number of members of the House of Representatives, emboldened by grass-roots pressure, make clear they will simply not vote for any legislation that lacks a robust public plan.

With opinion polls showing wide popular support for a public option, this is the time for President Obama to set aside his deep-seated instinct for compromise and to show the kind of steely resolve President Roosevelt displayed in defeating the Clark amendment. Obama's ability to rise to this challenge will do much to determine not only the fate of health care reform, but also whether he will join the ranks of that handful of presidents who have increased the security of the American people against what FDR memorably called the "hazards and vicissitudes of life."