The fate of the potentially historic health care reform initiative hangs precariously by the figurative thread. Passage of a plan that conforms to the core elements of the House bill could legitimately be called a success insofar as it promises to extend insurance coverage to tens of millions using subsidies from the federal government to pay for it.
Let us have no illusions, though, as to how much of the existing non-system is actually going to be reformed. All of the structural features that have been the source of gross inefficiencies will remain in place, only slightly amended. Whatever modifications in care and treatment do occur will depend mainly on the goodwill of the interested parties with the barest of governmental oversight. If the House bill is amended by the Senate in ways that weaken either the public plan option or the provision for partial funding via a tax surcharge on the super rich, we will have failed a once-in-a-lifetime opportunity.
Primary responsibility for this disappointing outcome rests in the Oval Office. Obama's approach to the health reform effort has been feckless. He never laid down markers specific enough and firm enough to serve as strategic guideposts for the backers of reform. He made no concerted effort to marshal support nationwide for his plan; indeed, he never presented a plan.
He temporized about all crucial reform components, including the public option which just two weeks ago Rahm Emanuel and David Axelrod publicly stated was expendable. He condemned at the same time ad campaigns directed at recalcitrant Democratic Senators. He invited into the White House every organization with a vested interest in perpetuating the status quo while continuing the high-minded rhetoric about keeping lobbyists from entering his administration's side door.
Finally, he seems totally ignorant of the elementary truth that for a president to get what he wants from Congress, he has to wade in, twist arms, jawbone, offer enticements, make threats, etc. A half-hearted facsimile of such a vigorous, savvy campaign at the eleventh hour is a futile gesture. That's why Lyndon Johnson succeeded on the civil rights front while John Kennedy failed. That at least is something Mr. Obama should know and take to heart.
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