03/18/2010 05:12 am ET Updated May 25, 2011

Can Obama Re-Unite Liberals and Moderates?

The 2008 Political Play of the Year was Barack Obama's ability to unite political liberals and moderates in their opposition to the Bush/Cheney economic policies and military engagements. His short resume and soaring rhetoric (short on specifics) allowed him to maintain appeal to a loyal cadre of liberal volunteers (and many who were not so liberal) knocking on the doors of enough moderate voters to win the presidency and at the same time elect a bunch of new Democratic congressional representatives who were moderate enough to be successful in traditionally Republican districts.

The 2009 Political Play of the Year may turn out to be the Republican policy of "just say no," because it puts maximum pressure on Democrats to keep their two wings flapping in the same direction. The strategy seemed high risk when Obama owned sky high job approval ratings and political momentum, and it may yet backfire, but it challenges Democrats to bridge the span between their most liberal and their most moderate members to get anything done, something that has proved to be a real challenge in the past.

And nowhere is this more evident than on the issue of health care reform, where all of the current discussion focuses on the areas on which Democrats disagree with other Democrats, and very little attention is being paid to the important provisions of the proposals that would do the most to help real people: health insurance reform, health insurance exchanges, and assistance to help people afford insurance.

"The Cause of My Life"

Let's talk about some real people. Shortly before his death, Senator Edward M. Kennedy shared a letter he had received from Mary Dunn, a 58-year-old schoolteacher in Eden, S.D. Mary wrote that she was unable to get health insurance after being laid off from her job due to a pre-existing condition, Type I diabetes. In her letter Ms. Dunn asked, "What am I to do after 39 years of teaching to acquire adequate health coverage?" In his Newsweek essay entitled, "The Cause of My Life," Kennedy asked, "How will we, as a nation, answer her?"

Kennedy raised a second example, Cassandra Wilson, a 14-year-old competitive ice skater, whose parents have run up huge expenses because she suffers from petit mal seizures and can't get insurance. In his Address to the Nation in August, President Obama introduced several examples of his own. Political groups like and Democracy for America have introduced us to thousands of individual stories of people who are being crushed by the current health care system.

The liberal groups Progressive Change Campaign Committee and Democracy for America went as far as to run this attack advertisement against Democratic Senator Ben Nelson of Nebraska. In the ad we meet Ralston, NE restaurant owner, Mike Snider, whose health insurance rates are increasing 42% forcing him to consider dropping insurance for his business and his family.

All of these stories have one thing in common; they can be addressed through a combination of health insurance reforms; health insurance exchanges and other efforts to lower the cost of health insurance for families and business that are common to all of the bills in congress.

The health insurance reforms that are part of every bill under consideration will help Mary Dunn, Cassandra Wilson and millions of others by ending exclusions for pre-existing conditions and yearly or lifetime limits on coverage for people with expensive illnesses. For most of the individual who have become discussed by all of the groups supporting health care, these are the protections that will matter most replacing the anxiety of people with illnesses and nowhere to turn, with the security of coverage that you can keep even if you are sick or get sick.

Health Insurance Exchanges, also in every bill that is under consideration, continue to be the most important and least talked about aspect of health care reform. The exchanges are markets for health insurance created by government at the state, or regional, or national level (regional or national exchanges make the most sense, to break up local monopolies and so small states can be part of larger markets) and they offer the individuals and smaller businesses that qualify to enter them a broad range of choices of insurance plans to buy.

Health Insurance Exchanges are modeled after the popular health insurance system all federal workers use and they are just what Mike Snyder needs to keep costs for insuring his workers manageable so he can keep his restaurant business going and create jobs. He would be able to shop among a half dozen or more plans that meet the to-be-defined minimum standard, as well as others that offer stronger coverage for a higher price.

And Exchanges are the nuts and bolts necessary first step toward other insurance options like health insurance coops or the much debated public insurance option. If, like us, you support a pubic option, then you have to strongly support the establishment of Exchanges as soon as possible, because they are the markets in which any public option would compete, and it is likely to take a couple of years to get the Exchanges up and running. Whether some form of a public option makes it into the reform package this year (or in subsequent bills in future years) is a matter of little consequence if the work to build the Exchanges does not get started this year.

The path from here forward could be very easy or very hard.

Thomas Friedman is fond of paraphrasing Golda Meir, in saying that there will be peace in the Middle East when both sides love their children more than they hate their neighbors. Well health care reform would be easy if people wanted their policy proposals more than they want to deal defeat to their enemies.

Nearly every Republican has made their choice; their goal for health care reform is to ensure that Barack Obama does not win. On the other side many Democrats are threatening to withdraw their support from any bill that does not punish the Insurance companies, which many define as any bill that does not include a public option.

The most important elements of health care reform are not the most controversial. As President Obama has noted, eighty percent of the policy proposals are common to every bill. It is possible to see how a bill could get through the obstacle course ahead - pass a Senate floor vote, and a House floor vote, get through a Conference Committee, and then pass each chamber again and then get to the President's desk - fairly easily.

But at other times the path ahead looks too long, steep and narrow. A week ago it looked like any bill without a Public Option was dead in the House and any bill with one was dead in the Senate. Creative people are trying to come up with compromise solutions that try to split the difference between seemingly mutually exclusive principle -- and these efforts may prove successful.

Our favorite contender was recently introduced into the discussion by Senator Thomas Carper (D-DE). We have been calling it the Public Option Option (POO) which sets up Exchanges and lets states decide if they want to add a Public Option or not. Massachusetts already has one, California can't afford one, and other states can decide if they want one or not.
In the final analysis optimism has gained the upper hand over pessimism. Despite Republicans sitting on the sidelines, Democrats have to have "Quote: health care reform, unquote." And there are enough areas of agreement to make compromise possible. But the real reasons to bet on success are Mary Dunn, Cassandra Wilson, Mike Snyder, and all the individual stories of people who need health care reform right now.

Elected officials like to threaten to withhold their vote to gain bargaining leverage, but few who support the idea of health reform will hold out for their ideological principles when it means they would be voting against a bill that helps Mary, Cassandra, and Mike.

This article is the third in a series on
Part 1: Compromise Needed to Pass Health Insurance Reform
Part 2: 5 Steps to Major Health Care Reform
This is Part 3: Can Obama Re-Unite Liberals and Moderates?