The Health Care Battle Resumes

Andy uses his weekly column in the Sunday Times of London to review the state of play on health care reform and to predict an Obama victory.

I remain convinced Obama will win this fight. Not totally; not without political cost; but win it he shall. And the strategy is really very simple. The most popular elements of the bill will be kept in and the most contentious left out.

The fundamental issue of costs will be deferred. A bill that prevents insurance companies from denying coverage to people with pre-existing illnesses; that creates healthcare exchanges, where people can buy their own insurance policy subsidised by the government; that brings agreed price reductions by the drug companies in return for all these new, previously uninsured clients: this will pass and be popular. How could it not? The option of a government-run insurance plan to compete with private ones will be either dispensed with or held in reserve. If, after a few years, health costs keep soaring and the private companies have not mended their free-spending ways, it could be brought back.

Obama has a solid majority and can achieve all this with Democratic votes alone. So why is he in such trouble? Partly it is that this kind of reform rightly stirs scepticism, and Obama has allowed a hapless and divided Congress to take the lead, muddying the message. Partly it is that the hard right is becoming more and more extreme and its fears have eclipsed the hopes of Obama’s supporters. But the most critical part, in my view, is the public understanding that after two massive bank bailouts and a vast stimulus package, with two still-intractable wars, the US cannot afford even the modest 10-year trilliondollar package Obama is proposing. And Obama’s inability to cut spending while the economy is so fragile means he is constrained from offering fiscal reassurance.

So, tactically, Obama is on the defensive. Strategically? Again, he is stronger than he now appears. When the health insurance bill is passed and elderly Americans are not rounded up into concentration camps and granny isn’t subjected to euthanasia, and when many uninsured people gain a peace of mind they have never felt before, and people become able to change job without fearing loss of insurance, the Republican scare tactics may come to seem absurd.