Obama's Health-Care Gamble

Article excerpt

Byline: Howard Fineman

And why he may come to regret it.

President Barack Obama begins and ends each workday at the White House by going over a to-do list with his chief of staff, Rahm Emanuel. The two were reviewing things recently when Emanuel reminded him of the sheer size of the administration's workload, which includes fending off the Great Recession and dealing with terrorists in Iraq, Afghanistan, and now, evidently, Yemen. "You know, Mr. President," Emanuel said, "Franklin Roosevelt had eight years to deal with the economy before he had to lead a war. You have to do it all at once."

Nothing unusual about a little fawning in the Oval, but it prompts questions. Given the urgency of those challenges, underscored by the Nigerian bomber, was it wise for the president to spend most of his first year and political capital on a monumentally complicated overhaul of the nation's health-care system? And will the results of that gamble--not fundamental reform, but rather an expensive set of patches, bypasses, and trusses bolted onto the existing system--improve the lives of Americans enough to help him or his fellow Democrats politically?

Put me down as skeptical.

Perhaps not since the New Deal has a new president made such a massive bet on a single domestic initiative. I think I understand Obama's reasoning. It did not take him long (probably after the first round of CIA briefings) to realize that he was not going to be able to satisfy his liberal base on intractable, unwinnable foreign and security policy. It's easier to make history on the home front. And Obama was genuinely moved by the heart-wrenching health-care stories he heard on the campaign trail. So he sought--and may well get--things to brag about. The legislation will extend coverage to at least 30 million of the uninsured, and it will end, or at least limit, some of the insurance industry's most predatory practices.

But the crusade that is dragging itself toward the finish line doesn't quite feel like a triumph, let alone the launch of a new New Deal. The reasons offered for the undertaking have been ever-shifting. In the campaign, it was about rationalizing the system and saving federal cash; then it was about protecting coverage of the middle class; then about the moral duty to cover the uninsured. By the time Bill Clinton met privately with Senate Democrats on Obama's behalf, it was (in his telling) primarily about the political optics: the need to pass something, anything, to avoid defeat. …