As the full scope of the nation's economic crisis came into view during the final months of the presidential campaign, pundits kept suggesting that Barack Obama would have to postpone his most ambitious plans--starting with his promise of major health care reform. It was too expensive, they said, and would soak up too much political capital.
Obama himself never seemed to agree. Whenever somebody put the question to him directly, as all three of the moderators in the televised presidential debates did, he indicated health care reform remained an urgent priority--one he would deal with early in his term. Last month, while introducing Tom Daschle and the rest of his health care advising team, Obama was even more explicit. Obama vowed to address health care "this year...and in this administration," noting that unaffordable health care was part of the economic crisis--not distinct from it.
Over the weekend, though, a New York Times story by Peter Baker seemed to fuel those doubts. Under the headline "Economy May Delay Work on Obama’s Campaign Pledges," Baker wrote:
Other signature promises may be addressed in piecemeal fashion in the opening weeks of the Obama administration but then put on a long track toward more comprehensive resolutions. For example, Mr. Obama plans to include what aides call “down payments” on his promises to expand health care coverage and promote energy independence in the economic recovery package he is developing, as a sign of dedication to the broader goals.
The passage was a bit ambiguous, suggesting that perhaps Obama merely intended to handle health care later in the first term--as opposed to the first hundred days (something nobody expects, as far as I know). But then Baker went even further during a panel discussion later reported in Politico:
“A lot of the things he said on the campaign trail you can now dispense with,” said correspondent Peter Baker. “For the moment he has to focus on the economy.”
Baker suggested Obama would tackle smaller-scale issues related to his major agenda items as a kind of political “down payment” on his promises, for now would retreat from even some of his firmest pledges.
“You’re not going to see universal health care, I don’t think, this year,” Baker said.
As a substantive matter, Baker could be right. After looking over the budget numbers or surveying the political landscape, Obama might decide it’s not possible in 2009 to enact reforms that would cover everybody--or nearly everybody, which is what Obama has promised. Even if he does, it’s always possible Congress won’t go along.
What’s more, everything I’ve heard from both the transition team and Capitol Hill suggests nobody is backing off major reform yet. Staff and advisers are proceeding under the assumption that it remains a "year one" priority for Obama. That means they are continuing to do what they've been doing for the last few months: Crunching numbers, consulting experts, meeting with interested parties--all in the name of fleshing out a plan that Congress could formally consider sometime before year's end.
One thing to keep in mind, as the debate moves forward: Obama and his allies may well decide they need to address health care affordability sequentially. The "down payments" could then take the form of institutional changes (like setting up an institute to study the effectiveness of new treatments) and significant coverage expansions (starting with Medicaid and the State Children's Health Insurance Program) that might still fall well short of universal coverage. The idea, then, could be to return later on--maybe in 2010 or 2011--with additional legislation, backed by additional funding, designed to finish the job.
Of course, whether that's a better strategy than trying to do most of the heavy political work now--with Obama's huge election win so fresh in collective memory--is another question entirely.