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Why Obama Can’t Abandon Health Care Now

In the wake of Massachusetts, President Obama faces two urgent decisions. One concerns his agenda for 2010 and beyond. I offered my advice on this last week, have not changed my mind, and won’t repeat myself.

The president must also decide how to proceed with health care legislation. Here I find myself in a paradoxical position. In this publication and elsewhere, I have argued since October of 2008 against beginning the new administration with an ambitious agenda that included comprehensive health reform. Nonetheless, I believe that the president and congressional Democrats would be ill-advised to shelve the effort at this point. Here are my reasons.

First: At the most basic political level, turning tail and running for the tall grass is bound to fail. Democrats who have already voted for health reform (and that’s most of them) can’t take their votes back. Whatever they do between now and November, they’ll be called on to defend what they’ve done. Are they going to say that they’ve changed their minds? Who would believe them?

Second: The American people won’t support representatives they don’t respect. The people respect sincerity, consistency, and strength of purpose. It is often the case that constituents will respect positions with which they disagree—if they think their representatives really mean it. One thing is clear: They won’t respect vacillation and weakness. Does anyone?

Third: The president and congressional Democrats have spent the past year arguing that health reform is in the national interest—that it will broaden coverage, begin to contain costs, increase disposable income, and help improve the government’s long-term fiscal outlook. Which of those arguments ceased to be true between Monday and today?

Fourth: The Founders designed a representative republic, not a plebiscitary democracy. Officials are elected to make judgments on behalf of the people, and the people get to judge those judgments. Large changes are always more uncertain than is the status quo, which is why change is so hard. At some point, elected officials have to tell their constituents, “I’ve done my best to think this issue through, and this is the conclusion I’ve reached. Now it’s your turn.”

There are two cogent arguments against the position I’m defending. The first is that there’s not nearly enough trust in government to sustain comprehensive health reform, and ramming it through in the face of public disapproval will only intensify mistrust and make matters worse. The shortage of trust was a compelling reason not to go down this road in the first place--especially in the context of necessary but expensive and unpopular measures needed to ward off a second Great Depression--but it doesn’t resolve the question of what to do now. It’s a judgment call: Are you more likely to begin rebuilding trust by sticking to your guns--or by in effect saying that you weren’t really that serious about the most important piece of social legislation in decades?

The second counterargument is that elected officials have involved the people in a year-long discussion about health reform, and the people have rendered their judgment, first in public opinion surveys, then in Massachusetts. Proceeding in the face of this judgment, the argument goes, is a gross violation of small-d democratic norms. This brings us back to the issue of the nature of our political system and the principles of conduct it embodies. One might argue that by the fall of 2006, the American people had rendered a negative judgment on the Iraq war and that George W. Bush’s decision to double down with the troop surge was undemocratic. Well, speaking as someone who publicly opposed that war well before we entered it, I have to say that I respect President Bush for making the decision he did ... and that it was probably right on the merits. Yes, it’s one thing to be the chief executive, another to be a member of the House. But that difference doesn’t mean that it’s always wrong, or undemocratic, for Congress to exercise independent judgment.

So what is to be done? President Obama’s opening post-Massachusetts gambit--his interview with George Stephanopoulos--was not helpful. Consider the following statement: “I would advise that we try to move quickly to coalesce around those elements of the package that people agree on.” Which people? If he means the American people as a whole, I’m not sure what that proposal amounts to. Sure, everyone would like restraints on insurance companies and constraints on costs increases (the two areas the president cited), but you can’t get them without other things that many people don’t like, such as costly coverage expansion and increased regulatory bureaucracy. If he means Democrats and Republicans in Congress, the zone of agreement is near zero and likely to remain there until November. Given the success of their obstructionism so far, why would Republican leaders change course? And after the failed negotiations in the Senate Finance Committee last year, who believes that Republican moderates would break ranks now? As for focusing on areas of agreement between House and Senate Democrats, I thought that’s what the discussion up until Monday was all about.

If the president sounds such an uncertain trumpet, who will follow? If he still wants legislation, he should invest the full authority of his office to persuade the House to endorse the Senate bill, accompanied by a package of amendments to be considered separately under the reconciliation process.  If he has concluded that he has no choice but to take the issue off the table, he should say so. If he continues to utter hopeful banalities devoid of concrete meaning, the fragile reform coalition will collapse within days, with consequences that will endure for decades.