Obama Performs a Triple Bypass

More than a year of efforts to push through health care reform cost Barack Obama dearly. Desperately, the president opted for viable legislation that falls far short of its promises.

At the end of 2009, the White House abandoned the plan to organize a system of universal public health care as an alternative to private insurance.

The political embarrassment increased as hesitations and failures of leadership became notorious when Obama tried to avoid the mistakes of Bill Clinton, who in 1993 presented a detailed plan for reform with little bargaining power in Congress. Obama left it to Capitol Hill to negotiate the special interests of the reform.

Obama lost any chance of bipartisan consensus given the Republicans’ conservative shift, which was apparent in the unanimous vote against the economic stimulus package in the first month of the presidential term. In January, the loss of the qualified majority in the Senate forced the president to attempt to take the legislative initiative into his own hands.

Bogged Down at Home and Abroad

The approval of legislative reform in the House of Representatives was of utmost importance and comparable to the Medicare bill proposed by Lyndon Johnson in 1965, which sought to provide subsidized health care to seniors 65 and older. No Republicans voted in favor of the bill, which was also opposed by 34 Democrats. The bill finally passed, at a time when the plight of domestic policy put a noticeable dent on foreign affairs.

The Chinese prime minister’s refusal to meet with Obama in last-minute negotiations during December’s Climate Change Conference in Copenhagen was followed by the Israeli government’s announcement of its plans to construct settlements in East Jerusalem, just as Vice President Joe Biden arrived in the country.

The diplomatic insults to the White House reached yet another high point this month when Vladimir Putin said that Iran’s Russian-built nuclear power plant will become operational in the summer, at the same time Hillary Clinton continued to negotiate strategic arms reductions in Moscow, the Middle East crisis and the military nuclear program of Tehran.

Even when viewed as mere tactical acts, negotiating such deliberate insults only furthered the idea that Obama was ensnared in a straight jacket of internal politics and in trouble by the slow economic recovery. America is losing its popularity.

Term Gains

A key victory in Congress has allowed Obama to relaunch his political agenda at a time when the approval ratings of the president fell below 50 percent.

The shortcomings of the reform, (behind Richard Nixon’s failed proposal in 1974 for compulsory employer-based insurance) which excludes 12 million illegal immigrants, are counterbalanced by the progressive increase in the number of U.S. citizens, about 32 million, who in the next 10 years will rely on health insurance.

The reform has immediate beneficial effects for much of the electorate: It prevents, in particular, the insurers from denying coverage to children with pre-existing conditions (prohibited in 2014), allows young people under the age of 26 to enjoy the benefits of their parents’ health contracts, offers tax credits to small companies that provide health insurance to their employees, and extends discounts on drugs for those over 65 years of age.

The downside of the reform is that compulsory health insurance, enforced by 2014, will raise taxes for families with annual incomes greater than $250,000 and for individuals earning $200,000. The reform is only the first step in stopping a worsening situation where the total health expenditure exceeds 16 percent of GDP. Coverage and effectiveness are far worse than they are in Portugal, where costs are lower than 10 percent.

Right now, reform has already opened legal disputes over state rights versus federal laws and the level of regulation for health insurance. It has also opened discussions about Congressional Budget Office estimates. The bill would cost $940 billion over the next 10 years in exchange for a $138 billion reduction in the federal budget.

Chimera Republican

Rising health care costs and the premiums for health insurance are inevitably on the minds of the majority of American voters, and it is with this purpose that they are counting on the Republicans to upset the Democrats in the November elections for the entire House of Representatives and one third of the Senate seats.

In the torrid climate of ideological polarization, there are credible Republican hopes of victory in November, but the fundamental elements of health care reform, particularly mandatory universal insurance, are unlikely to be changed.

To fight for votes, Republicans are starting a new campaign slogan by promising to repeal the Obama legislation. This is a difficult feat to achieve, yet the rallying call touches the core of the conservative electorate and can attract many Independents fearful of the consequences of increased involvement from a state with an out-of-control deficit.

The repudiation of reform requires an absolute majority in the Senate and control of the House of Representatives, something that is hardly achievable before the 2014 presidential election year, and at that time another 32 million Americans will already be covered by the new health insurance law.

For Democrats, the possible beneficial effects of the reform and expansion of health insurance will be irreversible, much like those of the initially controversial criminalization of racial segregation or the Johnson administration’s creation of health benefits in 1964 and 1965 for low-income individuals and people over 65.

This is an imperfect and controversial reform that is in many ways similar to the one enacted by former and future Republican presidential candidate Mitt Romney when he was governor of Massachusetts in 2006. The reform is presently condemned by a majority of the electorate and could cost the Democrats the majority in the House of Representatives in November, mainly to hold steady the current level of unemployment (9.7 percent). But right now, Obama has been freed from a political burden that constrained his presidency.