A victory that may come to define the Obama presidency

The deal on US healthcare is a compromise, but still hugely significant

American presidents, it is often said, have about a year to make their mark – enact a major piece of legislation that then shapes and defines the rest of their term in office. Failure to choose the right weapons, or the right turf, can be fatal.

Barack Obama has at times struggled to find a cause he can truly make his own. He seemed to take on too many issues at once, from Middle Eastern peace to climate change, without demonstrating that he had a clear strategy to carry them through. With the Senate's passage of his bitterly contested healthcare bill, the clouds have lifted a little. Just in time for the Christmas break, the President can afford to wipe the sweat from his brow and contemplate his holiday with some satisfaction.

That is almost certainly a lost cause now, a casualty of a savage Senate battle against resurgent Republicans who closed ranks against Obama's supposedly "socialist" health reforms with frantic and, at times, disconcerting zeal.

Nor is the battle over the trimmed-down health reform package finished, even now. What the Senate agreed to on Christmas Eve was not the same package that the House of Representatives nodded through in the autumn. A joint committee will have to meet, therefore, probably within the next few days, to fuse the two bills into one, which will then go back to both houses. Only then will the bill become law, hopefully before the President delivers the State of the Union address next month.

Nevertheless, we should not lose ourselves in all the details about messy compromises, and so miss the vital significance of what Mr Obama is tantalisingly close to achieving. The President is surely right to assert that most of a loaf is better than no loaf at all, and to describe his health reform package as the most important item of social policy in America since the 1930s.

Tens of millions of poor Americans who have been denied healthcare cover in the past can in all likelihood look forward quite soon to a day when they will be able to face the prospect of illness with a little more equanimity than they do now. Under the new bill, most people who are not currently covered by Medicaid – the existing federal and state-funded insurance scheme for those on low incomes – will either have access to it, or will receive subsidies to obtain health insurance elsewhere. Businesses will be obliged to offer coverage to their employees. The number of potential beneficiaries of these changes is huge, and could affect the lives of more than 30 million people.

Democratic presidents and politicians since the era of Teddy Roosevelt have fought and lost battles to set up a comprehensive national system of health insurance for Americans – a system that would benefit the many, not just the few. The Clintons tried their hand at this and failed. If Mr Obama closes this deal, he has a chance to earn a place in American history as a great reformer.

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Democrats should heed Daley's steer-to-the-center advice

By David S. Broder
Sunday, December 27, 2009; A21

On the day before Christmas, President Obama found two presents under his tree. One was the health-care reform bill passed that morning by the Senate, a historic measure so freighted with promise and problems that it could blow up.

The other was an op-ed in The Post by William Daley, his fellow Chicagoan and one of the canniest Democrats I know, warning Obama that he is on the verge of losing his hold on the vital center of politics.

Daley, a former commerce secretary who shares with his brother, Mayor Richard M. Daley, and their late father an iron grip on reality, cited all the signs of defection among swing voters whose support in 2006 and 2008 swelled Democratic ranks in Congress and elected Obama. He ticked off the losses Democrats suffered in the only two gubernatorial elections of 2009, in New Jersey and Virginia; the polls showing independents rejecting Democrats (and such handiwork as the health-care bill); a wave of early retirements by marginal House members; and, last week, the party switch by Alabama Rep. Parker Griffith from Democratic to Republican.

To be sure, there are counter-indicators not mentioned by Daley, including a string of special election congressional victories for the Democrats, culminating in New York's 23rd District. The Republican civil war that enabled this upset is symptomatic of a growing GOP liability that could cripple the party's comeback hopes.

But this does not weaken the thrust of Daley's main argument. His target is the left of his party -- the grass-roots liberal activists who condemn the centrist Democrats sitting in marginal seats for blocking some provisions of health-care reform, for example, and the leaders of organized labor who threaten to retaliate by withholding their support from the moderates.

These groups put heavy pressure on Obama to move his agenda to the left -- even when a Congress with swollen Democratic majorities is balking at the measures that Obama already has endorsed.

The president is surrounded by people who share Daley's grasp on reality, none more important or better placed than Rahm Emanuel, the White House chief of staff and a fellow Chicagoan. But the picture is not so clear on the other end of Pennsylvania Avenue.

House Speaker Nancy Pelosi's inner circle is made up of long-standing veterans of gerrymandered House districts, virtually immune from Election Day challenge, just as she is. The wants and needs of "the Democratic base" count heavily for them, and Daley's warnings may be resented or ignored.

Senate Majority Leader Harry Reid's home-state party in Nevada is as closely tied to the unions as Michigan used to be in the days of Walter Reuther, and Reid views the world from that perspective.

As a loyal Democrat, Daley insisted in the closing paragraphs of his op-ed that his party is not doomed to ruin. It can still avoid anything more than a minimal setback in 2010, he said, if it will simply "acknowledge that the agenda of the party's most liberal supporters has not won the support of a majority of Americans -- and, based on that recognition . . . steer a more moderate course on the key issues of the day, from health care to the economy to the environment to Afghanistan."

I am not so certain. It will be up to Obama to steer the Democrats in that direction. No one on Capitol Hill is likely to lead such a change. The first test will come with the revisions of health care in the House-Senate conference and whether the White House insists on strengthening the cost-saving measures in the bills.

The larger tests will lie in Obama's 2010 State of the Union and budget messages -- whether he fulfills his promise to start addressing the runaway budget deficits left in the wake of the recession. A presidential endorsement of the much-discussed commission empowered to slow the hemorrhage of red ink would signal to voters that Daley's message has been heard.

E

Compromising on 2 Issues, Obama Gets Partial Wins

WASHINGTON — President Obama’s chief of staff, Rahm Emanuel, likes to say that the only thing that is not negotiable is success. The last 48 hours offered a case study in how the president applies that maxim to governing.

After weeks of frustrating delays and falling poll numbers, Mr. Obama decided to take what he could get, declare victory and claim momentum on some of the administration’s biggest priorities, even if the details did not always match the lofty vision that underlined them.

From Copenhagen to Capitol Hill, the president determined the outer limits of what he could accomplish on climate change and health care and decided that was enough, at least for now. He brokered a nonbinding agreement with other world powers to fight global warming, averting the collapse of an international summit meeting. And he blessed a compromise on health care to guarantee the votes needed to pass the Senate.

Neither deal represented a final victory, and in fact some on the left in his own party argued that both of them amounted to sellouts on principle in favor of expediency. But both agreements served the purpose of keeping the process moving forward, inching ever closer toward Mr. Obama’s goals and providing a jolt of adrenaline for a White House eager to validate its first year in office.

Mr. Obama seemed encouraged by the progress. He had just left Denmark on Air Force One with the climate change agreement in hand when he reached Senator Harry Reid of Nevada, the majority leader, and heard of the health care deal. “He was, fair to say, pretty happy,” Mr. Reid later told reporters.

After landing in a Washington-area snowstorm and retiring for a few hours of rest, Mr. Obama appeared in the Diplomatic Reception Room of the White House on a snowy Saturday. He called the health care deal “a major step forward” and the climate change agreement an “important breakthrough.”

Still, he acknowledged that neither was exactly what he had set out to achieve. On climate change, he said that the Copenhagen pact “is not enough” and that “we have a long way to go.” On health care, he noted that “as with any legislation, compromise is part of the process.”

In an interview, Mr. Emanuel said the developments showed that Mr. Obama “sets out the North Stars for us” in terms of broad and ambitious goals, but is willing to let his staff and allies haggle over the specifics. “He doesn’t negotiate the ends,” Mr. Emanuel said. “He’s very open to discussing alternative routes.”

Critics cautioned against making too much of the agreements. “They are pyrrhic victories,” said John Feehery, a Republican strategist and former Capitol Hill aide. “Neither deal will necessarily improve his poll ratings with swing voters, nor will they energize his base. And neither take the necessary steps to put the American economy back on track, which should be the only thing he is thinking about right now.”

The climate deal in particular may seem more than it is. With the Copenhagen conference unable to agree on binding limits on greenhouse gases linked to climate change, Mr. Obama settled for a three-page agreement with no short or midterm goals but a long-term commitment to prevent world temperatures from rising by more than two degrees by midcentury.

The health care legislation is much further along, and while it compromised on abortion and abandoned a government-run health plan, it still includes many changes long favored by Democrats. If it passes the Senate this week as now appears probable, it stands a much better chance of actually becoming law, culminating decades of largely failed efforts to revamp the nation’s health care system.

Mr. Obama has put a high value on process and keeping things moving, recognizing that history generally does not remember the to and fro, only the big sweep of presidential accomplishments. He may not get the health care plan he envisioned but, if the legislation passes, he will insure 30 million more people, stop insurers from denying coverage for pre-existing conditions and at least try to rein in costs. He will not end climate change in his presidency, and may not get the market-based emission caps he wants, but he may move the country, and the world, toward meaningful action.

Of course, to many on both sides of the aisle, there is a less sympathetic narrative. To the left, Mr. Obama seems increasingly to lack the fire to fight on matters of principle. To the right, he appears to be overreaching, saddling the country with debt and the weight of a bloated and overly intrusive government.

Yet whatever their merits, coming at the end of a tough first year, the developments of the past couple of days were something of a balm for the Obama White House. Little this year has come as easily as Mr. Obama and his team once imagined, but as they sort through the balance sheet, they argue that the mediocre poll ratings do not reflect the record.

Mr. Emanuel noted that a year ago, the economy was on the brink of a depression and the financial and auto industries were near collapse. Today, the economy is growing again, and banks and one of the large car companies are repaying government bailouts, although unemployment remains perilously high and the national debt is soaring.

He also ticked off a series of legislative measures that passed with little notice — an expansion of health care for lower-income children, new regulations on the tobacco and credit card industries and an overhaul of military acquisition. With health care now looking closer to passage, Mr. Emanuel called it the “most significant legislative first year of a first-term president since Franklin Delano Roosevelt.”

Even so, White House officials are frustrated at the difficulties they have had. As they talk about their agenda for 2010, some Democrats have suggested looking for a few easy, popular initiatives as sort of a breather between the big-ticket, often polarizing proposals that dominated 2009.

The problem, as they noted, is that they had expected some of this year’s proposals to be more popular, only to discover otherwise in a treacherous political climate.

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The two big mistakes

Michael Tomasky

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Obama is handcuffed by the political mess at home

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Health-care debate wearing on Democrats' unity, popularity

By Dan Balz
Washington Post Staff Writer
Saturday, December 19, 2009

Amidst the spectacle that has become the health care debate, Democrats have taken comfort in the belief that they will be rewarded politically if in the end they pass something -- almost anything. That proposition is being sorely tested in these final days of maneuvering.

For all the talk of the damage President Obama has sustained during this long and difficult year, congressional Democrats have suffered at least as much -- and will have to face the voters far sooner than the president.

Senate Majority Leader Hary Reid announced Saturday he had the 60 votes to pass the bill. The House still must be persuaded to go along but Obama and the Democrats are one step closer to achieving the goal that has eluded so many presidents and Congresses. That in itself is a significant achievement.

The long fight has been costly, however. The health care debate has split the Democratic coalition. Unity has given way to bitter infighting. This has been a moment for individuals to make war on one another.

What good will that existed among Democrats at the start of Obama's presidency has been fractured and will be difficult to put together again. The events of the past week underscore that reality.

Joe Lieberman who bolted the party in 2006 to salvage his Senate seat and then accepted the Democrats' generosity to maintain his committee chairmanship despite having backed John McCain in last year's presidential race, held the party hostage in negotiations, enraging many liberals.

Howard Dean, who has grievances about the way he was discarded by the Obama team after running the Democratic National Committee for four years, has led a vocal guerrilla war against the bill from outside the Congress, enraging the party leadership.

Democratic centrists have extracted costly promises to stay aboard but still fear for their political futures. Bloggers and progressive activists have counterattacked against them vowing retribution. Labor is unenthusiastic to hostile.

Progressives in Congress have swallowed hard over the compromises that have been needed to round up enough votes to beat back a Republican filibuster.

Hard-headed politicians would say there was no way to avoid this kind of squabbling, given the stakes and complexity of health care reform and the rules of the Congress. There are no immaculate legislative struggles on a piece of social legislation of this consequence.

Leading Democrats also believe that, in the end, voters care less about process than about outcomes. If, in the face of united Republican opposition, the Democrats produce historic changes in the availability of health care to millions more citizens and protect against some of the arbitrary practices of the insurance industry, that will override the messy path to success.

But there is something broader for Democrats to worry about as they try to finish their work this year and prepare for 2010 and the midterm elections. What began as an undercurrent of dissatisfaction has grown throughout the year. Disappointment with the president is dwarfed by discontent with the Congress.

No Congress is ever loved, but the assessments of this Congress are striking in their negativity. In the most recent NBC News-Wall Street Journal poll only seven percent rated the performance of Congress above average, and 34 percent called it one of the worst.

Two benchmarks put that number into perspective. In October 1994, shortly before Republicans ousted Democrats from power in the House and Senate, 16 percent called that Congress one of the worst. In October 2006, just before Democrats recaptured control, 25 percent called that Congress one of the worst. In the past five months, the percentage who rate this Congress that low has jumped 11 percentage points.

Thirty-five percent gave the Democratic Party a positive rating, still higher than the 28 percent who rated the Republican Party that way. But since February, Democrats have seen their overall image go from net positive to net negative. Republicans, while still living in negative territory, have improved slightly.

A third finding underscores the problem for Democrats: 38 percent said their member of Congress deserves to be reelected, while 49 percent said it is time to give a new person a chance. That is identical to the percentage who said give a new person a chance a month before the 1994 GOP landslide and slightly above the number a month before the 2006 Democratic takeover.

Why won't that anti-Washington sentiment fall equally on Republicans and Democrats? Because it rarely does. Republicans are hardly secure or popular, but Democrats are in control. If the public is ready for change again next November, the Democrats will feel the brunt of that anger.

Many factors contribute to the dissatisfaction with Washington. People are angry about bailouts for bankers. The unemployment rate is at 10 percent. They see the deficit rising and worry about the long-term consequences. Conservatives and liberals question whether their leaders have the right priorities.

Health care has exhausted the Democrats and tested their capacity to govern. Democrats hope that passage of a health care bill will prove to be a political restorative. But the longer the debate has gone on, the less people like what they think they may be getting. Congress may be on the cusp of a historic achievement, but right now the public believes the status quo is preferable to change.

Democrats have a dual problem. They must find the votes to pass a bill to avoid the charge that, even with their big majorities, they are incapable of governing. They also must persuade voters that the policy changes they want to enact include far more plusses than minuses.

That is a big challenge, not only for Obama and Democratic leaders. They are governing in difficult times and and see themselves close to the finish line on health care. But they are nonetheless bracing for a difficult election year in 2010.

Congressional staffers turn lobbyists:

Health care lobby drafts army of insiders to help fight overhaul

Former staffers of lawmakers from Harry Reid to Mitch McConnell push clients' agenda

Tribune Newspapers

December 20, 2009

WASHINGTONDavid Nexon had a big problem. An early version of national health care legislation contained a $40 billion tax aimed squarely at members of the medical device trade association he represents.

Nexon, a former adviser to the late Massachusetts Sen. Ted Kennedy, went to work. He marshaled 14 people like himself -- lobbyists who were once congressional aides, many of them from staffs of congressional leaders or committees that had a hand in crafting the health care overhaul.

When Senate Democrats unveiled their bill in mid-November, Nexon's handiwork was evident. The tax on device-makers was still large -- $20 billion -- but only half what it might have been without the efforts of Nexon and his fellow lobbyists.

Nexon's team is an illustration of how deeply the health care industry has embedded itself on Capitol Hill, using former aides of lawmakers and ex-lawmakers themselves.

An analysis of public documents by Northwestern University's Medill News Service in partnership with the Tribune Newspapers Washington Bureau and the Center for Responsive Politics found a revolving door between Capitol Hill staffers and lobbying jobs for companies with a stake in health care legislation.

At least 166 former aides from the nine congressional leadership offices and five committees involved in shaping health overhaul legislation -- along with at least 13 former lawmakers -- registered to represent at least 338 health care clients since the beginning of last year, according to the analysis.

Their health care clients spent $635 million on lobbying over the past two years, the study shows.

The total of insider lobbyists jumps to 278 when non-health-care firms that reported lobbying on health issues are added in, the analysis found.

Part of the lobbying pressure on current members of Congress and staffers comes from the powerful lure of post-congressional job possibilities.

"There's always a worry they may be thinking about their future employment opportunities when dealing with these issues, particularly with health care, because the stakes are so high and the breadth of the issues -- pharmacies, hospitals, doctors," said Emory University political scientist Alan Abramowitz.

Lobbyists' earnings can dwarf congressional salaries, which currently top out at $174,000 annually for lawmakers and $156,000 for aides, though committee staff members can earn slightly more.

In the health care showdown, insider lobbying influence has magnified the clout of corporate interests and helped steer the debate away from a public insurance option, despite many polls indicating majority support from Americans, according to Rutgers University political scientist Ross Baker.

"It imposes a kind of conservative bias on the discussion," said Baker, himself a former Senate staffer.

The lineup of insiders working for clients with health care interests includes at least 14 former aides to House Majority Leader Steny Hoyer and at least 13 former aides to Montana Democratic Sen. Max Baucus, the chairman of the Finance Committee and a key overseer of the health care overhaul.

Nexon, who is now senior executive vice president of the Advanced Medical Technology Association, is among at least a half-dozen former Kennedy aides lobbying on health care.

Nexon acknowledged the value of congressional connections, "but in the end, it's not who I know, it's what I know."

It makes sense to hire former staffers for the health care showdown because they tend to be "more generalists, dealing with a broad range of issues," something that is in demand for legislation that sprawls across at least a half-dozen federal agencies and encompasses issues ranging from tax policy to hospital reimbursement rates, according to Nexon.

But specific issues also get specialized help. Earlier this year, the Christian Science Church hired a former Kennedy staffer, Carolyn Osolinik, and three of her colleagues at the Mayer Brown law firm, all veterans of Capitol Hill. The firm has been paid at least $110,000 so far to push a provision requiring insurers to consider covering Christian Science prayer treatments.

Phil Davis, a senior official of the church, said the church wanted access to decision makers. "The noise level goes sky high. It's hard to get in to talk to people," he said.

The largest insider lobbying cadre belongs to the Pharmaceutical Research and Manufacturers of America, or PhRMA, which employs at least 26 former congressional members and staffers, according to Medill/CRP research.

Two other drug interests, biotech firm Amgen Inc. and the Biotechnology Industry Organization trade group, with at least 24 and 16 insiders respectively, ranked second and fourth among reported hiring over the past two years of lawmakers' former staffers and members of committees considered in the analysis.

"The numbers shouldn't surprise anyone," said Ken Johnson, a PhRMA senior vice president. "Former staffers have a unique understanding of how the legislative process works. And when you are trying to advocate on behalf of smart public policies, you want smart people on your team."

But Bob Edgar, president of Common Cause, a nonpartisan, nonprofit watchdog group, had a harsher assessment, blaming "a toxic cocktail of insiders and money" for short-circuiting a government-run plan that would have competed with private insurers.

"We'll get a bill. And the president will sign it. But it'll be less than the country deserves," said Edgar, a former six-term member of the House.

Health care lobbyists increase their effectiveness by strategically targeting their campaign contributions or the donations of the interests they represent, Edgar said.

Health industry contributions to congressional candidates have more than doubled so far this decade, rising to $127 million in the 2008 election cycle from $56 million in the 2000 election, with disproportionate sums going to the party in power and to members of committees that oversee health care, according to the Center for Responsive Politics.

But lobbyist and former Kennedy staffer Andrew Rosenberg said political conditions, not big money or the predispositions of lobbyists sidelined a public option.

"You could see this coming from a long way off. The Democratic Party is now the big tent party. They have to get to 60 votes. That is the reality," Rosenberg said. "It was going to have to be something that appeals to moderates" opposed to expanding government-run health insurance.

 

Tribune Newspapers' Tom Hamburger and Joe Markman contributed to this report.

Sen. Ben Nelson, right, agreed after hours of negotiation Friday to back the Senate Democrats’ legislation, making him the pivotal 60th vote.

"Senate Democrats said on Saturday that they had clinched an agreement on a far-reaching overhaul of the nation’s health care system, and that they were on track to approve the legislation by Christmas over fierce Republican opposition."

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Johann Hari: The truths Copenhagen ignored

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Copenhagen closes with weak deal that poor threaten to reject

Copenhagen climate conference: The grim meaning of 'meaningful'

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Gutless, yes. But the planet's future is no priority of ours

Obama emerges from climate talks with slender pact and bruised stature

US president urges decisive action on climate change, but shows no sign that Washington will take such steps itself

Barack Obama emerged from the chaotic final hours of the Copenhagen summit last night having salvaged an agreement for action on global warming – and his own reputation as a politician who can bridge the most challenging of political divides.

After 15 hours of negotiations, an exhausted looking Obama said he managed to secure a deal on climate change incorporating America's three main goals of emissions cuts, financial aid for the poorest countries, and a measure of accountability for emissions pledges from developing countries.

But he acknowledged the skimpy 2.5 page draft produced at the end of his effort was not the comprehensive agreement he had come to Copenhagen for.

"I think it is important that instead of setting up a bunch of goals that just end up not being met, that we get moving," he said. "We just keep moving forward."

Obama's hectic day of negotiations began immediately on his arrival in Copenhagen, when he encountered what he described as a "fundamental deadlock" between rich and developing countries.

Much of that was a product of the deep resentment at America for its emissions reductions target: a 17% reduction over 2005 levels by 2020. That offer too was conditional on Congress passing climate change legislation. In the final days of the summit, a more vexing issue emerged over America's demands that China and other rapidly emerging countries offer an accounting of their actions to curb the growth of greenhouse gas emissions.

Obama emerged last night claiming to have wrung an important concession from China and India to offer a fuller accounting of its emissions reductions.

"The truth is that we can actually monitor a lot of what takes place through satellite imagery and so forth," he said.

The reassurances are crucial for American domestic political consumption, where there is concern about losing economic ground to China and India in the transition to a clean energy economy. It did not seem at first that the president would be capable of breaking down the divide. Obama's eight-minute speech to the summit was viewed as a huge disappointment.

Although he called for bold and decisive action, Obama – who had been skittish at going to Copenhagen in the first place – offered no sign that Washington was willing to take such steps itself.

There were no further commitments on reducing emissions, or on finance for poor countries, beyond Hillary Clinton's announcement that the US would support a $100bn global fund to help developing nations adapt to climate change. He did not press the Senate to move ahead on climate change legislation, which environmental organisations have been urging for months. Obama did say America would follow through on his administration's clean energy agenda, and would live up to its pledges.

But in the absence of any evidence of that commitment the words rang hollow and there was a palpable sense of disappointment in the audience. He warned African and island countries that the alternative – of no agreement – was worse.

Obama's lacklustre speech proved a frustration to a summit that had been looking to him to use his stature on the world stage, and his following among African leaders, to reach an ambitious deal.

But by the end of the day, after Obama spent hours closeted with Chinese, Indian, South African and Brazilian officials, he managed to pull the situation back from the brink.

In his press conference, Obama held up the results of his deal-making as a sign that the era of American isolation under George Bush was over, and that he had returned the country to a position of leadership.

The day of diplomacy also allowed him to reassert the political skills which have not been seen to best advantage in the US during the struggles over health care and Afghanistan. "The time has come for us to get off the sidelines and shape the future that we seek. That is why I came to Copenhagen today," he said. "I believe that what we achieved in Copenhagen is not going to be the end, but rather the beginning."

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China holds the world to ransom

Michael McCarthy:

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The Conservative-Christian Big Thinker

By DAVID D. KIRKPATRICK

Robert P. George, a Princeton University professor of jurisprudence and a Roman Catholic, is this country’s most influential conservative Christian thinker.

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“If there really is a vast right-wing conspiracy,” the conservative Catholic journal Crisis concluded a few years ago, “its leaders probably meet in George’s kitchen.”

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Democratic congressman from North Carolina angers supporters by voting against health-care bill

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"People want change, and when someone puts their foot in the door to kill the whole thing, that's what has them riled up," said Michael Lawson, an African American leader of the state Democratic Party and one of Kissell's constituents. "It's almost like 'Mr. Smith Goes to Washington,' but Mr. Smith turned out to be somebody that wasn't Mr. Smith."