GRAY MATTERS: The New Obama

Pulitzer Prize-winning journalist Saul Friedman (bio) writes the weekly Gray Matters column which appears here each Saturday. Links to past Gray Matters columns can be found here. Saul's Reflections column, in which he comments on news, politics and social issues from his perspective as one of the younger members of the greatest generation, also appears at Time Goes By twice each month.

---

Judging from the negative reaction to my attempt last week to provide a fair and balanced assessment of the health insurance reforms, which I support with reservations, I’ve been persuaded to amend my views. The primary reason is the new President Barack Obama, who at last has given us the presidency we hoped for.

Edward Luce of my favorite journal, The Financial Times, said it best. The shock of the election of Republican usurper Scott Brown to Ted Kennedy’s senate seat,

“turned him (Obama) from America’s lecturer-in-chief, who had even his most ardent supporters nodding off in mid-paragraph, into the robust campaigner who could electrify his troops...Mr. Obama finally took day-to-day control...By showing spine, Mr. Obama made it easier for Democrats in marginal seats to show spine as well.”

By finally abandoning his futile and damaging search for bipartisanship, to be liked by everyone, Obama was able to provide strong, more convincing leadership for tepid Democrats without losing committed liberals. In a sense, the blind and dumb Republicans, by hollering “hell, no,” helped remind Obama and the Democrats that they were Democrats – and in the majority, and in 2006 and 2008, were chosen to govern.

Thus, I was impressed by a speech he made in Iowa after his health insurance reforms became law, in which Obama clearly explained why, as he had intended and planned, “this is a middle-of the road bill.”

Perhaps because the burden of the battle had been lifted, Obama seemed to find a different voice, laying out as never before the thinking that went into his version of the health reforms. As he put it, without sounding defensive,

“This isn’t single payer, which some people wanted. It’s also not what the Republicans were looking for, which was basically to deregulate the insurance industry...This is a commonsense bill...It moves us in the direction of universal coverage.”

He dared Republicans to try to repeal its most popular provisions, knowing they would have difficulty seeking the repeal of the measure which would provide insurance, for children under parents' policies, until they reach 26, or covering children in with pre-existing conditions, or giving seniors $250 if they fall into the Part D drug doughnut hole.

But Obama also explained frankly that the bill, more than anything was not about health care, but about regulating and restricting the conduct of insurers so that care becomes accessible when you need it.

“What this reform does is build on the system of private health insurance that we already have,” he said. “But it finally tells the insurance companies that in exchange for all the new customers they’re about to get, they’ve got to start playing by a new set of rules that treats everybody honestly and treats everybody fairly. The days of the insurance industry running roughshod over the American people are over.”

Never before have the nation’s health insurers, which have been subjected to state regulations, faced rather stringent national regulation. Obama acknowledged that “it’s going to taker four years to implement this entire plan–because we’ve got to do it responsibly and we need to do it right.”

The president was challenged by an audience member who asked why a public option was not in the bill as part of the insurance choices. “Because we couldn’t get it through Congress,” Obama replied. That was true, in part, but Obama didn’t really push the issue and use his clout to organize support.

Nevertheless, he told his questioner,

“Thirty two million people are going to have health insurance because of this legislation...what this is is a historic step to enshrine the principle that everybody gets health coverage in this country. Every single person.”

Despite the complicated nature of the reconciliation process, the bill was passed in pieces by the newly disciplined Democrats who ignored the rather childish Republican tantrums. And like a magic potion, its passage has given new life to the Obama presidency, said The Financial Times. First, said the article, he “seems to be getting better at governing.”

That bodes well for him in the next fight for Obama intends to take on, with or without Republican help, the re-regulation of Wall Street and the nation’s rogue banks. That will be more difficult for Republicans to oppose; a few may even say “yes.”

It’s possible, as I have speculated, that with the health care issue behind him, Obama feels free to tend to other issues. Thus within a week of the passage of the bill, Obama fired a warning shot at Israel that said Obama will not be trifled with; sent a similar message to Republicans by making 15 recession appointment that they’ve been obstructing; he announced he had concluded a new arms reduction treaty with Russia, before he flew off to his war in Afghanistan to lecture its leader, Hamid Karzai, on the need to shape up and to tell the American troops why they are there.

Success at home helps build credibility and power and a president’s confidence for success abroad.

Still, the scars and wounds of the health insurance bill remain. And Obama will struggle to prove that he has no illusions about the for-profit insurance industry, which is beholden to stockholders and the bottom line. Already, the administration came down hard to thwart an effort by some insurance companies to avoid providing insurance to children with pre-existing conditions.

The companies promised to behave, but you know they won’t. Even as we speak, they’re plotting ways around the law. With his legislative success, Obama has gained power to be used to compel, as well as persuade the insurance companies to abide by the new rules.

But there will be plenty of opportunity, as the government writes the rules and regulations, for the insurance and drug companies to make mischief. New Yorker medical writer Atul Gawande notes in the April 5 issue that in the year after the passage of Medicare, Lyndon Johnson was forced to fight a series of nearly crippling rear guard attacks on the program, which was damned as “socialized medicine” by the American Medical Association and thousands of physicians who threatened to boycott Medicare. Today the AMA is an ally, but will the insurers and drug manufacturers behave?

While the Obama health reforms “could prove as momentous as Medicare,” Gawande wrote, “because most of the provisions phase in more slowly than Medicare did, they are even more vulnerable to attack. “ This time, he said, the threat comes from party politics, specifically the obstructionist Republicans.

If Obama and the Democrats follow up their legislative victory with an improvement in their prospects for 2010, the Republicans won’t continue a fruitless cause without their natural allies and source of funds, meaning the insurance and drug companies. They could use loopholes to deny or delay coverage and thus weaken the complicated the law and keep costs too high.

States could help implement and strengthen the law, yet 14 state attorneys general seek to overturn as unconstitutional its provision that everyone must buy health insurance eventually or face penalties. That is similar to state laws mandating the purchase of auto insurance or Medicare’s Part B penalties for persons who don’t sign up.

Nevertheless it’s a sign that resistance among conservative states and communities could endanger even this middle of the road health reform without the continued tough leadership of the new Obama.

Write to saulfriedman@concast.net

Comments

[Nance]

A gracefully accomplished volte-face.

I've had a front-row seat at the Coliseum where the giants of Insurance and Wall Street have chewed up and spit out their hapless victims and I am sickened by it. It feels good to have a voice, a direction, and a confident leader. Mine is one of the states that opposes the bill; now, to locate those who oppose the opposers and get to work!

[mary jamison]

Thanks, Saul.

[Sheilahalet]

Dear Saul - YOU ARE BRILLIANT!!!! I hope you are doing well.

[janinsanfran]

It looks as though Obama is serious about making this Rube Goldberg edifice work for patients since he has appointed Dr. Don Berwick as Medicare/Medicaid administrator. Gawande really thinks highly of Berwick (and I think highly of Gawande -- to such measures are citizen by-standers reduced for information.) Fox News et al are already in witch hunt mode about the guy. Another fight ...

[Darlene]

There are times I become discouraged, Thank you, Saul, for putting everything in perspective. I have hope again.

[Dee]

I sensed the change, but thanks to you Saul you were able to articulate it for me. You are a treasure. Hope you're feeling as well as you sound. Dee

[Nellie Johnson]

Thanks Saul. I always enjoyed your column in Newsday and I enjoyed this one. I have missed your common sense with emphasis on the "sense". As for the mid term elections, you are not out on that limb alone. Passing the health insurance reform should help Democrats in November. The new health law is not perfect but neither is the Medicare Part D drug program. Again thanks, I am glad I found you again.