Obama's Big Health Care Speech and Echoes of Clinton

A week from tonight, President Obama will address a joint session of Congress to push for health care reform. He will walk to the rostrum in the House chamber 15 years and 352 days (16 years for those comfortable rounding up) after President Bill Clinton did the exact same thing to address the nation on exactly the same topic.

Clinton's address on Sept. 22, 1993, sought to galvanize a Democratically led Congress behind a 1,000-page bill his White House health care task force, steered by First Lady Hillary Rodham Clinton, produced to deal with rising health care costs (twice the rate of inflation, Clinton said) and 37 million uninsured residents.

Here's the big difference. Clinton's speech came at the beginning of the process. The legislation his White House authored didn't arrive on Capitol Hill until Nov. 20. Obama will speak after three House committees and one Senate committee have already produced bills to their liking - bills Obama has generally praised.

Another difference? Clinton's speech succeeded. Post-speech polling showed the country somewhat open to Clinton's call for mandatory insurance coverage purchased and supplied through tightly regulated Health Maintenance Organizations. Obama's speech will occur after a summer -- a month, really -- of discontent driven by raucous town hall events, and deepening public opposition to Obama's health care plans and new-found skepticism about his ability to lead.

Doug Schoen, who took over polling for Clinton after the GOP landslide that propelled them to leadership of the House and Senate for the first time in 40 years, says the last thing this debate needs is another Obama speech.

"I think he's out of touch with what he needs to do," Schoen said. "I don't think he needs another speech. I don't think it's a question of oration. I think it's a question of the bill, the agreement, showing presidential leadership in getting the Democrats and Republicans in Congress, and their leadership, to the White House to hammer out an agreement that works in the interest of the American people."

White House officials say Obama will be more specific about what he wants. But, they caution, he won't be too specific. They cannot say, for example, if Obama will rule out the government-funded entry into private insurance known as the public option.

But when they discuss the public option, White House aides sound less-than-enthused.

"The president thinks it's the best way to achieve his ultimate goal - choice and competition - but certainly not the only way to get there," one adviser said.

Democrats already assume it's gone.

"This debate is focusing on a very minute sliver of the overall reform picture," said Anne Kim of Third Way, a think tank that says it represents the "moderate wing of the progressive movement."

"Treating it (the public option) as if it is everything has really, really skewed the public perception of what health reform is all about," Kim said. "Substantial reform can be done with or without a public option. It's the garnish that's on top. It's the means, but not the ends."

Kim also predicted liberals admit defeat and fall in line.

"You're going to see a lot of movement, I think, in the progressive caucus toward a more pragmatic position, particularly in the next 4 to 6 weeks," Kim said.

But in San Francisco today, House Speaker Nancy Pelosi said this: "In all three of our committees we have have come up with a public option. And so, we will have a public option in the bill. Let me say it another way: we can't pass a bill without a public option. Unless someone comes up with a better idea which we haven't heard yet."

Note Pelosi's caveat, unless a better idea surfaces.

What could that idea be?

No one knows.

But White House advisers hope it is found and agreed upon before the House votes a bill off the floor, probably in mid-October.

When asked if the House would approve a public option but give up on it in an eventual compromise with the Senate, where the public option lives in name only, a White House adviser advised, well, caution.

"I'm not sure that would be the way to go because once that vote goes up, it's much harder to walk that back."

The White House knows if the House bill contains a public option, liberals may abandon the final product if it's dumped in a compromise with the Senate. In other words, Democrats have to find a way to set the public option aside sooner rather than later.

Kim, of Third Way, said if the public option is dropped, liberals can achieve other reforms without bleeding Obama of more popularity.

"The public option is like the python that has swallowed the elephant," Kim said. "Once it's out of the way and digested and gone then everything else is very easy to deal with. What we already have on the table amounts to the next New Deal for middle class Americans."

It's unclear if liberals will regard a bill that addresses portability, pre-existing conditions, and preventative medicine as the "next New Deal." It's even less clear they will vote for it.

What is clear, Schoen said, is that Obama must stop believing every political problem can be solved with another "big speech."

"What hasn't been present is a clear direction, a clear plan and a clear strategy," Schoen said. "That's what the American people need and require and that's what's been absent."