President Obama’s healthcare summit, broadcast live to a national and international audience, must have puzzled anyone who does not grasp the importance of his proposed reforms to the economic future of the United States, and to the political prospects of his own party and administration. Forty years ago, the American healthcare system cost about one per cent of the national GDP, today it accounts for nearly 20 per cent of a GDP which has grown from $3 trillion to more than $14 trillion. Healthcare spending consumes 30 times more than the federal budget for law enforcement, 80 times more than is spent on land management and conservation, and 800 times more than is spent on energy conservation. Even after all the horsetrading which has taken place, should Obama’s reforms succeed – whether by political suasion or the cruder mechanism of budget reconciliation – they will dramatically alter the status quo. One authority estimates that if the Senate’s version of the bill becomes law it will “provide about $196 billion per year down the income scale in subsidies to low-income and working Americans.”
The President’s courtesy towards his critics offered a shaming contrast with their jeremiads against “ObamaCare.” For months they have thundered against his creeping “socialism,” and blamed him for abandoning the country’s embrace of free markets and personal choice. They have accused him of endangering the future of healthcare with a stultifying bureaucracy of “death panels,” sweetheart deals for special interests and a number of other boondoggles. Surprisingly, the proposals have received only a slightly warmer reception from leftwing critics, many of whom have railed against the President’s supposed pusillanimity over pursuing a ‘public option,’ and his reluctance to use majorities in Congress and the Senate to trump his more intractable opponents.
The details of US healthcare reform are dauntingly complex – its current versions in Congress and the Senate run to more than a thousand pages – but its bottom line is reasonably straightforward. Either the current system, notoriously uneven, expensive and inefficient, will be left in the hands of private interests – insurance and pharmaceutical companies who have made staggering fortunes during the last few decades – or the government will introduce regulations to encourage competition, extend insurance to people who cannot currently afford it, and end some of the more extravagant exploitation which has been explained away as the workings of “the free market.” It is not hard to see how this has played into the larger partisan bickering which has dominated Washington since Obama’s inauguration.
Obama’s willingness to sit in a room with people who have spent much of the last year trying to smear him as an elitist, a “teleprompter” president, and an anti-American leftwing zealot, will either prove to be a political masterstroke or further expose the gap between his Lincolnian idealism and the ugly reality of contemporary American politics. Having dithered over whether this summit would turn out to be a political trap, the Republicans used much of their time to embarrass him with examples of corporate venality which his proposals would enable, and to tie him down in discussions of the nuts and bolts of his policies. And, for at least half of the summit there was a noticeable lack of tactical support from other Democrats, forcing Obama to wrestle with fairly recondite points, and trade opinions with junior members of the opposition. But he held his own comfortably, and never grew testy or pulled rank – as almost every one of his predecessors would have – in the back and forth of debate. In fact, Obama showed a shrewd instinct for the public relations opportunities which live television can allow. Some have claimed he is over-dependent on scripted speeches, so he showed an effortless understanding and recall of legislative minutiae. Others have accused him talking down to the public, so he absorbed criticism thoughtfully and responded respectfully and intelligently. But he also showed he wasn’t simply there to make nice with the other side. In one memorable exchange, he reminded Senator John McCain, who had rattled off a stream of sarcastic, ad hominem remarks, that the election was over and it was time to leave talking points alone and work towards solutions. It made McCain look foolish, cranky and out of touch – deservedly so.
Unlike the Clintons, who blundered in with an explicit agenda, only to be outmanoeuvred by the special interests they threatened, Obama has approached healthcare reform with remarkable tact. Standing on the sidelines, while Congress hammered out the details of the plan, the President has wisely avoided being drawn into discussions of specifics before his summit, but his distance from the process has also allowed different bills to pass in Congress and the Senate, and unsettled a significant portion of the Democratic party which now fears retribution in the mid-term elections. It has also made Obama look weak in the face of extreme criticism, and occasionally given his opponents the luxury of framing the debate to their advantage.
Despite these liabilities President Obama held fast to his political instincts and gambled on the power of transparent government. By drawing his loudest critics into the open, listening to them at length, and nudging them towards common ground, he punctured the myth of irreconcilable differences in Washington. He showed that reasonable compromise is still possible, even in the face of extremely negative criticism. His diplomacy undoubtedly gave the reforms a much needed second wind, but regardless of the outcome President Obama deserves full credit for delivering on at least one of his campaign promises and changing the tone in Washington, if only for a day.