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Health Care: Now, It's War

President Obama's speech to Congress and the nation this week recalled the heights his rhetorical power reached in last year's campaign. It also made clear he has abandoned any hope of a health care bill that's bipartisan enough to get 70 votes or more in the Senate.

What emerges from this year's historic debate will now be a distinctly Democratic bill opposed by virtually every Republican in both the House and the Senate. It will pass or fail depending entirely on Democratic leaders' ability to rally their own troops in support. In the Senate, that support will probably need to be unanimous.

The president reinforced his one-party strategy on the day after his speech, when he brought to the White House a critical group of senators who represent the middle ground on the issue in their chamber. Every one was a Democrat.

But even in the speech itself, the strategy was obvious. The president did make a few concessions to Republican thinking on health care, including a show of respect for the idea that excessive malpractice awards jack up the cost of care. He also signaled that he would jettison the government-run insurance alternative ("the public option") if necessary to get a bill to his desk. But apart from that, it was all full speed ahead and damn the torpedoes.

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In fact, the president deliberately stepped on certain GOP toes that are particularly sore these days. Denying that his health plan would add to the deficit, he accused the Republicans of hypocrisy. He pointed to the Iraq-Afghanistan wars begun by President George W. Bush, which were treated as "off budget" and will add roughly $1 trillion to the deficit over a decade.

What's more, he also referred to a similar addition to the deficit caused by tax cuts "for the wealthy" enacted under President Bush in 2001 and 2003.

The president also denounced certain conservative criticisms of his plans as "myths" and "falsehoods" and "lies," particularly with regard to health care for illegal immigrants. That was what prompted the loudest objections from the Republican side of the aisle, including the now famous outcry from Rep. Joe Wilson of South Carolina.

Wilson's shouted "You lie!" resounded in countless media replays, in part because a personal meltdown makes better TV than the details of selling health insurance across state lines. But Wilson was also channeling the anger heard in many August town halls, becoming the media message of the month. Confused about the president's vague plans and filled with misinformation from a variety of other sources, many turned out for these forums in a barely controlled rage.

Conservatives in general took heart from these uprisings, and Republican officeholders took note as well. Resistance to the president's health agenda stiffened, and at least some Democrats facing voters in 2010 got a sudden case of cold feet.

That was the impetus for the joint session the president addressed this week. Despairing of changing many minds on the Republican side, the White House determined it had to shore up support on its own side. And that meant going back to what the Obama team knows best — partisan politics of the kind seen in an election campaign.

Historically, this has not been the path to momentous legislative achievement. Even the controversial creation of Social Security, Medicare and Medicaid did not cleave the Congress so cleanly along partisan lines. Neither did the Civil Rights Act of 1964 or the Voting Rights Act of 1965.

But our politics have changed. In earlier times, the two parties each represented an amalgam of philosophies. Many Southern Democrats were more conservative than many Northern Republicans. A coalition comprising most of the majority party and a significant minor fraction of the other was a legislative force capable of considerable achievement.

Such a coalition had been President Obama's goal in approaching health care. Every president wants to unite the country in support of his goals. For this particular president, bridging the divides of age and race and ideology is both a special challenge and a focal point of personal ambition.

In fact, the new president's devotion to this ambition has been a disappointment to early supporters who expected a bolder shift to the left. Many would have preferred a larger stimulus package, a faster withdrawal from Iraq and Afghanistan, a single-payer European-style health care proposal and much more aggressive regulation of Wall Street and the energy industry.

Truth be told, Obama does not have much to show for disillusioning his most liberal base. So far, at least, conservatives have found his efforts at centrism utterly unalluring. And those few GOP centrists in Congress who had flirted with collaboration are now feeling singed by the August heat.

So achieving any sort of consensus on health care seems out of reach. The immediate problem for the White House is uniting Democrats to do a bill alone. Beyond that looms the problem of restoring relations with at least a few Republicans so as to make coalitions possible on other issues later on.