Health Care Debate Takes Center Stage

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President Obama takes his health care message to a rare joint session of Congress next week. The address is an indication of the high stakes of the debate surrounding a health care overhaul.

NOAH ADAMS, host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Noah Adams.

ROBERT SIEGEL, host:

And I'm Robert Siegel.

With most of the country getting ready for a long Labor Day weekend, Washington is in a state of high anticipation about what the president will say in next Wednesday night's health care address to a joint session of Congress. Since the announcement, Republicans who oppose the president's efforts are making it very clear that his speech will not turn them around. An address like this is very rare, and it's an indication of the high stakes of the health care debate. The success of the Obama presidency and his party's fortunes in next year's midterm elections may ride on the outcome of the health care fight.

Well, joining me now to talk about this is NPR's national political correspondent Mara Liasson. And Mara, the president's speech will come almost sixteen years to the day after President Bill Clinton gave a similar address to Congress; a year later, Clinton's health care effort was dead. Is it fair to draw parallels between these two Democratic presidents in their attempts to pass universal health coverage?

MARA LIASSON: Well, it's fair, although the parallels only go so far. There's no doubt that the lessons of the failed Clinton effort hang heavily over this White House and they've gone to great lengths to learn the lessons - some people say they over-learned them. They decided early on they wouldn't send up what they call the stone tablets of Hillary - send a bill up to Congress. They were going to let Congress write the bill. The president was going to be above the fray and talk about his broad principles. I think now they're adjusting.

There's got to be a happy medium between being incredibly deferential to Congress and sending up stone tablets and now with this speech, he's trying to get more involved. There are a lot of other big differences. First of all, President Obama is much farther along in his effort to pass this - it's gone through a number of committees - than Bill Clinton ever got. There's also a big difference in that Democrats in 1994 didn't understand that not passing health care would really hurt them politically. This year I think they all understand that not passing something is the worst outcome for them.

SIEGEL: One of the biggest questions about next week's speech is how President Obama will resolve one of the most polarizing fights in this debate, which is whether or not he wants or prefers or insists on a public option, a government-run insurance plan to compete with private insurers. Do you expect him to answer that question on Wednesday?

LIASSON: I don't know. He will definitely talk about it, but I don't know how specific he will be. The White House talking points have been he prefers a public option. He won't say he would veto a bill without it. He won't say it's a deal breaker. He won't say how hard he's going to fight for it. That makes liberal Democrats in Congress very nervous. Every time the president comes out with a statement that seems less than foursquare behind the public option, saying it's just one part of this, there's tremendous pressure on him to restate his preference and reassure them that he's not bailing out.

He is trying to balance the interests of his liberal wing, who wants this public option very much, and his moderates in the Senate, who he has to have to pass this bill, who will not vote for a public option. And this has become a real flashpoint. As a political matter, certainly in the House of Representatives and probably in the Senate there is no liberal Democrat who will lose their seat if there is not a public option in the bill, but there are moderates and conservative Democrats who might.

SIEGEL: Now what about the idea of a public option, a sort of a public option in waiting, in the wings. Something that would be triggered if the system without a public option didn't meet these standards that Congress seeks.

LIASSON: That is a big option right now. It's something that the White House is talking a lot about with Senator Olympia Snowe. She is the main proponent of this idea. She is in the catbird seat in the Senate right now because she is the only Republican who seems to be negotiating in good faith on this. She wields disproportionate power over the debate, not unlike the kind of power she wielded over the stimulus bill because she is one of the very few Republicans. The Democrats need 60 votes in the Senate to overcome a filibuster. And with 59 votes after the death of Ted Kennedy, they're going to need a Republican or maybe more than one. So the question is whether the president on Wednesday would say he's open to this idea of a trigger. The trigger is anathema to liberal Democrats. They think it's a way of never getting to a public option. They point to the Medicare prescription drug bill, which has a trigger in it. It's never been pulled. And that's what they're worried about. That the mechanism for the trigger would be set too strictly.

SIEGEL: Thank you, Mara.

LIASSON: Thank you, Robert.

SIEGEL: That's NPR national political correspondent Mara Liasson.

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Obama's New Health Care Strategy: Get Specific

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In an effort to regain momentum for changes to the nation's health care system, President Obama will make a tactical shift when he addresses a joint session of Congress on Wednesday.

Nearly 16 years ago, President Clinton delivered his own high-profile health care speech to Congress — a year later, his reform effort was dead. The Obama White House is determined to avoid that fate.

So Obama is abandoning his initial strategy of sticking to broad principles and letting Congress write the legislation. The plan was that both houses would pass bills before the August recess, and then he would get involved with the details as the House and Senate negotiated later in the fall.

That didn't happen, so now the president has a new plan: He'll be much more specific about what he wants in a health care bill.

Senior adviser David Axelrod says the time is ripe for the president to step in more forcefully.

"We've been talking about it for months and months and months. All the ideas are on the table now. We're well down the road, 90 yards down the field, and now we have to go the last 10 yards together," Axelrod said. "And the best way to start that is for the president to address this issue with force and clarity, and that's what he's going to do Wednesday night."

White House aides say Obama's goal is to clear up the confusion, particularly among Americans who have health insurance. By the time he's done, they say people will understand how coverage will work, who will get subsidies to buy health insurance, how those subsidies will be paid for and how the bill will cut costs and increase competition among insurers.

The president also will stress popular health insurance reforms with wide agreement on Capitol Hill. But he probably won't be more specific about one of the most polarizing issues in the health care debate: what kind of government-backed option, if any, should compete with private insurers.

Axelrod says he still believes in the public option "as a device to promote competition and choice and keep the insurance companies honest." But the administration has signaled in a dozen ways that a Medicare-style public option, the kind desired by many congressional Democrats, is not a requirement. Even liberal Democratic Rep. Jan Schakowsky of Illinois says that while a robust public option must be in the initial House bill, it's not a make-or-break issue for her final vote.

"Even insured Americans can't get health care," she said. "So, yes, the public option is very important; it's important to our base. But so is the assurance that they're going to have health care when they need it."

On Wednesday night, the president will say he's still open to compromise with Republicans, but the earlier hopes of a big bipartisan consensus on health care are gone. No House Republican is likely to vote yes, and the White House has decided it's unrealistic to expect more than one, maybe two Senate Republicans to sign on.

That means Democrats must find their own consensus — a bill that balances the interests of their liberal and moderate wings. Schakowsky says the stakes for the president and the party are very high.

"This is an issue on which his presidency hinges, on which the Democratic future in 2010 hinges," she said. "He's aware of that, we're aware of that, and we're going to get a bill passed."

During the August recess, public support slid for Obama's health care effort. Obama's job approval percentage rating also has declined steeply, from the mid-60s at the beginning of the year to the low 50s today. That might diminish his clout with members of his own party or, as political analyst Norman Ornstein suggests, have the opposite effect.

"A lot of Democrats were there in 1994 when the failure of the Clinton health care plan sent them into a disastrous election that, in turn, meant 12 years in the political equivalent of Guantanamo: the minority," Ornstein said.

Now that Democrats have been back in power since 2006, he said, they know they must follow the lead of their president — even a weakened one.

"If they don't follow the lead of the president," Ornstein said, "if they don't pass any kind of health care plan and show that government now works after years of gridlock, they're going to be back in the minority or dangerously close to it."

It's hard to find anyone in Washington who believes Democrats will fail to pass something. The only question is how close the final product will be to their original vision of sweeping reform.

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