Health reform's last stand: Obama abandons bipartisan effort (Feature)

By Chris Cermak Mar 7, 2010, 1:14 GMT

Washington - After more than a year of ups and downs, bitter disputes and endless speeches, Barack Obama has had enough: The US president is launching one final push to get his ambitious and controversial health reform package through Congress.

Obama is headed to Philadelphia Monday and St Louis, Missouri, on Wednesday. Last week he called for a final vote in Congress in the coming weeks and promised to do 'everything in my power' to convince the public of the merits of reform in the meantime.

The stage has been set for one last mammoth fight between supporters and opponents of universal health care. The White House is confident a final bill can reach Obama's desk by March 18, when the president departs on a trip to Indonesia and Australia.

The all-out push represents a sharp change in tactics for what has been Obama's top domestic priority since entering office. Both supporters and detractors recognized his most recent rhetoric as a departure from the more bipartisan approach he pledged during the 2008 presidential campaign.

After months of trying to woo Republicans to back his reforms, including an extremely rare seven-hour health care summit with lawmakers last week, Obama declared Wednesday that he would be satisfied if the legislation squeaked through Congress with only the support of his own left-leaning Democratic allies.

'It's most likely the end of bipartisanship on health care,' said Matt Dallek, a historian and visiting scholar with the Bipartisan Policy Centre, a think-tank created by moderate former lawmakers in Washington. Dallek said a mix of political calculations and ideology had doomed the chances of passing a bill with broad support.

Supporters argued it was about time - Republicans were never going to be brought on board. Critics warned Democrats will rue the day come mid-term congressional elections in November, when one-third of the Senate and the entire House of Representatives is up for grabs.

'History is clear: Big legislation always requires big majorities,' Mitch McConnell, the Senate's top Republican, said Wednesday. 'And this latest scheme to lure Democrats into switching their votes ... will be met with outrage.'

Obama said he had done his best to meet Republicans half-way, but there clearly remained irreconcilable differences between the two parties. He challenged Republicans to vote against his reform proposals as he sounded the final battle cry on Wednesday.

'I urge every American who wants this reform to make their voice heard,' Obama said. 'Every family, every business, every patient, every doctor, every nurse, every physician's assistant. Make your voice heard.'

Both sides recognize a problem with the current health care system, which gobbles up about 17 per cent of the US economy and yet leaves more than 30 million Americans without any form of health insurance coverage.

Yet the divide over solutions is as large as ever. Obama's reforms would for the first time require all Americans to purchase basic insurance coverage, expand subsidies for those who can't afford the cost, impose new regulations on insurance industry practices and create state insurance exchanges to help lower premiums for families.

Republicans have fiercely opposed most of Obama's initiatives as too costly and too much government infringement on a largely private health sector. They argued for a much stronger focus on boosting private competition and less regulation of the insurance industry.

The public winds are also hardly in Obama's favour. Comprehensive health reform was declared dead just over one month ago after the election victory of Republican Scott Brown in Massachusetts, who won partly on a promise to oppose Obama's health agenda.

Brown's victory in a liberal-leaning state shocked the Washington political establishment, ended the Democratic Party's supermajority in the Senate and emboldened Republicans that had long been united in their opposition to the health overhaul.

The House and Senate passed differing versions of health reforms late last year, but Brown's victory prompted many to believe Obama would scale back his plans or make enough changes to garner at least some Republican support for a final bill.

Instead, Obama has backed the use of some controversial procedural manoeuvres in Congress that will allow the final reform package to pass by a simple majority.

Obama's tactical shift does not guarantee success, as there are sharp divides within the Democratic Party as well. Some on the left have pushed for a single-payer government insurance system similar to those in many European countries, while others insist on at least giving consumers the option of a government-run insurer.

Both of those ideas have been scrapped, at one time in the hopes of attracting Republicans, but also in an effort to appeal to more moderate Democratic legislators.

The result was a left-leaning, yet relatively moderate bill passed by the Senate on Christmas Eve. The Bipartisan Policy Centre said roughly 80 per cent of the bill matched up with its own proposal developed by a group of former Republican and Democratic lawmakers.

'It's hard to call the Senate bill the most liberal or radical of options. I think far from it,' said Dallek, adding that there is a chance the reforms could end up winning more acceptance in the coming years once they come into use.

Some leftwing lawmakers feel the compromises have gone too far, while some centrists still believe they haven't gone far enough. In addition to policy differences, moderate Democrats facing re-election this November are wary of supporting a bill that has been viewed skeptically by the US public.

That means both the Senate and House of Representatives will face extremely tight votes this month.

A victory for Obama would mark the biggest achievement of his young presidency, enacting the most comprehensive overhaul of the health sector in at least four decades. A loss could spell the end for the biggest priority of his tenure to date.

'I do not know how this plays politically, but I know it's right,' Obama said Wednesday. 'And so I ask Congress to finish its work.'