Wrong Turns: How Obama's Health-Care Push Went Astray

Wrong Turns: How Obama's Health-Care Push Went Astray

By JONATHAN WEISMAN, NEIL KING and JANET ADAMY
WASHINGTON -- A group called the Herndon Alliance -- a coalition of
liberal health-care groups, unions and patient-advocacy groups created
in late 2005 -- was only a few months into its work planning a health-
insurance overhaul by the time it asked focus groups what they thought
of the idea of a government-run plan to compete with private ones.

The public-option was an article of faith for many in the alliance,
but the focus groups' reactions were sobering. Skepticism ran high.
The chief worry: Giving access to inexpensive government insurance to
America's 46 million uninsured would boost costs, or reduce care, for
those who were already insured.

When pollsters told the advocacy groups the public option probably
wouldn't fly, they were told to paper over the problem with a better
"message," according to a participant in the project.

"We tried to do our best to come up with some fancy words to help talk
about this," this participant said, but in the end, he said, marketers
and pollsters involved in the Herndon Alliance may have told their
advocacy group clients what they wanted to hear.

It was an early warning of the trouble that was to engulf President
Barack Obama's most ambitious legislative effort despite years of
careful groundwork laid by supporters.

Two overarching problems have bedeviled the Democrats' health-care
push. One is the difficulty of persuading people who already have
health insurance that the plan offers something for them. Polls
suggest many Americans are happy with the coverage they have.

The other is the cost, estimated at $1 trillion over a decade. While
Democrats say the plan will be budget-neutral, Republicans say the
cost savings and tax increases being used to fund new programs would
better go toward reducing the fast-growing federal budget deficit.

Mr. Obama has had trouble making the case that his health push would
carry teeth to elimimate the waste that he blames for driving up
costs. A key moment in the debate came July 16, when Congressional
Budget Office director Douglas Elmendorf told a congressional
committee, "We do not see the sort of fundamental changes that would
be necessary to reduce the trajectory of federal health spending by a
significant amount."

A look back suggests the president and his allies may have
"overlearned" the lessons of President Bill Clinton's 1993-1994 health-
care defeat. They expended great effort to line up the support of
health-care insurers, pharmaceutical makers and care providers,
believing that by keeping them around the table, they could win over
Republicans and stop the kind of industry-led attacks that helped sink
the Clinton plan. But this strategy left out the wooing of public
opinion, which was being affected by broader events, including the
economic crisis and anger over bank bailouts.

Some Democrats say the president exacerbated the message problem by
being too distant from the legislative process and too vague to the
public about his aims. (The White House says it was right to stay
aloof from the process but is now ready to wade in.) Democrats also
say that for all their preparations, they never anticipated
Republicans and their allies rolling out incendiary accusations that
the Obama plan would empower "death panels," help illegal immigrants
and raid Medicare.

By the time Congress turned to health care in earnest this spring,
lawmakers had just approved more than $1 trillion to support financial
firms and signed off on $787 billion in stimulus spending. Many
Americans were feeling overwhelmed, some lawmakers say. "What the
president has asked of the American people is a lot to absorb," said
Rep. Ron Kind, a Wisconsin Democrat.

Officials such as Nancy-Ann DeParle, head of the White House health-
reform office, spent hundreds of hours wooing organized groups and
members of Congress. But top Democrats underestimated the power of
small, conservative groups to stir public opposition. In May, little-
known groups like Americans for Prosperity Foundation and
Conservatives for Patients' Rights began airing television spots
likening the proposed changes to the government-controlled health
systems in Canada and the United Kingdom.

When the Senate Health, Education, Labor and Pensions Committee began
drafting a bill, partisanship quickly arose. This soured Republicans
who served on the Finance and health panels, including Sens. Orrin
Hatch, Pat Roberts and Michael Enzi. What had started as 11
negotiators on the Senate Finance Committee dropped to seven, then
six. Republican leaders increasingly felt emboldened to oppose any
overhaul of the health system.
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The Journey So Far
2005: A coalition of liberal and advocacy groups form the Herndon
Alliance to find a new language to press for universal health care.

Early 2008: Sen. Edward M. Kennedy assembles "the Work Horse Group,"
representing businesses, insurers, doctors, patients and others to
build consensus.

November: The insurance industry agrees to stop denying coverage to
people with pre-existing conditions in exchange for requiring most
Americans to carry insurance.

March 2009: President Obama gathers politicians and leading health-
care players at the White House and pledges to help pass a health
overhaul this year.

May: Conservative groups begin running advertisements likening
Washington proposals to the health systems in Canada and the United
Kingdom.

June: The Congressional Budget Office releases cost estimates for some
health proposals topping $1 trillion.

July: Senate health committee passes its bill; negotiations stall in
the Senate Finance Committee while the House struggles to pass its
bill out of committee.

August: Lawmakers head home and some get an earful from voters worried
about the health proposals.

Sept. 9: President Obama plans to address a joint session of Congress
and more specifically outline his plans to fix the health system.
--------------------------------------------------------------------------------------------------

In June, Sen. Max Baucus, the Montana Democrat who heads the Senate
Finance Committee, told the negotiators they had gone through all the
big issues and it was time to draft a bill. But the resistance didn't
just come from Republicans. Democratic Sens. Kent Conrad and Jeff
Bingaman said they weren't ready. A planned June bill "mark-up"
slipped to July, then to September.

Conservative Blue Dog Democrats and the leadership of the House Energy
and Commerce Committee held a marathon meeting with the president two
weeks before the August recess. White House Chief of Staff Rahm
Emanuel and Ms. DeParle spent 8½ hours in the speaker's suite trying
to reach a deal that would allow the committee to complete its work.
Lawmakers pleaded with the president to take a more forceful stance
and define his positions better.

But Mr. Obama was being pushed in two directions -- by liberal
Democrats who wanted him to embrace the public option and by
Republicans, such as Sen. Grassley, who told him they needed him to
renounce it, if a bipartisan bill that emerged was to be acceptable
after final negotiations. President Obama told him he couldn't give
such assurances, according to a senior Republican Senate aide, leaving
the Republican feeling he had no defense against leaders opposing his
efforts.

Sen. Tom Coburn (R., Okla.) got a call at home from Mr. Obama on a
Saturday morning in late July. The two have been close since the
president was a senator. "You need to take what you want to do and
really spell it out," Mr. Coburn says he told the president. "You need
to see if you can get some of us to come across the line, and
accomplish 80% of what you want to do."

"I understand what you're saying," Mr. Coburn says Mr. Obama told him,
"but I don't think we're there yet."

The president's focus on wooing groups often brought fewer benefits
than he expected. The seniors' lobby AARP backed him, but that
prompted loud complaints from AARP members worried about Medicare
cuts. The American Medical Association's cautious backing was
countered by state doctors' groups opposed to a public health plan.

Lawmakers, as they disbanded for the August recess, were shocked by
the level of discontent they found bubbling at home. Rep. Peter Welch,
a liberal Democrat from Vermont, had his epiphany during a meeting in
a Mini Mart parking lot in Derbyline, a small town on the Canadian
border. Over 50 people crowded around a couple of Dumpsters to berate
him. "It was stunning," Rep. Welch said. "They came with talking
points" gleaned from talk radio.

Many Democratic lawmakers say they remain resolved to push ahead on an
overhaul, even if in a reduced form. Republicans plan to portray the
overhaul as part of a Democratic agenda of heavy spending that
threatens to increase the deficit. "We don't want a health-care plan
that will break the bank," said Rep. Eric Cantor, the second-ranking
Republican in the House.

What Democrats want now, they say, is a big assist from Mr. Obama.
"There is no way we are going to get this passed without the
energetic, concentrated attention of the president," said Rep. Welch.
"He is going to have to weigh in on the details, and do so loudly."

Write to Jonathan Weisman at jonathan.weisman@xxxxxxx, Neil King at
neil.king@xxxxxxx and Janet Adamy at janet.adamy@xxxxxxx
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