by Obama Barack
The only upside to all this was that it helped me cure Max Baucus of his obsession with trying to placate Chuck Grassley. In a last-stab Oval Office meeting with the two of them in early September, I listened patiently as Grassley ticked off five new reasons why he still had problems with the latest version of the bill.
“Let me ask you a question, Chuck,” I said finally. “If Max took every one of your latest suggestions, could you support the bill?”
“Well…”
“Are there any changes—any at all—that would get us your vote?”
There was an awkward silence before Grassley looked up and met my gaze.
“I guess not, Mr. President.”
I guess not.
At the White House, the mood rapidly darkened. Some of my team began asking whether it was time to fold our hand. Rahm was especially dour. Having been to this rodeo before with Bill Clinton, he understood all too well what my declining poll numbers might mean for the reelection prospects of swing-district Democrats, many of whom he’d personally recruited and helped elect, not to mention how it could damage my own prospects in 2012. Discussing our options in a senior-staff meeting, Rahm advised that we try to cut a deal with Republicans for a significantly scaled-back piece of legislation—perhaps allowing people between sixty and sixty-five to buy into Medicare or widening the reach of the Children’s Health Insurance Program. “It won’t be everything you wanted, Mr. President,” he said. “But it’ll still help a lot of people, and it’ll give us a better chance to make progress on the rest of your agenda.”
Some in the room agreed. Others felt it was too early to give up. After reviewing his conversations on Capitol Hill, Phil Schiliro said he thought there was still a path to passing a comprehensive law with only Democratic votes, but he admitted that it was no sure thing.
“I guess the question for you, Mr. President, is, Do you feel lucky?”
I looked at him and smiled. “Where are we, Phil?”
Phil hesitated, wondering if it was a trick question. “The Oval Office?”
“And what’s my name?”
“Barack Obama.”
I smiled. “Barack Hussein Obama. And I’m here with you in the Oval Office. Brother, I always feel lucky.”
I told the team we were staying the course. But honestly, my decision didn’t have much to do with how lucky I felt. Rahm wasn’t wrong about the risks, and perhaps in a different political environment, on a different issue, I might have accepted his idea of negotiating with the GOP for half a loaf. On this issue, though, I saw no indication that Republican leaders would throw us a lifeline. We were wounded, their base wanted blood, and no matter how modest the reform we proposed, they were sure to find a whole new set of reasons for not working with us.
More than that, a scaled-down bill wasn’t going to help millions of people who were desperate, people like Laura Klitzka in Green Bay. The idea of letting them down—of leaving them to fend for themselves because their president hadn’t been sufficiently brave, skilled, or persuasive to cut through the political noise and get what he knew to be the right thing done—was something I couldn’t stomach.
* * *
—
AT THAT POINT, I’d held town halls in eight states, explaining in both broad and intricate terms what healthcare reform could mean. I’d taken phone calls from AARP members on live television, fielding questions about everything from Medicare coverage gaps to living wills. Late at night in the Treaty Room, I pored over the continuing flow of memos and spreadsheets, making sure I understood the finer points of risk corridors and reinsurance caps. If I sometimes grew despondent, even angry, over the amount of misinformation that had flooded the airwaves, I was grateful for my team’s willingness to push harder and not give up, even when the battle got ugly and the odds remained long. Such tenacity drove the entire White House staff. Denis McDonough at one point distributed stickers to everyone, emblazoned with the words FIGHT CYNICISM. This became a useful slogan, an article of our faith.
Knowing we had to try something big to reset the healthcare debate, Axe suggested that I deliver a prime-time address before a joint session of Congress. It was a high-stakes gambit, he explained, used only twice in the past sixteen years, but it would give me a chance to speak directly to millions of viewers. I asked what the other two joint addresses had been about.
“The most recent was when Bush announced the War on Terror after 9/11.”
“And the other?”
“Bill Clinton talking about his healthcare bill.”
I laughed. “Well, that worked out great, didn’t it?”
Despite the inauspicious precedent, we decided it was worth a shot. Two days after Labor Day, Michelle and I climbed into the backseat of the Beast, drove up to the Capitol’s east entrance, and retraced the steps we’d taken seven months earlier to the doors of the House chamber. The announcement by the sergeant at arms, the lights, television cameras, applause, handshakes along the center aisle—on the surface, at least, everything appeared as it had in February. But the mood in the chamber felt different this time—the smiles a little forced, a murmur of tension and doubt in the air. Or maybe it was just that my mood was different. Whatever giddiness or sense of personal triumph I’d felt shortly after taking office had now been burned away, replaced by something sturdier: a determination to see a job through.
For an hour that evening, I explained as straightforwardly as I could what our reform proposals would mean for the families who were watching: how it would provide affordable insurance to those who needed it but also give critical protections to those who already had insurance; how it would prevent insurance companies from discriminating against people with preexisting conditions and eliminate the kind of lifetime limits that burdened families like Laura Klitzka’s. I detailed how the plan would help seniors pay for lifesaving drugs and require insurers to cover routine checkups and preventive care at no extra charge. I explained that the talk about a government takeover and death panels was nonsense, that the legislation wouldn’t add a dime to the deficit, and that the time to make this happen was now.
A few days earlier, I’d received a letter from Ted Kennedy. He’d written it back in May but had instructed Vicki to wait until after his death to pass it along. It was a farewell letter, two pages long, in which he’d thanked me for taking up the cause of healthcare reform, referring to it as “that great unfinished business of our society” and the cause of his life. He added that he would die with some comfort, believing that what he’d spent years working toward would now, under my watch, finally happen.
So I ended my speech that night by quoting from Teddy’s letter, hoping that his words would bolster the nation just as they had bolstered me. “What we face,” he’d written, “is above all a moral issue; at stake are not just the details of policy, but fundamental principles of social justice and the character of our country.”
According to poll data, my address to Congress boosted public support for the healthcare bill, at least temporarily. Even more important for our purposes, it seemed to stiffen the spine of wavering congressional Democrats. It did not, however, change the mind of a single Republican in the chamber. This was clear less than thirty minutes into the speech, when—as I debunked the phony claim that the bill would insure undocumented immigrants—a relatively obscure five-term Republican congressman from South Carolina named Joe Wilson leaned forward in his seat, pointed in my direction, and shouted, his face flushed with fury, “You lie!”
For the briefest second, a stunned silence fell over the chamber. I turned to look for the heckler (as did Speaker Pelosi and Joe Biden, Nancy aghast and Joe shaking his head). I was tempted to exit my perch, make my way down the aisle, and smack the guy in the head. Instead, I simply responded by saying “It’s not true” and then carried on with my speech as Democrats hurled boos in Wilson’s direction.
As far as an
yone could remember, nothing like that had ever happened before a joint session address—at least not in modern times. Congressional criticism was swift and bipartisan, and by the next morning Wilson had apologized publicly for the breach of decorum, calling Rahm and asking that his regrets get passed on to me as well. I downplayed the matter, telling a reporter that I appreciated the apology and was a big believer that we all make mistakes.
And yet I couldn’t help noticing the news reports saying that online contributions to Wilson’s reelection campaign spiked sharply in the week following his outburst. Apparently, for a lot of Republican voters out there, he was a hero, speaking truth to power. It was an indication that the Tea Party and its media allies had accomplished more than just their goal of demonizing the healthcare bill. They had demonized me and, in doing so, had delivered a message to all Republican officeholders: When it came to opposing my administration, the old rules no longer applied.
* * *
—
DESPITE HAVING GROWN UP in Hawaii, I have never learned to sail a boat; it wasn’t a pastime my family could afford. And yet for the next three and a half months, I felt the way I imagine sailors feel on the open seas after a brutal storm has passed. The work remained arduous and sometimes monotonous, made tougher by the need to patch leaks and bail water. Maintaining speed and course in the constantly shifting winds and currents required patience, skill, and attention. But for a span of time, we had in us the thankfulness of survivors, propelled in our daily tasks by a renewed belief that we might make it to port after all.
For starters, after months of delay, Baucus finally opened debate on a healthcare bill in the Senate Finance Committee. His version, which tracked the Massachusetts model we’d all been using, was stingier with its subsidies to the uninsured than we would have preferred, and we insisted that he replace a tax on all employer-based insurance plans with increased taxes on the wealthy. But to everyone’s credit, the deliberations were generally substantive and free of grandstanding. After three weeks of exhaustive work, the bill passed out of committee by a 14-to-9 margin. Olympia Snowe even decided to vote yes, giving us a lone Republican vote.
Speaker Pelosi then engineered the quick passage of a consolidated House bill over uniform and boisterous GOP opposition, with a vote held on November 7, 2009. (The bill had actually been ready for some time, but Nancy had been unwilling to bring it to the House floor—and force her members to cast tough political votes—until she had confidence that the Senate effort wasn’t going to fizzle.) If we could get the full Senate to pass a similarly consolidated version of its bill before the Christmas recess, we figured, we could then use January to negotiate the differences between the Senate and House versions, send a merged bill to both chambers for approval, and with any luck have the final legislation on my desk for signature by February.
It was a big if—and one largely dependent on my old friend Harry Reid. True to his generally dim view of human nature, the Senate majority leader assumed that Olympia Snowe couldn’t be counted on once a final version of the healthcare bill hit the floor. (“When McConnell really puts the screws to her,” he told me matter-of-factly, “she’ll fold like a cheap suit.”) To overcome the possibility of a filibuster, Harry couldn’t afford to lose a single member of his sixty-person caucus. And as had been true with the Recovery Act, this fact gave each one of those members enormous leverage to demand changes to the bill, regardless of how parochial or ill-considered their requests might be.
This wouldn’t be a situation conducive to high-minded policy considerations, which was just fine with Harry, who could maneuver, cut deals, and apply pressure like nobody else. For the next six weeks, as the consolidated bill was introduced on the Senate floor and lengthy debates commenced on procedural matters, the only action that really mattered took place behind closed doors in Harry’s office, where he met with the holdouts one by one to find out what it would take to get them to yes. Some wanted funding for well-intentioned but marginally useful pet projects. Several of the Senate’s most liberal members, who liked to rail against the outsized profits of Big Pharma and private insurers, suddenly had no problem at all with the outsized profits of medical device manufacturers with facilities in their home states and were pushing Harry to scale back a proposed tax on the industry. Senators Mary Landrieu and Ben Nelson made their votes contingent on billions of additional Medicaid dollars specifically for Louisiana and Nebraska, concessions that the Republicans cleverly labeled “the Louisiana Purchase” and “the Cornhusker Kickback.”
Whatever it took, Harry was game. Sometimes too game. He was good about staying in touch with my team, giving Phil or Nancy-Ann the chance to head off legislative changes that could adversely affect the core parts of our reforms, but occasionally he’d dig his heels in on some deal he wanted to cut, and I’d have to intervene with a call. Listening to my objections, he’d usually relent, but not without some grumbling, wondering how on earth he would get the bill passed if he did things my way.
“Mr. President, you know a lot more than I do about healthcare policy,” he said at one point. “But I know the Senate, okay?”
Compared to the egregious pork-barreling, logrolling, and patronage-dispensing tactics Senate leaders had traditionally used to get big, controversial bills like the Civil Rights Act or Ronald Reagan’s 1986 Tax Reform Act, or a package like the New Deal, passed, Harry’s methods were fairly benign. But those bills had passed during a time when most Washington horse-trading stayed out of the papers, before the advent of the twenty-four-hour news cycle. For us, the slog through the Senate was a PR nightmare. Each time Harry’s bill was altered to mollify another senator, reporters cranked out a new round of stories about “backroom deals.” Whatever bump in public opinion my joint address had provided to the reform effort soon vanished—and things got markedly worse when Harry decided, with my blessing, to strip the bill of something called “the public option.”
From the very start of the healthcare debate, policy wonks on the left had pushed us to modify the Massachusetts model by giving consumers the choice to buy coverage on the online “exchange,” not just from the likes of Aetna and Blue Cross Blue Shield but also from a newly formed insurer owned and operated by the government. Unsurprisingly, insurance companies had balked at the idea of a public option, arguing that they would not be able to compete against a government insurance plan that could operate without the pressures of making a profit. Of course, for public-option proponents, that was exactly the point: By highlighting the cost-effectiveness of government insurance and exposing the bloated waste and immorality of the private insurance market, they hoped the public option would pave the way for a single-payer system.
It was a clever idea, and one with enough traction that Nancy Pelosi had included it in the House bill. But on the Senate side, we were nowhere close to having sixty votes for a public option. There was a watered-down version in the Senate Health and Education Committee bill, requiring any government-run insurer to charge the same rates as private insurers, but of course that would have defeated the whole purpose of a public option. My team and I thought a possible compromise might involve offering a public option only in those parts of the country where there were too few insurers to provide real competition and a public entity could help drive down premium prices overall. But even that was too much for the more conservative members of the Democratic caucus to swallow, including Joe Lieberman of Connecticut, who announced shortly before Thanksgiving that under no circumstances would he vote for a package that contained a public option.
When word got out that the public option had been removed from the Senate bill, activists on the left went ballistic. Howard Dean, the former Vermont governor and onetime presidential candidate, declared it “essentially the collapse of health reform in the United States Senate.” They were especially outraged that Harry and I appeared to be catering to the whims of Joe Lieberman—an object of liberal scorn who’d be
en defeated in the 2006 Democratic primary for his consistently hawkish support for the Iraq War and had then been forced to run for reelection as an independent. It wasn’t the first time I’d chosen practicality over pique when it came to Lieberman: Despite the fact he’d endorsed his buddy John McCain in the last presidential campaign, Harry and I had quashed calls to strip him of various committee assignments, figuring we couldn’t afford to have him bolt the caucus and cost us a reliable vote. We’d been right about that—Lieberman had consistently supported my domestic agenda. But his apparent power to dictate the terms of healthcare reform reinforced the view among some Democrats that I treated enemies better than allies and was turning my back on the progressives who’d put me in office.
I found the whole brouhaha exasperating. “What is it about sixty votes these folks don’t understand?” I groused to my staff. “Should I tell the thirty million people who can’t get covered that they’re going to have to wait another ten years because we can’t get them a public option?”
It wasn’t just that criticism from friends always stung the most. The carping carried immediate political consequences for Democrats. It confused our base (which, generally speaking, had no idea what the hell a public option was) and divided our caucus, making it tougher for us to line up the votes we’d need to get the healthcare bill across the finish line. It also ignored the fact that all the great social welfare advances in American history, including Social Security and Medicare, had started off incomplete and had been built upon gradually, over time. By preemptively spinning what could be a monumental, if imperfect, victory into a bitter defeat, the criticism contributed to a potential long-term demoralization of Democratic voters—otherwise known as the “What’s the point of voting if nothing ever changes?” syndrome—making it even harder for us to win elections and move progressive legislation forward in the future.