Obama takes his campaign for health care reform on the road.

Who's winning, who's losing, and why.
June 12 2009 10:52 AM

The Hard Sell

Obama takes his campaign for health care reform on the road.

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The president has promised to get more specific next week on the key question of how he's going to pay for a plan that might cost close to $1.5 trillion over 10 years. He'll explain where he's found the $200 billion to $300 billion in new savings he's talked about but hasn't explained in detail.

Proving the plan is paid for may be the biggest of all the hurdles. Politically, voters are most wary of the president's spending policies and the growth of the deficit. Members of Congress from districts and states likely to be contested in 2010 are also nervous about voting for a big new federal entitlement. Republicans are focusing on the size and cost of the plan in their argument that it is just the latest in the Democrats', and the administration's, headlong rush to expand government. First AIG, then car companies, now this!

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To prove he can pay for his plan, Obama won't be able to use fuzzy math of the kind displayed earlier this week when the president and aides claimed his stimulus plan saved or created 150,000 jobs. He's got to make a more serious case to the Congressional Budget Office, which has been skeptical of some of the administration's cost-saving measures. It will be a challenge to come up with a number CBO approves of, but if the administration can meet that test, it wins a crucial third-party seal of approval that will help blunt criticism.

But that's just the first of Obama's CBO tests. He also faces an evaluation over his claims for the long-term savings of health care reform. "If you're worried about spending, and you're worried about deficits; you need to be worried about the cost of health care," Obama told the crowd in Green Bay, pointing out that health care costs are the biggest driver of the deficit.

This argument about deficits is designed to help convince those resistant to such massive change that there's a larger fiscal urgency. Obama hopes to start whittling down the deficit by finding savings in various reforms: computerized medical records, standardized best practices, changes in incentives for patients and doctors to encourage efficiency. Whether these savings amount to wishful thinking is a matter of considerable debate. The CBO will weigh in next week in a report to the top Republican and Democrat on the Senate budget committee. If the report is skeptical, it will undermine Obama's key argument for urgency.

In Green Bay, the president not only worked to sell his plan, but he anticipated Republican attacks. He challenged Republicans to come up with their own option to meet the unsustainable growth in health care spending, and he scoffed at their charge that he wanted to take over health care: "I have enough stuff to do. I have North Korea and Iran and Afghanistan and Iraq."

It was easy to see from the performance why the president prefers taking his pitch on the road. He's been engaged in this conversation about health care with voters for quite some time. He's also at ease in the setting. When a man stood to ask him a question, he admitted he'd taken his daughter, Kennedy, out of school to attend the event. The president said he'd write the young girl's teacher a note. He did: "To Kennedy's teacher—please excuse Kennedy's absence. She's with me. Barack Obama." The crowd loved it. It was probably worth the risk of exposing himself to the charge that he wants to insert himself into local education issues.

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