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.

President Obama. Click image to expand.
President Obama at his health care town-hall meeting in Wisconsin

When President Obama wants to sell something, he has two strategies: He takes his message on the road, or he gives a big speech. So you can tell the president really wants to sell his health care reform plan, because he's doing both. On Thursday he held a town-hall meeting in Green Bay, Wis. On Monday, he'll travel to Chicago to give a speech to the American Medical Association.

John Dickerson John Dickerson

John Dickerson is Slate's chief political correspondent and author of On Her Trail. Read his series on the presidency and on risk.

Obama has done a lot of selling already in his young administration, but this may be his hardest sell yet. He's calling for an overhaul of nearly one-fifth of the economy. The country wants reform—in some polls more than 70 percent of Americans want some kind of change—but the president still has to get people to buy into the details of the sweeping legislation.

How he manages this task will be another test of just how much of his personal popularity he can transfer to the policies he's pushing. The president is still very popular. His approval rating in various polls is around 60 percent, but in some policy areas there's a gap. A recent Gallup poll shows that while the president has a 67 percent approval rating overall, on issues like government spending and the deficit, people are less approving of the job he has done. On the economy, 52 percent of the country approves of his approach, but his disapproval rating on the economy has risen from 30 percent in February to 42 percent, according to a Gallup poll completed May 31.

In Green Bay, the president spoke for an hour, but the theme of the pitch was simple: Expanding coverage is "an economic imperative, but it's also a moral imperative." Yes, health care reform is necessary to shrink trillion-dollar deficits, but America must also help the 47 million people without health insurance.

How he's going to specifically address these two problems is harder to divine. The president's new engagement is still not full engagement. Obama is still mostly a third-base coach, sending signals but no direct commands to Republicans and Democrats working out the elements of health care legislation. He won't come right out and say where he stands on what kind of public insurance program he would like, or whether companies should be taxed on the health care they provide, or how coverage will be mandated. Instead he winks, nods, and puts his finger to his nose.

Last week the president sent a letter to the Senate committee chairmen writing the legislation, saying for the first time that he'd be "open" to an insurance mandate. In a recent meeting with members of the Senate finance committee, he signaled he was intrigued by the idea of a cooperative structure to the public plan. White House aides say the president doesn't want to dictate what Congress should do, but members of Congress see the signs that he's open to the idea of taxing employer plans.

This approach respects Congress' prerogatives. "Congress doesn't really like you to just tell them exactly what to do," Obama told the audience in Green Bay. It also gives the administration political room to maneuver. Accepting an individual mandate or taxes on employee health care would be reversals of Obama's position in last year's campaign. He beat up Hillary Clinton for the former and John McCain for the latter. The president is pragmatic and open to changing his position when necessary.  But it'll be easier to manage these reversals if he can look like a flexible executive accepting what Congress hands him.

The relationship is symbiotic, of course. The whole point of sending signals to Congress is to help make it easier for some members to embrace the plan, or elements of it, when they've gotten the glitter of being approved of by the president.

But knowing the president's position on taxing employer health care plans requires a Ph.D.-level knowledge of the coded signals. A top administration aide said the White House was a little irritated that Senate finance committee Chairman Max Baucus misread one of the president's signals as support for the plan. But in private meetings with various experts, administration aides have signaled they would be open to taxing employer plans to help pay for reform. They've even suggested outside groups start talking up the idea, according to one participant, to help build public support for it.

So why doesn't Obama just come out and say he'd like to tax the plans? "He'd prefer we take the angry phone calls from labor," says a senior aide to a Senate Democrat. Unions don't like the tax idea, because over the years they've negotiated for better health plans for their members. A new tax on those benefits might cause companies to cut back on coverage or get stingier about wage increases.

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!

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.