Please God, no more health reform speeches.

How to fix health policy.
Sept. 8 2009 6:29 PM

No More Speeches!

On health reform, Obama needs to twist arms, not win hearts and minds.

Click here for a guide to following the health care reform story online.

Barack Obama. Click image to expand.
Barack Obama

If President Obama wants to pass a health reform bill, he shouldn't be giving a speech to Congress tomorrow. In fact, he shouldn't be giving any more speeches, period. From now until whenever, any time he had scheduled for speeches on health care should instead be spent meeting privately with Democratic holdouts to explain how very difficult their lives will be if they don't vote yes.

Even on its own PR terms, a high-profile presidential address on health care is ill-advised because it invites the press to declare health reform dead based on nothing more than how eloquently Obama makes the same case for health reform that he's been making for six months. By the count of the Wall Street Journal's editorial page, the Sept. 9 speech will be Obama's 28th on the topic of health care (not counting, the Journal says, "another 92 in which it figured prominently").

This is, Clive Crook explains in the Financial Times, "A Make or Break Speech for Obama." Michael Kranish, writing in the Boston Globe, calls it "a make-or-break address." Sheryl Gay Stolberg, writing in the New York Times, predicts this will be "a make-or-break week for health care." CBSNews.com says we are witnessing a "make-or-break moment."  But wait. Wasn't August the "make-or-break month" for health reform? That's what Janet Adamy and Naftali Bendavid wrote at the end of July in the Wall Street Journal. Or maybe the make-or-break month was July, when Obama gave a press conference on the topic. That's what NPR said at the time. U.S. News declared it "make or break time" for health reform on June 2.

What the fight for health care reform needs isn't more fake public drama about how Obama handles the latest in an unending sequence of "make-or-break" moments. It's not even clear that health reform especially needs a shoring up of public support. Yes, the angry right fringe's disruptions of this summer's public meetings and Congress' failure to move more quickly on the issue drove Obama's approval rating down from 57 percent to 44 percent, according to the latest CNN poll. But these setbacks have only slightly dampened the public's appetite for health care reform. Forty-eight percent still favor "Barack Obama's plan to reform health care," down from 51 percent in June. The public option, which risks being dropped due to lack of public support, actually enjoys more support than health reform itself; 55 percent favor it.

Of course, in a recent CBS News poll, 60 percent said that Obama hadn't "clearly explained what his plans for health reform would mean."  But that doesn't necessarily mean the public is baffled. In the CNN poll, 59 percent affirmed they did understand the proposals, up from 51 percent in June. To the extent public support for any health reform plan is down, it isn't just for the Democrats' plans. It's also for the Republicans' (such as they are). In the CBS News poll, 50 percent of respondents said Obama had better health reform ideas than the Republicans in Congress. That's down from 55 percent in July, but confidence in the Republicans' plans has dropped too, to 23 percent from 26 percent in July.

The constituency that Obama should be worrying about right now isn't the defining-moment-loving press or the Republican-wary public. It's the risk-averse Democratic Congress. He's already got enough Democratic votes to get health reform through the House with a public option. In the Senate, passing health reform with a public option will probably require splitting the bill in half, passing the uncontroversial parts (mostly regulations governing health insurers) with a filibuster-proof 60-vote majority and passing the controversial parts (taxes, the public option, Medicaid expansion, subsidies for the purchase of health insurance) under no-filibuster reconciliation rules. Although many fear this places the fate of health reform in the hands of unelected Senate parliamentarian Alan Frumin, as I have explained, Vice President Joe Biden, as president of the Senate, is free to overrule Frumin.

Liberal blogger Chris Bowers estimated on Aug. 28 that the public option has 44 Senate votes, putting it only six votes shy of the necessary 50 (with Biden as the tie-breaking 51st vote). Sens. Mark Warner, D.-Va., and Ron Wyden, D.-Ore., seem to be inching out of the "maybe" and into the "yes" column, which might mean a deficit of only four votes. Even Sen. Max Baucus, D.-Mont., who excluded a public option from his new "framework" document for his deadlocked finance committee to mull over, might be persuadable.

But these votes aren't going to be won through speechifying. They're going to be won through some combination of flattery, arm-twisting, and promise-giving. One argument I might make if I were Obama: "You're a Democrat, and I'm a Democrat. If the Democrats' health reform fails to pass, then, yeah, I'll look weak. But you'll look weaker. Remember the 1994 midterm elections? Bill Clinton's health reform plan was in deep trouble, causing him serious problems, but it caused even more serious problems for Democrats in Congress. Two years later Clinton won himself a second term, but in 1994 the Democrats lost the House and Senate. Capiche?"

It isn't the public that needs inspiration right now. It's Obama himself. I recommend that he turn to Page 960 of Robert A. Caro's Master of the Senate:

He used his stories, and he used his jokes, he used his promises, used his threats, backing senators up against walls or trapping them in chairs, wrapping an arm around their shoulders and thrusting a finger in their chests, grasping lapels, watching their hands, watching their eyes, listening to what they said, or to what they didn't say: "The greatest salesman one on one who ever lived"—trying to make his biggest sale. Never had he tried harder. In the intensity of his effort, he even instituted a new variation on one of his old devices. Lapels had long been for grabbing, but now he used them—or rather the buttonhole in them—for another purpose. Trying to persuade a senator who was resisting persuasion, Lyndon Johnson would stick his long forefinger through the hole in the senator's lapel to prevent him from moving away. "The other day," [newspaper columnist] George Dixon wrote, "I spied Majority Leader Johnson holding Senator Estes Kefauver in captive conference. Kefauver couldn't have gotten away without leaving his lapel behind."

Johnson, incidentally, couldn't give a decent speech to save his life, and had he ever recorded an audiobook of The Vantage Point, it's doubtful he'd have won a Grammy. On the other hand, as Senate majority leader he got the first civil rights bill since Reconstruction through Congress, and later, as president, he created Medicare and Medicaid.

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