WASHINGTON (AP) - Embarking on arguably his most complex
political fight yet, President Barack Obama is using skills honed
during his presidential campaign and lessons learned from past
failures to try to overhaul the health care system.
It's a feat none before him has achieved. As such, it would pay
monumental dividends for a popular new president looking for
history-making accomplishments ahead of his likely 2012 re-election
"Nothing is harder in politics than doing something now that
costs money in order to gain benefits 20 years from now," Obama
acknowledged last week.
That's exactly what he's trying as he seeks to ensure health
care for everyone in a country with the world's costliest system
and an estimated 48 million uninsured people.
In office since Jan. 20, Obama has laid down an ambitious marker
of one year to get done what the last Democratic president
spectacularly failed to do in two. Bill Clinton made a series of
tactical mistakes and was outmaneuvered by the opposition.
"We soon learned that nothing was off-limits in this war and
that the other side was far better armed with the tools of
political battle: money, media and organization," Hillary Rodham
Clinton, who led the health care fight for her husband, said in her
Obama is determined not to let that happen again.
He and his advisers, including several who served in Clinton's
White House, have studied what went wrong during 1993-1994, and are mindful to avoid the same miscalculations and missteps.
In concert with the White House, the Democratic National
Committee and Obama's campaign apparatus - Organizing for America,
with its 13 million-strong e-mail list and 2 million "super
volunteers" - will be intimately involved in promoting the plan as
well as pressuring opponents. A paid TV ad campaign is all but
Other advocates of revamping health care also have created a
network of diverse coalitions. They are made up of strange
bedfellows, such as labor unions and industry representatives,
consumers and businesses. Others, like America's Agenda: Health
Care for All, are comprised of insurers and drug makers, including
some that fought Clinton's plan. Those, too, now generally support
All are stockpiling cash, and waiting to see how they will need
to use it. Budgets and strategies are being closely held.
Both Democrats and Republicans expect an expensive fight. They
say it will dwarf the $30 million that the Health Insurance
Association of America spent on its TV commercials featuring Harry
and Louise, a couple who talked fearfully about the Clinton plan as
they paid bills at their kitchen table.
This time, the mountain of money is expected to come from
well-funded Obama backers trying to create a climate for success;
some already are airing ads to drum up support for major changes in
Last week, in a sign of what's to come, a group called
Conservatives for Patients Rights began what it said would be a
multimillion-dollar advertising campaign to promote "free-market"
reform rather than a "Big Government takeover."
A costly and complex proposition, revamping health care probably
will be a much tougher task than anything Obama has faced so far as
It's an issue that touches everyone in the United States, every
constituency group, and every elected official. There are thickets
of competing interests among patients, doctors, drug makers,
insurers, labor, businesses and others.
Any plan must get through a Democratic-controlled Congress,
where most lawmakers are up for re-election next year. Also,
there's an ideological fault line between Democrats and
Republicans, and liberals and conservatives over the level of
government involvement in health care.
Given all that, Democrats and Republicans contend Obama must use
all tools available to ensure success.
"President Obama needs to invest everything he learned in
winning the presidential campaign to get affordable health care for
everybody. That's what it's going to take to trump the
opposition," said Judy Feder, a senior health care official under
Bill Clinton who now is at the Center for American Progress.
"It's extremely important for him to use his political
skills," agreed Bill Gradison, a former GOP congressman from Ohio
who was the head of the insurance association when it launched the
anti-Clinton commercials. Still, Gradison added: "Bill Clinton had
those same skills in a lot of ways. Both are excellent
communicators and had strong organizational and political support
behind them. And both had control of Congress."
But Clinton, who won a three-way race in 1992 with only 43
percent of the popular vote, didn't have was the mandate from
voters that Obama now has after winning 52 percent last fall.
Clinton also didn't come into office inheriting a crisis that
presents opportunity for change the way Obama has with the
Nevertheless, Obama administration officials acknowledge that
the push for an overhaul - what Obama calls the lynchpin to the
country's future financial health - will be complicated and
contentious, even though the environment is now more amenable to
it. The public overwhelmingly supports revamping the system, while
businesses, insurers and drug makers that balked at Clinton in the
1990s are working with Obama.
For now at least, Obama is approaching health care much
differently than did Clinton. He cut out Congress and interest
groups, wrote his own legislation and threatened to veto any
measure that didn't contain what he wanted.
Obama has chosen to be flexible. He's outlining broad principles
and leaving the heavy lifting to Congress. He also is calling both
allies and skeptics to the table to solicit ideas and advice. He's
created a Web site, www.healthreform.gov, to keep people in the
loop. Obama also is indicating he's willing to compromise.
Obama also has secured $19 billion in the economic stimulus
package to convert medical records to electronic formats and
proposed a budget that projects spending $634 billion over 10 years
toward universal health care. He devoted a significant chunk of his
first address to Congress on the matter, and is dispatching
surrogates to hold regional forums on the issue.
At some point, he almost certainly will travel across the
country to take the proposal directly to the people, using his
rhetorical skills and charisma to keep people on the side of change
- and pressure lawmakers to get it done.