Believer: My Forty Years in Politics (50 page)

Even with the industry groups sidelined, however, health reform’s opponents found their footing as details of the House and Senate bills surfaced. The Senate was marking up a bill that would cost almost nine hundred billion dollars over ten years to help insure some thirty-one million Americans who lacked coverage. The House bill, more generous in its subsidies, had a price tag of more than a trillion. Each day’s stories from Capitol Hill left the impression of a huge, new social welfare program that would swell already intolerable deficits. It mattered not that, with the savings and new revenues the bills would generate, they would actually
lower
the deficits. That sounded like Washington math. Few believed it.

“They’re going to add these numbers up,” said an exasperated Rahm. “Seven hundred billion for the banks and auto companies, eight hundred billion for a stimulus they still don’t believe in, and now another trillion to buy someone else health care.”

Cautious at first, the Republican leaders saw opportunity. They were buoyed by a memo from Frank Luntz, a Republican pollster and language Svengali. Noting that Americans did believe there was a health care crisis, Luntz advised the GOP to embrace reform—but only “the right kind of reform that protects the quality of healthcare for all Americans.” In the Orwellian world of Luntz, this was not a primer on how to pass or improve health reform. It was a blueprint on language to
defeat
it. He advised Republicans to rail against a “Washington takeover” of health care and a one-size-fits-all system that would rob Americans of their choice of doctors and access to timely care.

Fear too often trumps reason. There was plenty of support for a law that would ban the worst practices of the insurance industry and bring down costs. Yet given widespread public disdain for Washington, our promises of relief were not considered as credible as the scary warnings against the intrusion of a meddling, incompetent government. Moreover, all the news coverage focused on the plight of the uninsured. Many came to see health reform as something that would help others, but at a cost to them. By June, we were losing momentum. Democrats on Capitol Hill grew increasingly wary of the politics, and there were signs that the president’s own standing was beginning to take a hit.

Around that time, I brought him some data that showed how we were suffering politically as a result of the ongoing debate. “I’m sure you’re right,” he said, after giving me a respectful hearing. “But I just came back from Green Bay, Wisconsin. I met a woman there who was thirty-five years old, had a job, a husband, and two children, and health insurance. But she also has stage-three breast cancer, and now she’s hit her lifetime caps, so her insurance company is refusing to pay her bills, and she’s terrified that she’s going to die and leave her family bankrupt.”

By then, I felt Obama’s hand in the small of my back, gently ushering me to the door of his office. As he opened it, he paused for a moment. “That’s not the country we believe in,” he said. “So let’s just keep on fighting.”

 • • • 

Obama desperately wanted a bipartisan bill to come out of Congress, and it wasn’t just a matter of getting the votes to make health reform the law. He knew that to pass the biggest piece of social legislation in half a century on a straight party-line vote would only exacerbate the deep divisions in the country and undermine public confidence.

The Senate Finance Committee was working to mark up and pass its version of the law by the August recess, and the ranking Republican member of the committee, Chuck Grassley of Iowa, had in the 1990s supported a law with an individual mandate and health insurance exchanges as a GOP substitute for the Clinton plan. The bill that was emerging in the Senate now looked very much like the one Grassley had supported then, so Obama invited Grassley to the White House as part of his ceaseless lobbying effort—and, at least as the president related it, they found plenty of common ground.

“I said, ‘Chuck, we agree on ninety-eight percent of this stuff. Can you support a bill?” Obama reported after the meeting. “He said, ‘Not unless you can get another ten Republicans to stand with me. I can’t be out there alone.’” “Another ten” was a polite way of saying no. We were having trouble finding even one Senate Republican to support our plan. McConnell had locked up his caucus and would squeeze even harder as the year went on.

Inside the White House, doubts were growing about our ability to pass sweeping reform legislation. Worried that a long, costly fight could hurt Democrats come midterms while ultimately yielding nothing, Rahm recommended scaling back to a plan that would cover fewer people, but garner more votes. Obama asked his legislative director, Phil Schiliro, to rate the chances of passing the larger bill.

“Depends how lucky you feel, Mr. President,” Phil replied.

Obama smiled. “Can I say this? I always feel lucky. Let’s go all in. When your name is Barack Obama and you’re the president of the United States, how can you not feel lucky?”

Still, Obama was frustrated by the traction that his opponents were getting. It drove him up a wall when a group from the consulting firm McKinsey and Company came in and outlined the unconscionable waste, fraud, and market manipulation that had made health care in America the most expensive in the world. Why didn’t people understand that his reform package could save enough to help millions obtain coverage and, in the long run, cut health care spending? “We haven’t communicated this well,” he told me. “They think it will raise their costs and the deficits.”

His frustration frustrated
me
, with its implication that this was all a failure of the messaging that I had devised. I had warned from the beginning how difficult this would be. Health care was the Fort Knox of messaging. Forgive me for not having picked the lock!

The predictable carping had begun in political circles: Why was an operation that had been so deft in winning the presidency now so hapless in selling Obama’s chief priority? Perhaps because, in the campaign, we had recognized the political pitfalls and dodged the most challenging aspects of health reform. Now that we had taken up the cause, our fears had proven to be justified.

I wasn’t sure, even as he spoke in March of spending his political capital on health reform, that the president fully grasped what a difficult sell this would be. He was so confident in his ability to communicate, and was convinced that, with the need so obvious, the benefits would eventually become apparent. It might have been valiant to dismiss the political concerns that Rahm and I and others had raised months earlier, but they hadn’t been unfounded.

“Despite our best efforts to explain, many Americans are simply finding it too hard to square adding a trillion dollars as part of a strategy to cut costs,” I wrote to the president in an August memo. “They suspect that this is about spending and taxing more to take care of someone else. And even if they see universal coverage as a laudable goal, they think it’s irresponsible to undertake it now—a liberal indulgence we can’t afford. To them, our determination to plow forward on an expedited timetable in the midst of a fiscal crisis is not sensible. It aligns us with the Washington they disdain—the dogmatic politics they thought we were going to change.”

Washington is a terrible place to be when the story line has turned against you. The town is one big echo chamber, and if you’re the target—as the White House often is—the din becomes deafening and deflating. The resident experts are always generous with their advice, which in this case, not surprisingly, was to limit our losses by taking what we could get and moving on. Before heading out west in mid-August for a set of town hall meetings, though, the determined president laid down the principles we needed to communicate, and exhorted all of us to forge ahead.

“Here’s what I want to go out there and say. This law will help the vast majority of people who have health care. It will help all of those who have insurance to make sure that if someone gets sick, you don’t get screwed. And I want to make sure that anyone who wants insurance can get it at a price they can afford. If we can make that case, we win. If we can’t tell that story, we lose.

“I know things are tough right now and a lot of the pundits are saying that the presidency is at stake and all of that,” he continued. “I don’t care about any of that. I’m not thinking about reelection. There will be plenty of time to worry about that. I don’t want to let down. I don’t want to give up. It’s important for the country and the future and many, many people. That’s why we’re here. It’s to get important things done. So I don’t want anyone losing heart. We’re doing the right thing.”

But doing the right thing isn’t often the easiest politics.

Throughout the country, members of Congress were assaulted by angry mobs at town hall meetings, railing against runaway spending and a “government-run” takeover of health care. Though the Republicans no doubt fanned the flames, much of the impetus was coming from an edgy new force in our politics, the Tea Party, which began as an organic protest movement but would quickly be enhanced by deep-pocketed Republican oligarchs intent on wresting the Congress away from Obama and the Democrats. Their vitriol was reminiscent of the angry crowds that had turned up at McCain-Palin rallies less than a year earlier. Now, in Obama’s initiatives, they were convinced they had found evidence of the dark, socialist impulses they had imputed to him all along.

The ugliness and personal tone of the protests betrayed a truth we were loath to acknowledge publicly. For some in the crowd, their ire was rooted in more than disagreements over policy. It was rooted in race: a deep-seated resentment of the idea of the black man with the Muslim name in the White House. The facts notwithstanding, to them, health reform was just another giveaway to poor black people at their expense.

Speaking with the authority of a former president and a lifelong southerner, Jimmy Carter decided to weigh in on the nature and tone of the protests. “When a radical fringe element of demonstrators and others begin to attack the President of the United States as an animal or as a reincarnation of Adolf Hitler . . . those kinds of things are beyond the bounds,” he said during a speech at Emory University. “I think people who are guilty of that kind of personal attack against Obama have been influenced to a major degree by a belief that he should not be president because he happens to be African-American.”

I appreciated Carter’s candor, but cringed when I read his remarks. I didn’t doubt that race had added an element of fury to some of the protests that summer, and even to the defiance of some in Congress. I also knew that Lincoln had been depicted as an ape. Roosevelt had been denounced as a dictator. Clinton was the fulcrum of relentless personal attacks from the Right, as was George W. Bush from the Left. If we appeared to be dismissing opposition to Obama’s policies as racism, it would enrage all those who had honest concerns about his legislative priorities, including millions who had voted for him.

The day after his comments, President Carter sent me an e-mail acknowledging these challenges. “Please express my regrets to the President if I have created an additional problem for him,” the Georgian wrote. “I have lived with these people for 85 years, been their governor and their President. I have made it clear in all my statements that it is ok to debate important issues, even to claim falsely that Obama supports death squads to kill old people. But some of the ad hominem and extremely vitriolic attacks go beyond a tough political debate. I’ll do anything to help him, but cannot deny what I am convinced is true.”

“Mr. President, I never doubted your sincerity or your intentions,” I wrote in reply. “I know very well the vantage point from which you spoke. But race is the catnip of the media. They didn’t believe Obama could win because of it and, given the current story line that he is stumbling, they tremble with excitement at any suggestion of it as a defining factor now. It is not a diversion we need.”

Whatever was behind the serial maelstroms that erupted over the summer, the beating we took from them dominated the news coverage, compounding a sense that health reform and its chief proponent were sinking.

We had to do something dramatic if we hoped to be heard over the mob. I suggested a joint address to Congress as soon as it returned after Labor Day. A prime-time speech would be broadcast by the networks and watched by tens of millions of Americans. It would be our best opportunity to explain plainly and clearly the benefits of reform to
all
Americans, not just the uninsured: an end to the ban on preexisting conditions and lifetime limits on care; savings to consumers that included a cap on out-of-pocket expenses; the requirement that every insurance plan cover routine preventive care; and the creation of an affordable, competitive market for people to buy insurance. Such a speech would also allow us to knock down health-rationing “death panels,” exploding deficits, and the other menacing myths our opponents had created and embellished.

On the evening after Labor Day, as I stood on the floor of the House chambers listening to the president’s address to Congress, I kept refreshing my BlackBerry for bulletins from Tempe, Arizona, where Binder was conducting dial groups with forty-nine swing voters. The news was encouraging. The president’s speech had accomplished what we needed it to by assuaging people’s concerns and winning them over to our side. Even so, as if to affirm Carter’s analysis, the speech was marred by a stunning moment, when the president refuted yet another pernicious piece of fiction—that the law would cover illegal immigrants—and one of the Republican House members, Joe Wilson of South Carolina, shouted back at him, “You lie!”

Obama’s forceful performance gave us a respite. Yet within weeks, any benefit had faded and we found ourselves once again bogged down in the grinding realities of the legislative process and the hyperpartisanship that gripped Washington and beyond.

Fighting against this factionalism, we still held out hope to get at least one Republican vote for health reform in the Senate. We might need it if anyone of the Senate’s sixty Democrats flaked, making it impossible to break a Republican filibuster to block a vote on the bill. Ben Nelson, a conservative Democrat from Nebraska, was no sure thing. So we pinned our hopes on Olympia Snowe, a moderate Republican from Maine, who had a long history of independence and had broken with Mitch McConnell by supporting the Recovery Act. She was working on her own amendments to the plan, and was still hinting at supporting it.