(Cross-posted from Think it Through)
The latest polls showing that President Obama is more popular than some of his policies are a sure sign that meaningful health care reform with a public option should be a slam dunk for Obama.
The intangibles of leadership, not the specifics of policies, usually determine whether or not the country will accept large scale change like health care reform.
If Franklin Roosevelt had lived through his fourth term in office, the country would have heard him call for national health insurance as part of a Second Bill of Rights he was preparing. After FDR's death, President Harry Truman took the first step by calling on Congress to provide universal health care coverage. But in 1945, Truman was not popular, and the American Medical Association and others crushed Truman's plan.
Twenty years later, President Lyndon Johnson had just won a landslide election and he enjoyed a national consensus behind his leadership. He move quickly in January of 1965 to ask Congress to send him a Medicare bill. He faced the same bitter opposition as Truman, as the AMA fought back hard with lobbyists and money. The AMA even offered an alternative it named Bettercare, a voluntary program run by the private insurance companies. None of this mattered in the face of LBJ's popularity. Just 204 days after LBJ asked for a Medicare bill, he signed it into law on July 30, 1965, in Independence, Missouri with former President Truman at his side.
President Obama's personality and style of leadership is polar opposite that of LBJ. Yet, Obama has the same level of trust at a time of hope and anticipation that he will accomplish great things for the country.
Obama's consistently high job approval ratings -- 65% in the latest ABC/Washington Post poll -- reflect the public's general trust in his leadership. This high level of trust is much more important than the fact that somewhat fewer Americans like his specific policies. For example:
- 61% approve of the way Obama is handling foreign affairs
- 57% approve of his handling of the threat of terrorism
- 56% approve of his handling of the economy
- 53% approve of how he is handling health care
President Clinton's health care reform did not unravel due to the details of his plan as much as the public doubts about his leadership and voters' disgust at Congressional behavior. The infamous "Harry and Louise" ads did not focus on the particulars of the president's plan as much as they argued that something as important as your personal health could not be entrusted to the government at a time when Clinton had stumbled during his first year in office and Congressmen were bouncing checks and playing the float at the House Bank.
Although the history of health care reform covers decades of defeats, the level of trust the public has for Obama should make health care reform achievable.
Yet, there are some things he can do to lose:
- He can lose if he relies on men and women of good faith to come together to do what is right for the country. For the insurance, hospital, medical and trial attorney lobbies, health care reform is about money, and they will oppose every dollar they are asked to sacrifice for the common good.
- He can lose if he depends on selling the details. Flow charts did more to hurt than help the Clinton plan's presentation to the public. The devil is not in the details, it is in his determination. If the issue is reduced to one of who do you trust: the President or the insurance industry, who do you think will win?
- He can lose if he talks more about how he will pay for the plan rather than how we will benefit. Obama's best line so far on health care has been "we cannot afford not to do it." He must describe for us the pay-off, not the process of how to get there.
Like LBJ, Obama has the opportunity to either convert or roll over the naysayers and enact a program that will benefit hundreds of millions of Americans for years to come.
Health care reform is his to lose.
John Russonello is a partner with Belden Russonello & Stewart: Public Opinion Research and Strategic Communications in Washington, DC. He writes the blog "Think it Through."