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President Obama is receiving a significant amount of criticism for being too "hands off" in governance.  His leadership style with respect to health care in his first year largely involved speaking in generalities on the topic and leaving the details and messy process to Congress for resolution.  When the process would start to collapse, he would once again deliver a powerful, albeit unspecific, speech on health care, and urge Congress to get back to work.  Time and again they did.  In the end, health care reform hasn't yet passed, but whatever you may think of Obama's leadership in the first year, he came closer to shepherding comprehensive health care reform to passage than any president who has ever tried.  

Now granted, "close" isn't much consolation in politics, especially to the tens of thousands of people who will die because they do not have health insurance in the United States. So why does "close" matter?  Because if we were close to finalizing health care reform two weeks ago, there is no good reason we can't still be close today- and finished tomorrow.  To understand what Obama can do to finalize the bill, we need to first understand who the obstacles are.

The House of Representatives has been particularly responsive to Obama's calls to action- and not just on health care either.  Of course, the House doesn't have to deal with the filibuster or the nonsensical Senate tradition of the "hold" which permits one single Senator to block debate or passage of a bill indefinitely (or at least until the Majority Leader grows weary of the hold).  At every step of the health care reform process last year, the House was ahead of the Senate.  The House Energy and Commerce Committee passed a draft bill in August while Sen. Baucus' committee toiled on.  The House then passed its full bill in November while the Senate remained stuck in negotiations.  The nation's attention turned to the Senate and, rather than rise to the occasion, the Senate had to deal publicly with the ego of Joe Lieberman, the special interest demands of Senator Nelson and Landrieu, and procedural votes taking place in the late hours of night or in the early morning on Christmas Eve.  The public reacted to the messy Senate process about as one would expect- negatively.  

Neither the House nor the Senate bills are perfect, but both are quite good.  Both could be improved by, among other ways, adding elements from the other.  Previously, the Senate and, implicitly Obama, have taken the position that it is harder to pass a bill in the Senate than it is the House, and therefore the final bill should be closer to the Senate version than the House version.  That may have been true before the Massachusetts election, but since that election, the "sidecar" option (which likely wouldn't have emerged if Coakley had won), has gained significant traction.  Using reconciliation to amend the Senate bill is workable.  The Senate bill provides the framework for reform (and that framework couldn't have been accomplishedthrough reconciliation alone- a non-reconciliation bill was needed), and reconciliation provides the tweaks.  Care to guess who is dragging their feet on the sidecar option?  The Senate.  

Enter the State of the Union speech.  Obama went straight for the Senate jugular, repeatedly drawing express contrasts to the progress of the House.  On jobs:

The House has passed a jobs bill that includes some of these steps. As the first order of business this year, I urge the Senate to do the same. People are out of work. They are hurting. They need our help. And I want a jobs bill on my desk without delay.

On financial reform:

The House has already passed financial reform with many of these changes. And the lobbyists are already trying to kill it. Well, we cannot let them win this fight. And if the bill that ends up on my desk does not meet the test of real reform, I will send it back.

On passage of a climate bill:

I am grateful to the House for passing such a bill last year. This year, I am eager to help advance the bipartisan effort in the Senate.

On education:

When we renew the Elementary and Secondary Education Act, we will work with Congress to expand these reforms to all fifty states. Still, in this economy, a high school diploma no longer guarantees a good job. I urge the Senate to follow the House and pass a bill that will revitalize our community colleges, which are a career pathway to the children of so many working families.

And what did he have to say about the Senate?

I’ve called for a bipartisan, Fiscal Commission, modeled on a proposal by Republican Judd Gregg and Democrat Kent Conrad. This can’t be one of those Washington gimmicks that lets us pretend we solved a problem. The Commission will have to provide a specific set of solutions by a certain deadline. Yesterday, the Senate blocked a bill that would have created this commission. So I will issue an executive order that will allow us to go forward, because I refuse to pass this problem on to another generation of Americans....  And when the vote comes tomorrow, the Senate should restore the pay-as-you-go law that was a big reason why we had record surpluses in the 1990s.

For Senate Republicans:

...if the Republican leadership is going to insist that sixty votes in the Senate are required to do any business at all in this town, then the responsibility to govern is now yours as well. Just saying no to everything may be good short-term politics, but it’s not leadership. We were sent here to serve our citizens, not our ambitions.

Obama's first year was defined by high oratory and smart commentary, when needed, and giving legislators space to do the messy business of legislating.  If the State of the Union is any indication, his second year is going to be defined by aggressively dealing with the Senate, including Senate Republicans, and by stating, in clear terms, the precise details he wants to see in legislation.  

Whether or not it is attributable to Obama's change of pace, there does appear to be quite a bit of movement on the health care front today.  Senator Harkinis backingthe sidecar option.  Senator Reid convened a meeting of key Democratic Senators today to discuss moving forward with health care- and the meeting showed some movement.  Senator Sherrod Brown also came out in favor of the sidecar option.  Senator Nelson called on Republicans to work with Democrats to pass health care reform, but indicated that if they don't, reconciliation may be the only viable option left.  On the House side, Nancy Pelosi was even stronger, saying:

You go through the gate. If the gate’s closed, you go over the fence. If the fence is too high, we’ll pole-vault in. If that doesn’t work, we’ll parachute in. But we’re going to get health care reform passed for the American people.

Pelosi also noted that she thought sufficient votes in the House could be found to pass health care reform through the sidecar option.  

For the momentum to continue, Obama is going to have to be more involved.  He is going to have to twist arms, cajole, and use the weight of his popularity and his office to get the bill finalized.  As Obama's poll numbers fall in each state, so too do the numbers of the Democratic Senator from that state running for reelection.  Obama must be willing to tell those Senators "get health care reform passed, or I will willingly go down with the ship- and you with me."  He has said he is willing to be a one term president if needs be.  Senators need to believe him.  

I postulated a few weeks back that if Coakley lost in Massachusetts, Democrats would fold and health care reform would die.  Now I think I may have been wrong.  If Obama means what he says, that he "will not walk away" from health care reform, and if he gets personally involved in the process, health care reform will pass.  Finally.

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Originally posted to thefourthbranch on Thu Jan 28, 2010 at 09:57 PM PST.

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