Prospects for healthcare reform

Brookings' Darrell West takes an optimistic view.

Obama already has demonstrated much greater political effectiveness than Clinton. The new president is more popular than Clinton was at the six-month point. In mid-July, 1993, for example, Clinton had a 41 percent approval rating in the Gallup poll, much lower than Obama's most recent rating of 56 percent.

Four of the five relevant congressional committees actually have passed health care reform, which is not something Clinton was able to achieve. Obama's leadership style of delegating specific policy decisions to Congress has led to committee approvals and given himself maximum room for bargaining and negotiation at the end of the legislative process.

When you look at public opinion polls, there is little evidence that opposition scare tactics are working. Sixty-six percent of Americans in a recent CBS News/New York Times survey favored a "government administered" public health insurance option. This is despite private insurance industry anguish over a public option. And 55 percent believe the federal government should guarantee health insurance for all Americans. Critics who claim America should not expand the role of the government are losing that argument with the general public.

Even more striking are poll numbers revealing that voters have much greater confidence in Obama on health care than congressional Republicans. For example, 55 percent of Americans say Obama has better ideas about reforming health care, compared to only 26 percent who think that of congressional Republicans.

All good points.

Where I'm less sure is here:

If Democrats lose health care reform, the biggest victims will be Blue Dog Democrats. Since many of them represent conservative areas, they will be the ones swept out of office if liberals are disillusioned by failure and stay home in the 2010 elections. Moderate members who oppose health care reform because they worry about specific provisions should understand they have more to fear from failure than success in passing comprehensive reform.

I'm guessing that the Blue Dogs have a highly developed sense of where their electoral interests lie. I'd trust their judgment on that, if on nothing else. On the other hand, there's no denying that the outright failure to pass a measure would be a disaster for the president and his party. It's very hard to believe that a deal cannot be scrabbled together to avoid that outcome.