His eloquence is a big part of the reason that Barack Obama got to the Oval Office. There's always been a sense that his ability to explain things was tantamount to his ability to fix them. But the sheer complexity of health care has so far defied both his ability to explain and his power to fix. And in this case, the latter is an even greater challenge than the former.
As the President sat surrounded by his health-care brain trust on July 28, his words seemed unequal to the task before him. Dr. Bob Kocher, a special assistant at the National Economic Council, was on the cream-colored brocade couch across from Obama, laying out figures that showed what a sinkhole the country's health-care system has become: the U.S. spends more to get less than just about every other industrialized country. Still, Obama and his team are aware that the more Americans learn about how Washington proposes to cure that system, the more skeptical they are about the whole enterprise. The more the public hears, the less it seems to understand. What Obama and his team also know is that fixing health care has become not only a defining moment for his presidency but also a test of his leadership.
In an interview in the Oval Office, Obama did not attempt to hide his frustration. "This has been the most difficult test for me so far in public life, trying to describe in clear, simple terms how important it is that we reform this system. The case is so clear to me. And when I sit with our policy advisers," he told me, pointing across the room to the spot where Kocher had given his presentation hours before, "when you start hearing the litany of facts, what you say to yourself is, This shouldn't be such a hard case to make, because the American consumer is really not getting a good deal ... It leads me to spend a lot of time thinking about how can I describe this in clearer terms, so that we can get the health care that the American people deserve."
Clarity in describing the challenge is only one test. The hard part is making sure that in transforming a system that is bankrupting the country, Washington doesn't create a new one that does it even faster. Or that in expanding health coverage to the minority of Americans who don't have it, Washington doesn't leave the majority who do have it and who like what they have with less. The next 90 days will be particularly treacherous, as Obama's campaign to remake the health system enters its final, make-or-break stretch. The President will need all his rhetorical skills and some fresh legislative moves to persuade this Congress to pass his signature domestic-policy initiative.
Obama has gotten this far in part because he has put off the thorniest questions of who should pay and how big a role government should have. These, he says, are the issues that deepen "some long-standing ideological divisions in our Congress and, frankly, in our society." They are also the ones that have defeated Presidents who have tried to solve the problem, going all the way back to Teddy Roosevelt. But what looked like shrewd politics early in the process is increasingly being viewed on Capitol Hill as a failure to lead. As a senior Democratic congressional aide put it, "The President is going to have to step forward and start making decisions soon."
In our interview, Obama noted correctly that there is broad agreement about how to fix the inequities and inefficiencies of the current system: new insurance rules to make certain that people won't lose their coverage if they get sick; a marketplace or "exchange" where small businesses and those without coverage could purchase what suits them best; research that would show which treatments were effective and which were wasteful; a payment system that would give health-care providers incentives to focus on the quality rather than the quantity of care. And Obama has laid down a marker that any bill that passes must not add to the deficit over the next 10 years. "Eighty percent of all the various bills that are out there, that people have agreed to, reflect most of our ideas from the start of this process," he says.
But most of the pivotal questions particularly about money and who will lose it remain unresolved. The continuing uncertainty over what the final plan will do, and to whom, helps explain why public doubts are growing. A new TIME poll reveals that 46% of the nation approves of Obama's handling of health care exactly the same percentage that disapproves. Lawmakers will soon head home to face voters without answers to many of their most basic worries: Will taxes go up? What treatments will be covered? Will there be a new, government-run public plan like Medicare? What new requirements will it put on businesses and individuals? What new sacrifices will Americans have to make? And what are the guarantees that an overhaul will bring health-care costs under control rather than make them rise even faster?
There are signs of a coming backlash. Obama's health-care-reform allies are currently outspending his opponents 2 to 1, says Evan Tracey of the nonpartisan Campaign Media Analysis Group. The actors who starred as a fictitious middle-class couple in the famously devastating "Harry and Louise" spots that helped kill the Clinton health plan in 1994 are now featured in ones that push for overhaul. But the other side is just warming up, so you can expect to see plenty of nightmarish scenarios in TV advertisements featuring legions of government bureaucrats standing between patients and doctors, and long waits for lifesaving treatments. The U.S. Chamber of Commerce has already allocated $2 million to fight the idea of a public plan that would compete with private insurers; two liberal groups Health Care for America Now and the National Physicians Alliance have run ads in six states arguing that a public option is essential. "August," says White House chief of staff Rahm Emanuel, "has both peril and opportunity."