Which Obama Will We Get On Health Care?

The President-elect was for single-payer before he was against it.

On June 30, 2003, Illinois state senator Barack Obama spoke to a gathering of AFL-CIO officials and declared his unequivocal support for a government takeover of our medical delivery system: "I happen to be a proponent of a single payer universal health care program." He went on to cite the standard "progressive" pretext for his statist vision: "I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its Gross National Product on health care cannot provide basic health insurance to everybody."

Fast forward to January 21, 2008: During the Democrat presidential debate sponsored by the Congressional Black Caucus, Obama responded to Senator Clinton's charge that he had flip-flopped on government-run health care by saying, "I never said that we should try to go ahead and get single payer." Then, taking advantage of the stunned silence precipitated by this brazen whopper, Obama attempted to give the tale verisimilitude to by adding a retroactive caveat: "What I said was that if I were starting from scratch ... I would probably go with a single-payer system."

This brisk pirouette did not, even in combination with similar reversals on a number of other issues, trouble enough voters to prevent the Illinois Senator from winning the election. In retrospect, however, it does raise a question as to which Obama we will be getting on inauguration day. Will we end up with the proud single-payer proponent who addressed the AFL-CIO, or the presidential candidate who ran on a more moderate reform plan that combines the best features of market-based and government health care? Obama's history suggests that the answer depends largely on which way the "righteous wind" is blowing.

When the President-elect raises his dampened finger in the air next January he will detect a great deal of wind emanating from Congress about health care, and it will be blowing in the direction of single-payer. In the Senate, Edward Kennedy has been very busy on this issue. The Washington Times reports that "Kennedy has secretly been orchestrating meetings with lobbyists and lawmakers from both parties to craft legislation that would greet the new president with a plan to provide affordable medical coverage to all Americans." And the Massachusetts Senator is committed to getting this done. He has taken to calling his health care bill "the cause of my life." 

The reform plan that emerges from these meetings is unlikely to resemble Obama's stated proposal in its important details. Kennedy has long advocated converting Medicare, the taxpayer-funded health insurance program that currently covers only Social Security beneficiaries, into a full blown single-payer system covering everyone "from birth to the end of life." And the pressure on the new President to go along with the Kennedy plan will be immense. The bill will not only have the backing of the powerful interest groups that Kennedy is lining up, its backers will use the Senator's declining health to generate sentimental public support for what will probably be his final legislative project.

The Kennedy health care push will be aided and abetted by influential voices in the House. Pete Stark, the Chairman of the Health Subcommittee of the House Ways and Means Committee is also a vocal advocate of "Medicare-for-All." In a 2006 article for The Nation, Stark wrote, "With Medicare as a model, we can fill the growing gaps in health coverage and ultimately weave together a stable, comprehensive, affordable system for Americans of all ages." And Stark probably won't be reticent about throwing his weight around. As it was recently phrased in the Wall Street Journal, "Obama may want to strike a deal with Senate Republicans on health care, but Mr. Stark will be pulling him left at every turn."

Stark and Kennedy will not be "pulling" gently. Indeed, it appears that all of the key Democrats in both houses of Congress are prepared to get out the brass knuckles in the cause of major health care "reform." As Jonathan Cohn points out in The New Republic, they are even prepared to use the budget reconciliation process to get it done: "The rules of reconciliation limit debate, restrict amendments, and prohibit filibusters. It's the one time a simple majority of 50-plus-one votes-rather than the 60 it takes to break a filibuster-can definitively pass legislation." The Democrat leadership professes reluctance to go this route, but their recent history suggests that they will do what it takes.

With all this momentum behind a single-payer system based on Medicare, how likely is it that President Obama will bitterly cling to his newfound affinity for moderation in health care reform? Not very. His record is one of going along to get along. As John McCain pointed out to no effect in the recent presidential campaign, Obama voted with the Democrat herd 96 percent of the time during his short tenure in the Senate. With Kennedy, Stark, et al pushing "Medicare-for-All," Obama will likely rediscover his erstwhile enthusiasm for single-payer. He will no doubt extract a few superficial concessions for CYA, but the President who signs health care "reform" into law will be very familiar to the people who attended that 2003 meeting of the AFL-CIO.

David Catron is a health care finance professional who has spent more than twenty years working for and advising hospitals and medical practices. He blogs at Health Care BS.