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September 11, 09

NEWS / Remaking the U.S. Health System Takes More than Presidential Will

In the United States, reform requires public support and legislative effort

By Bridget Hunter
Staff Writer

Washington — On September 9, when President Obama spoke to Congress and the American people about health care in a televised address, he underscored some fundamental principles of U.S. democracy: No branch of government has ascendency over any other branch and all governmental power derives from the people.

In the address, Obama pushed back against critics of his reform plan, reiterating the urgent need to provide health care to all and trying to convince the American people reform is necessary.

“Too many have used this as an opportunity to score short-term political points, even if it robs the country of our opportunity to solve a long-term challenge,” Obama said. “Well, the time for bickering is over. … Now is when we must bring the best ideas of both parties together, and show the American people that we can still do what we were sent here to do.”

The U.S. Constitution strictly limits the president’s power, as Obama’s ongoing battle to reform health care illustrates. At his request, Congress is developing legislation to reform America’s $2.5 trillion health care system without degrading services or increasing costs, but progress is slow.

The president needs to convince more than half the members in the Senate and the House of Representatives to agree on a bill to reform health care. Simultaneously, he will need to convince U.S. voters to support his plan. With one-third of Senate seats and all seats in the House of Representatives being contested in the November 2010 elections, members of Congress fear an unpopular vote on health care could cost them their jobs.

The challenge facing Obama is daunting, but past American presidents have met similar challenges successfully through leadership, effective communication, consensus building and compromise.


In 1933, another president, Franklin Delano Roosevelt, was elected on a platform of change and promises of economic and social reforms aimed at bringing the nation out of the Great Depression. His “New Deal” triggered a flood of legislation, regulation and government policies that profoundly affected banking, trade, farming, manufacturing and labor standards.

“The only thing we have to fear is fear itself,” the president told the nation in his inaugural address, and he continued to talk to the nation throughout his presidency in a series of “fireside chats” broadcast on radio, bolstering popular support to help secure votes in Congress.

Despite Roosevelt’s success in pushing through his New Deal legislation, the very speed with which it moved meant some measures were poorly drafted, inadequately implemented or even contradictory. Nonetheless, the New Deal paid a democratic dividend by reviving Americans’ interest in their government: FDR’s policies were continuously debated and frequently criticized throughout the New Deal era.


In the 1960s, Lyndon Johnson, who served as the majority leader in the Senate before becoming John F. Kennedy’s vice president, understood how Congress worked and showed extraordinary skill in shepherding legislation to enactment. When an assassin’s bullet brought him to the highest office in the land, he used his abilities to promote one of the broadest social reform agendas in American history.

“Your imagination, your initiative, and your indignation will determine whether we build a society where progress is the servant of our needs, or a society where old values and new visions are buried under unbridled growth,” Johnson told a Michigan University graduating class in 1964. “For in your time we have the opportunity to move not only toward the rich society and the powerful society, but upward to the Great Society.”

Johnson’s Great Society agenda called for eliminating poverty and distributing the benefits of prosperity to all. Johnson declared a “war on poverty,” fighting it with expanded job training and community action programs to give the poor a voice in health, education and housing. Under Johnson’s leadership, Congress enacted Medicare, a health insurance program for the elderly, and Medicaid, a program funding health care for the poor.

Like the New Deal, the success of the Great Society’s legislative agenda relied on public support and congressional cooperation, not just presidential will.


The current health care reform effort will need all three of those elements to succeed.

Already, in a series of town hall meetings sponsored by senators and representatives across the nation, voters have weighed in, citing problems with the current system but also objecting to greater government intervention in private lives and more government spending. Debate has been intense; tempers have flared; and public opinion remains sharply divided.

On Capitol Hill, five congressional committees are involved in drafting legislation. Once written, a bill must be approved by a majority vote of the committee. As is typical of U.S. legislation, the Senate and the House will consider different bills. If and when each has approved its bill, the differences must be reconciled by a joint committee. The reconciled bill is then returned to the full House and Senate for approval. Only when both chambers agree on identical language can the bill be sent to the president to become law.

But the law is only the first step in a process: The executive branch needs to develop rules and policies to implement the law.

It is too early to say how, or perhaps even if, U.S. health care will be reformed, but whatever is done will be a product of public debate, legislative effort and executive will.




AnnaMaria Realbuto
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