President Obama faces tough choices on healthcare

President Barack Obama speaks to reporters in the White House Rose Garden 15 June 2012 Is President Barack Obama's toughest election foe the Supreme Court?

Barack Obama could be about to suffer his worst defeat as president, a humiliation that would go to the heart of the election campaign.

The Supreme Court is expected to rule soon on his changes to America's healthcare system.

Obamacare, as his opponents call it, is hugely controversial. In a recent poll by Rasmussen, 53% of Americans say they wanted it scrapped.

But it is President Obama's single biggest domestic achievement. And he chose to do it. He had to deal with the economy. He didn't have to reform the healthcare system.

But providing comprehensive healthcare for all Americans has been a dream of liberals for more than a century. Teddy Roosevelt couldn't do it. FDR couldn't do it. The Clintons failed spectacularly. Obama succeeded.

His first year in office was consumed with the struggle. He spent enormous amounts of political capital and rather ruined his reputation as a man who would change the way business was done in Washington, not doing grubby deals.

The Tea Party first became vocal and visible while opposing the changes, and it helped them grow.

Historical court clashes

But now many expect the Supreme Court to rule that either the whole law, or a vital part of it, is unconstitutional. That would be a dramatic political blow to Mr Obama's legacy, credibility and effectiveness. It would leave him with some very hard choices.

The argument centres on the "individual mandate" - weird jargon for an accepted fact of life in most countries, that everyone has to have health insurance, just as in most places everyone has to have car insurance if they want to drive.

But a sizable number of Americans regard this as a grotesque government intrusion into their rights.

Start Quote

There are political consequences but there are huge policy implications as well”

End Quote Jeff Shesol Clinton speech writer

Of course, without this provision, insurance companies are loathe to adopt another vital part of the law - that they have to insure everyone, regardless of what medical conditions they have.

Jeff Shesol, former Clinton speech writer and author of a book on FDR's clashes with the Supreme Court, says if his law is struck down, Mr Obama would be in good company.

"It is a fairly common clash in American history between progressive presidents and conservative-minded Supreme Court justices," he says, mentioning that such troubled relationships occurred as far back as Thomas Jefferson, and continued with Andrew Jackson, Abraham Lincoln and both Roosevelts.

"The Supreme Court often suffers a lag between administrations," Mr Shesol says. "President Obama is facing a Supreme Court that was shaped by Ronald Reagan and by both Bushes. You often have the phenomenon where the court represents the past regime."

What now?

There's no doubt that if the Supreme Court does as expected, the initial reactions would be pretty straightforward.

Two police officers outside the Supreme Court 18 June 2012

"It's a huge blow to President Obama, and a big boost to the Republicans, particularly to the Tea Party grass roots," says Dean Clancy, a health specialist at Freedomworks, a conservative campaign group. "I don't see anyway the president can put a happy face on such an outcome."

But wouldn't it rob the Republicans of one of their main planks in the election campaign, one which really motivates their supporters?

"I think that is a bit like the person who is convicted of shoplifting saying the public prosecutor has a terrible problem because he now has no case to prosecute," Mr Clancy says.

"The healthcare issue will diminish in the sense that it has been resolved, but the American people will now get to make a judgment about the stewardship of the president. So it will be very relevant politically."

It would be a key moment for the president and the campaign. His dilemma would be how to play the defeat and indeed what to promise if he is re-elected.

"There are political consequences but there are huge policy implications as well," Jeff Shesol says. "The question is going to be: 'What are we going to do about it? What do we do about all these Americans who are struggling to afford healthcare?'"

"[Mr Obama] will come forward, I am quite sure, to do something about these Americans. He is not going to leave them to fend for themselves, so that will be a rallying point for the president and his campaign."

That is perhaps easier said than done.

The president can moan about the Supreme Court if he likes, but he can't campaign for a law they have ruled to be unconstitutional.

Arguing that reform is needed is easy in general terms. Designing a replacement that would be universal, but lack an element of compulsion would be extremely hard.

Persuading anyone that if re-elected, he could get such an imaginary scheme past a hostile Congress might prove impossible.

If healthcare is struck down, it will certainly fire up Mr Obama's supporters. But that would be cold comfort for a politician who's just watched his signature achievement gutted or destroyed.

Mark Mardell Article written by Mark Mardell Mark Mardell Presenter, The World This Weekend

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  • rate this

    Comment number 172.

    170 McJakome

    I agree.

    One of the bad things about getting older is you can remember more disappointing congresses and administrations than you care to think about. The constitution, it seems, was designed to produce just that.

    Here's question: if 1% to 2% of the population are psychopaths and same for sociopaths, how many psycho- and socio-paths are there in a population of 435?

  • rate this

    Comment number 171.

    168 LucyJ

    Republicans were still involved in shaping the law even though they, and a handful of Democrats, voted against in the end.

    168 third sentence should read advisory vote.

  • rate this

    Comment number 170.

    140. d_m RE #137

    "They aren't all stupid." True, and they aren't all corrupt, nor are all republicans heartless, but the number of those who are, in our cumbersome "Rube Goldberg" system guarantees poor governance and bad outcomes.

  • rate this

    Comment number 169.

    165 Scott0962

    Are you suggesting we have a capitalist Congress selling services. You're right money in Washington is making a mockery of our democracy. Perhaps we (citizens) should be able to provide an advisory on all legislation before the Congress. After all, it is the digital age.

  • rate this

    Comment number 168.

    dm: a compromise--it was what dems and repubs in Congress could agree on

    No Repubs voted Yes

    A Dem, Max Baucus, was leading the Senate committe on health care reform

    They only invited pharm corps, health ins corps, etc to the meeting

    Advocates for singer payer system including Drs+nurses were either not invited allowed or were arrested for protesting in support of universal health care

  • rate this

    Comment number 167.

    d_m @158

    Spectrum of insurance charges, to match spectrum of incomes, to match spectrum of work valuations, to match our respect for each other

    Sounds superficially OK, but mismatches that would be hardly noticed in upper income reaches, in the lower reaches almost bound to cause pain & default & damage for health & families

    No need for 'free lunches': only respect, full employ, equal pay

  • rate this

    Comment number 166.

    162 LucyJ

    The constit. issue is about to be settled--we'll know soon.

    I don't know what the mechanism for payment will be. If the court upholds the law, then I hope it will work in a way the helps you and people like you. If it does, you you should find out how to make it work for you. This law was a compromise--it was what dems and repubs in Congress could agree on.

  • rate this

    Comment number 165.

    re. 163.d_m:
    "160 Scott0962

    I doubt Congress could have agreed on single payer though single payer would have been better."

    Especially since insurance companies, trial lawyers, pharmaceutical firms, hospital corporations etc. all make political campaign contributions. Money in politics is the real obstacle to meaningful reform.

  • rate this

    Comment number 164.


    I don't want others to pay for me

    Just wish I could have health care all year round via being taxed like how govt makes us pay for medicare, soc sec, etc in our paycheck

    My job is prn so some weeks I work a lot, some weeks not at all

    I know I need full time job+have been looking lots

    Ok no more I's ;)
    I will start talking about you's or they's
    I do sound selfish

  • rate this

    Comment number 163.

    160 Scott0962

    I doubt Congress could have agreed on single payer though single payer would have been better.

    As for the constitutional argument, you may be right. We'll find out shortly. Should be interesting, especially if the court upholds the mandate (a seemingly doubtful outcome). Let's give credit where credit is due--the Congress caved-in to special interests--it was always up to them.

  • rate this

    Comment number 162.

    I dislike mandate foremost b/c I believe its unconstitutional

    Also yes I dislike forcing people to buy insurance out of pocket

    I want the govt to take money directly out of my paycheck for health care
    not send me a different check each month to cover when I don't make enough which is really confusing b/c every month it would be different+if its not enough, still wouldn't get health care

  • rate this

    Comment number 161.

    159 LucyJ

    I apologize if I misjudged. The affordable care act makes provisions for people who can't afford to purchase ins., perhaps like you. The reason for requiring all to pay, a republican idea, is to spread the costs over a broad base. The system is designed to pay for itself, hopefully, without borrowing to support it. Hopefully it will help someone like you. It's a compromise--not ideal.

  • rate this

    Comment number 160.

    It's not that Americans don't want health care reform or are unsympathetic to the need for access to health care but our consitution doesn't give the government the authority to order people to buy anything.

    Ironically, a single payer health care system funded by taxes would probably pass consititutional muster but our fearless leader allowed the insurance companies to talk him out of it.

  • rate this

    Comment number 159.

    d_m: You want care without having to pay for it

    I want to pay for health insurance but I don't make enough money to afford it every month

    Theres some months I can pay for it, some months I can't

    The best thing for me would be if the govt took it out of my paycheck via taxes along w/ soc security, medicare, etc
    which is probably the only way I can afford it
    which is universal health care

  • rate this

    Comment number 158.

    156 AfA

    No free lunch you know. It's the way it is. Somebody has to pay. The affordable health care act, irrespective of whether one agrees with it or not, is a sliding scale kind of thing. If you can afford insurance then your are expected to purchase it. If you can't then help purchasing ins. is available based on what you can pay, right up to and including nothing.

  • rate this

    Comment number 157.

    Phffft @155

    Thanks for considering

    Not to pre-judge any 're-set'

    Maybe 'a long hunch'

    But 'human nature' is reactive

    My guess, give all a job, all will value belonging and income

    No 'need' to have unlucky / miserable / despised / at-risk / destabilised 'under-class'

    No need to think 're-set' a crude, unfair, reversal

    Good night to you and all

  • rate this

    Comment number 156.

    d_m @154

    Condemning care without payment,

    Assumes able to pay 'anything', without knowing other demands

    Even ability to pay 'insurance' may differ, despite same income

    And circumstances do changeā€¦ and bureaucracies can lag

    Should we be scrabbling like this? Not focussing on our WORK?

  • rate this

    Comment number 155.

    153. All for All

    time to re-set?

    Well,can human nature be reset ?.

    We both are very different people in out look,& may be experience.
    But that does not stop me from thanking you for your civility & to wish you a peaceful good night.

  • rate this

    Comment number 154.

    150 LucyJ

    Now I understand. You want care without having to pay for it. Hence your dislike of the affordable health care act--you have to buy ins. Pretty selfish I'd say. The government doesn't pay for illegals who receive care at ER. ERs are required by law to provide care. Pres. Reagan signed that bill into law. They recover costs when and where possible and write off unrecoverable debt.

  • rate this

    Comment number 153.


    NOT to doubt your effort, earnings, winnings, or use made of 'advantages' gained, in support of family, community, future, etc

    BUT, like me, now living on goods & services from those not grown, not even born, when we 'gained our advantage'

    ALL SHOULD be able to rely on 'deals' to be honoured

    BUT, is it not clear 'the race' unfair & corrupting & in crisis: time to re-set?


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