Is Obama running out of time?

Barack Obama's stalled healthcare-reform plan reveals how crucial features of the American political system operate.

The members of the United States Congress have gone home withoutapproving Barack Obama's healthcare plan. The president has given theissue so much salience, and the case for reform is so urgent, that itis likely that some more or less satisfactory healthcare reforms willbe passed between September 2009 (when Congress reconvenes)and the end of the year. But even if this happens, it is now plain thatthe result will fall far short of what Obama promised as a presidentialcandidate and what so many hoped for; it will be rather an intricate complex of compromises, cobbled together to meet the conflicting political and financial needs of  dozens of special interests.

The exact lines of that package of reforms is not yet clear. Butalready it has offered a highly instructive look at three matters ofgreat importance:

* Obama's growing political difficulties

* The current mood of American politics

* How very different American politics are from the style and substance of politics in other developed democracies.

The magnified madness

The inherently ridiculous affair of the professor, the policeman andthe president revealed that, contrary to the"bliss-was-it-in-that-dawn" mood at the time of President Obama'selection in November 2008, the United States is still very far from being a "post-racial" nation.

On 16 July 2009, A (white) neighbour observed what seemed to her to betwo black men breaking into a house. The two turned out to be the bestknown African-American scholar in the country, the Harvard Universityprofessor Henry Louis Gates Jr, and his driver; they had gone round the back of Gates's home because the front-door was jammed.

Sergeant James Crowley of the Cambridge, Massachusetts police, was sent to investigate and arrestedGates, who - understandably, since he was in his own house - used someunprofessorial language. When asked about the episode at a pressconference, President Obama, a personal friend of Gates, saidthat the local police had acted "stupidly". This is a president who,like most non-white people in America, has personal experience of being"racially profiled", the euphemism for discriminatory harassment bypolice (see Darryl Pinckney, "Henry Louis Gates Jr: Every black man's nightmare", Independent, 4 August 2009).

With some grace and political style, Obama invited both the tactless policeman and the touchy professor to the White House to have a beer with him in the rose garden.

So much for a silly-season story. What is of lasting significance isthe storm of blogs, tweets and other responses the affair provoked, andwhat they reveal about the political mood. The great majority werefurious, not with the policeman, but with the president. The incidenthas even given new life to the truly mad minority who insist thatBarack Obama, a devoted Christian, is a Muslim; or that he isdisqualified by foreign birth from the presidency, though he was bornin Hawaii; and even that he is a "Manchurian candidate", sneaked intothe United States by some Muslim conspiracy to undermine itsconstitutional-liberties system and Christian faith.

The public illness

What, it may be asked, does this have to do with healthcare reform?

No one, I think, who has read both the bloggers' response to the Gatesaffair and the chorus of incoherent rage about healthcare could fail tostruck by the similarity of their stridency and irrationality.

True, there is one significant difference. On Gates, the great majority were hostileto the president: it looked very much as though only African-Americansand a thin sprinkling of liberals spoke up for Obama. On healthcare,the spluttering rage and wild indifference to the facts have come fromboth the president's assailants and his defenders.

There is now some evidence that support for both Obama's healthcarepolicy and his personal popularity are falling. Obama's own standinghas (according to a Quinnipiac University poll) fallen from 66% to 50% between early July and early August 2009 (and by a similar margin, albeit to a higher total, in a CNN survey.

Obama's political circle fear that time is against him, and they may beright. They pushed to get Congress to pass a healthcare-reform proposalbefore Congress adjourned, and failed. The health-insuranceindustry and the Republicans will used the congressional vacation tobombard vulnerable politicians with even more fear-inducing material.Already the heaviest advertising spending has been in the districts ofkey members of relevant committees. The closer the 2010 mid-termelections approach, the more congressmen will be reluctant to exposethemselves to this barrage.

The political mood in the United States is nervous, edgy, uncertain. Inforeign policy, a number of events - the re-election (albeit dubious) of Mahmoud Ahmadinejad in Iran, the return to power of Binyamin Netanyahu in Israel, the continued frustrationsin Afghanistan and Pakistan - have shown that Obama has less power tochange the world than he, or at least those who voted for him,imagined.

In the domestic arena, against the background of a deep economicrecession there is a strange political situation as the president seeksto push healthcare policy forward. A substantial majority of Americansstill say they want serious change in this area. But on this as on otherissues, Obama's wish to "reach across the aisle" and overcome the sharppolitical dichotomy (as well as to convince elements of his ownside) has not worked; Republican politicians still caricaturehealthcare reform as "socialised medicine", even if as yet they havederived little political benefit from this stance.

The media story, however, is more sharply defined than the political one. Conservative publicists and pundits, especially on radio and on Fox TV,have recovered their confidence. They shamelessly travesty Democraticpolicies, and a surprising number of their readers and listeners seemto agree. Senator Charles Grassley, the senior Republican on thefinance committee and a relatively responsible figure in the healthcare debate, assertedthat Senator Ted Kennedy - the veteran champion of healthcare reform,who has had surgery for a brain tumour - would have died by now if hehad lived in Canada or Britain.

The interest effect

The United States is a democracy. Its citizens have the right if theywish to spend twice what any other countries spend on healthcare, andreceive in return an overall inferior service. But it is worth askingwhy - since Lyndon B Johnson's introductionin 1965 of Medicaid (for the poor) and Medicare (for the elderly) - theclearer failures in the delivery of healthcare have been so hard toremedy.

An important factor is undoubtedly the extraordinary influence ofspecial interests at several points in the political system."Interests" - in this case health insurance, pharmaceuticalsand private hospitals on one side, and trial lawyers and trade unionson the other  - are able to exert three kinds of pressure (see JoeKlein, "Will Special Interests Stymie Health-Care Reform?", Time, 3 August 2009).

First, they target politicians directly with massive campaigns oftelevised political advertising of a kind that would not be permittedby law (on account that it skews public debate) in most other developed countries.  

Second, they lean on politicians by contributing large sumsto their re-election campaigns, or to those of their opponents. Thefact that elections for the House of Representatives are held every twoyears increases the temptation and vulnerability of congressmen.

Third, the interests can support a vast network of advocacy-groups,foundations, lobbies and  public-relations operations which all striveto frame the debate. This includes the often explicit aim ofinfluencing media reporting. The success here is most blatant in theresulting distortionof Americans' perception of how healthcare works in other countries(for example, the canard that people in Britain or Canada are notallowed to choose their own doctor).

The federal lesson

Most Americans believe that their system is more "democratic" thanothers, especially than parliamentary systems. There is some truth inthis. It is certainly true that "interests" in the United States -special or routine, benign or selfish - have greater opportunities tostall or avert change, even when there is evidence that largemajorities desire such change. Many Americans (and others) also believethat the spread of new media in America has introduced an enviableonline "people's democracy". The quality of much online debate in theUS makes this questionable.

Because the United States has a federal system, there is a widerrange of geographical variation. In other respects, too, the Americanconstitutional system makes quick and effective action by centralgovernments more difficult. The weakness of the two parties means thata new coalition has to be negotiated for each major legislation.

The constitution enshrined two principles:

* the balance of powers between the three branches of government (the executive, the legislative and the judicial)

* the distribution of "checks and balances" between them, and betweenthe federal government and the states, in a manner that was intended todefend against a tyranny of the majority. This it has done effectively.

The American constitution has worked well on the whole, and - even if William Ewart Gladstone'sdescription of it as the "noblest work ever struck at one time from themind of man" may be hyberbolic - it is respected to the verge ofveneration in its homeland. Like any human creation, however, it hasimperfections. A serious failing is that the constitution makes itharder to reach consensus on the need for change, or on the preciseform that change could take, than do the (equally imperfect) politicalinstitutions of other nations. When in addition the politicalatmosphere in the United States has become so febrile and partisan, theresult is that the fate of Barack Obama's flagship policy is in thebalance.

Godfrey Hodgson was director of the Reuters' Foundation Programme at Oxford University, and before that the Observer's correspondent in the United States and foreign editor of the Independent. His most recent book is The Myth of American Exceptionalism.

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