[AoI] Obama maps out savvy reform route

By Edward Luce in Washington

Published: March 3 2009 02:00 | Last updated: March 3 2009 02:00

Little could better summarise Barack Obama's approach to governing than his nomination yesterday of Kathleen Sebelius as his health secretary while sending aides out to describe Rush Limbaugh, the hard-right conservative talk show host, as the "leader of the opposition".

Ms Sebelius, who has twice been elected Democratic governor of Kansas, a state that has twice as many registered Republicans as Democrats, will help direct the president's most ambitious domestic reform - the drive to achieve universal healthcare within a year.

Nancy-Anne DeParle, a former official in Bill Clinton's administration, whom Mr Obama yesterday appointed as his healthcare adviser, will co-ordinate the drive from the White House.

Mr Limbaugh, meanwhile, is likely to continue to see that effort as a form of "class warfare" that will lead to "socialised -medicine". Mr Obama last week said that a large chunk of the money that would pay for an expansion of healthcare would come from capping what the wealthiest 5 per cent of Americans can deduct against their taxes. (What happened to the wealthiest 2%?)

On Thursday, Mr Obama plans to invite a bipartisan group of lawmakers and opinion-formers to a White House "summit" on healthcare reform. It is safe to say Mr Limbaugh will not be on the guest list.

But other Republicans, among them Susan Collins and Olympia Snowe, two moderate senators from Maine who helped push through Mr Obama's hard-fought $787bn economic stimulus last month, are likely to show up.

"Kathleen Sebelius is a very good choice, given her bipartisan record as governor of Kansas," said Tony Podesta, a leading lobbyist in Washington. "The way the White House is approaching healthcare reform is ambitious, but it is also tactically smart because it is offering to negotiate with Congress rather than presenting it with a pre-cooked plan."

In contrast to the Clinton administration, which sent Congress a 1,342-page bill to overhaul the US healthcare system, Mr Obama last week published a brief statement of principles on which he wished to negotiate.

These include an "aim for universality", an effort to insure the 46m Americans now without it, a reduction in premiums for Americans who have increasingly expensive insurance, a move to portability, which would help loosen the ties between employment and insurance, and an aim to make the reforms pay for themselves by reducing long-term health costs.

Any one of these would be hard to push through in a normal environment but Mr Obama's team argues that the economic crisis necessitates reform, given how many are now joining the ranks of the uninsured. In the past 12 months, unemployment has jumped 4.1m to more than 11m. The number of uninsured could top 50m.

"Let there be no doubt: healthcare reform cannot wait, it must not wait and it will not wait for another year," Mr Obama told Congress last week to a standing ovation that Republicans felt obliged to join (Mr Limbaugh being out of sight).

Obama aides say they know formidable lobbying groups will line up against them, not least many of the pharmaceutical companies that helped kill Mr Clinton's efforts in 1993 with the devastatingly effective "Harry and Louise" advertisements that warned of government-run healthcare.

But the business world is more receptive to healthcare reform this time. Jeffrey Kindler, chief executive of Pfizer, the US's biggest pharmaceutical company, is a Democrat.

Business Roundtable, one of the biggest lobby groups in Washington, last week praised Mr Obama's 10-year $634bn healthcare reserve fund as fiscally responsible.

Mr Obama is also approaching Congress with greater deference than did Mr Clinton at a time when Republicans are on the ropes. Unlike Mr Clinton, who won only 43 per cent of the vote in a three-way election, Mr Obama received almost 53 per cent of the vote last November.

"The stars are better aligned this time," said Mr Podesta. "The lobby groups are weaker and more divided than they were in 1993."

The task is nevertheless gargantuan and, before it begins, Mr Obama will have to ensure that Ms Sibelius is confirmed by the Senate.

Copyright The Financial Times Limited 2009

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