The White House and congressional leaders are increasingly conveying a desperate message: Pass health reform quickly, before the congressional recess, before the great moment is lost. In other words, before details of the plan are examined too closely, before concerns about spending and the deficit take even broader hold.
But it may already be too late for that. President Barack Obama remains a skilled and popular leader. But with his approval in the 50s and slipping among independents, he now seems more like a political mortal (his approval rating, in a recent poll, ranked 10th among the dozen post-World War II presidents at this point in their tenures). The Pelosi stimulus package not only has had minimal economic effect; it has increased public skepticism that Congress is capable of spending such vast sums wisely. Trillions of dollars in stimulus and bailouts, resulting in record levels of predicted debt, have made the addition of a trillion-dollar health entitlement seem ill timed, even to supporters of expanded coverage. And in a continuing recession with rising unemployment, the imposition of massive new taxes to fund health reform would be reckless -- adding burdens to a pack mule already on its knees.
It is difficult to imagine that an overwhelmingly Democratic Congress will do nothing on health reform. But as deadlines slip, and moderate arguments gain in momentum, the legislation is likely to disappoint liberal Democrats in several ways. William Galston of the Brookings Institution -- who kept an eye on moderate congressional opinion as part of the Clinton White House -- predicts that centrists "are not going along with a bill that isn't genuinely revenue neutral, without tricks." Taxes will need to be "sensible," which "takes the House approach (boosting taxes on the rich) off the table." Moderates, he says, "won't support a version of the public option that weakens or eviscerates the private sector in the provision of health insurance." And "there is broad agreement that any bill that is 90 percent expanded coverage and 10 percent cost control would be a disaster in the long run."
Some may accuse such moderates of lacking in boldness or ambition. It is better than lacking in responsibility and good judgment.