President Barack Obama was due to face down his Republican critics and sceptical Democrats in Congress last night with a high-stakes prime time speech demanding an overhaul of American health care.
White House sources indicated that Mr Obama would make a strong case for the controversial and expensive "public option" of government-run health insurance plans, but also signalled that he was prepared to compromise on this to keep conservative Democrats on board.
Mr Obama promised "a much more detailed plan" for transforming the US health care system, introducing coverage for the 46million uninsured at an estimated cost of $1trillion (£600billion) over 10 years. Many Americans fear this will lead to higher taxes and reduced choice.
"I am not the first President to take up this cause, but I am determined to be the last. It has now been nearly a century since Theodore Roosevelt first called for health care reform," Mr Obama was to say, according to pre-released excerpts.
"And ever since, nearly every President and Congress, whether Democrat or Republican, has attempted to meet this challenge in some way." At the heart of his speech would be an appeal over the heads of the politicians to regular Americans. To this end, the First Lady's box in the chamber was to be filled with ordinary people who had suffered at the hands of the current US health care system.
"The time for games has passed," he was to declare. "Now is the season for action. 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 stakes were raised as an Associated Press-GfK poll showed that disapproval of Mr Obama’s handling of health care had jumped to 52 per cent. It also indicated that 49 per cent disapproved of how he was doing his job, compared with 42 per cent in July.
Bill Clinton tried the same tactic of a speech to a joint session of Congress in 1993. Public support for his health care plan briefly rose but soon fell again and his reform bill died a slow death on Capitol Hill.
There were increasing signs that Mr Obama’s Democrats were preparing to abandon hopes of formulating a bipartisan bill even with minimal Republican support.
Senator Max Baucus, chairman of the Senate Finance Committee, had proposed a cheaper option of non-profit insurance co-operatives, which would raise a levy from private insurers to help reduce the burden on the public purse and potentially higher taxes. He said after talks yesterday that he was ready to “move forward anyway” without the three moderate Republicans he had attempted to woo with his compromise plan.
It remained to be seen whether Mr Obama could pull off a delicate balancing act between bringing conservative Democrats along without losing liberal Democrats, who have insisted on the “public option”.
Nancy Pelosi, Speaker of the House of Representatives, said a government insurance plan was “essential to our passing a bill”. Democratic sceptics, however, believe that this would undercut private insurance companies, forcing them out of business and leading to a wider government takeover.
In preparing to abandon the public option, Mr Obama is calculating that his party’s Left will not be able to bring themselves to vote against a bill that would extend health coverage to millions, even if they consider it imperfect.
Some on the Left, however, might be hard to placate. Steve Hildebrand, Mr Obama’s deputy campaign manager and an architect of his crucial primary victories in Iowa and South Carolina, this week became the most senior Obama ally to break ranks.
“I am one of the millions of frustrated Americans who want to see Washington do more than it’s doing right now,” he told the Politico website, saying that he “needs to be more bold in his leadership” and is among Democrats in power who should not be allowed to “get away with a lack of performance for the American people”.
Pressure was also being ratcheted up from the Right. Sarah Palin, the former Alaska governor, reiterated her summer warning about Democrats introducing “death panels” to tell old people it would be too expensive to treat them. That was a powerful catalyst for boosting opposition to Mr Obama.
Even though no Democratic proposal amounted to a “death panel” and Democratic leaders had signalled they would drop the clause that Mrs Palin had cited, she wrote in The Wall Street Journal that this was what was being proposed.
Mr Obama, she said, had suggested in an April interview that expert panels “should guide decisions regarding that huge driver of cost ... the chronically ill and those towards the end of their lives.
“Given such statements, is it any wonder that many of the sick and elderly are concerned that the Democrats’ proposals will ultimately lead to rationing of their health care by – dare I say it – death panels?”
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