I found the story both heartbreaking and maddening, an indictment of a wealthy nation that failed too many of its citizens. And yet I knew that almost every one of those people waiting to see a free doctor came from a deep-red Republican district, the sort of place where opposition to our health-care bill, along with support of the Tea Party, was likely to be strongest. There had been a time—back when I was still a state senator driving around southern Illinois or, later, travelling through rural Iowa during the earliest days of the Presidential campaign—when I could reach such voters. I wasn’t yet well known enough to be the target of caricature, which meant that whatever preconceptions people may have had about a Black guy from Chicago with a foreign name could be dispelled by a simple conversation, a small gesture of kindness.
I wondered if any of that was still possible, now that I lived locked behind gates and guardsmen, my image filtered through Fox News and other media outlets whose entire business model depended on making their audience angry and fearful. I wanted to believe that the ability to connect was still there. My wife wasn’t so sure. One night, Michelle caught a glimpse of a Tea Party rally on TV—with its enraged flag-waving and inflammatory slogans. She seized the remote and turned off the set, her expression hovering somewhere between rage and resignation.
“It’s a trip, isn’t it?” she said.
“What is?”
“That they’re scared of you. Scared of us.” She shook her head and headed for bed.
Ted Kennedy died on August 25th. The morning of his funeral, the skies over Boston darkened, and by the time our flight landed the streets were shrouded in thick sheets of rain. The scene inside the church befitted the largeness of Teddy’s life: the pews packed with former Presidents and heads of state, senators and members of Congress, hundreds of current and former staffers. But the stories told by his children mattered most that day. Patrick Kennedy recalled his father tending to him during crippling asthma attacks. He described how his father would take him out to sail, even in stormy seas. Teddy, Jr., told the story of how, after he’d lost his leg to cancer, his father had insisted they go sledding, trudging with him up a snowy hill, picking him up when he fell, and telling him “there is nothing you can’t do.” Collectively, it was a portrait of a man driven by great appetites and ambitions but also by great loss and doubt—a man making up for things.
“My father believed in redemption,” Teddy, Jr., said. “And he never surrendered, never stopped trying to right wrongs, be they the results of his own failings or of ours.”
I carried those words with me back to Washington, where a spirit of surrender increasingly prevailed—at least, when it came to getting a health-care bill passed. A preliminary report by the Congressional Budget Office, the independent, professionally staffed operation charged with scoring the cost of all federal legislation, priced the initial House version of the health-care bill at an eye-popping one trillion dollars. Although the C.B.O. score would eventually come down as the bill was revised and clarified, the headlines gave opponents a handy stick with which to beat us over the head. Democrats from swing districts were now running scared, convinced that pushing forward with the bill amounted to a suicide mission. Republicans abandoned all pretense of wanting to negotiate, with members of Congress regularly echoing the Tea Party’s claim that I wanted to put Grandma to sleep.
The only upside to all this was that it helped me cure Max Baucus of his obsession with trying to placate Chuck Grassley. In a last-stab Oval Office meeting with the two of them in early September, I listened patiently as Grassley ticked off five new reasons that he still had problems with the latest version of the bill.
“Let me ask you a question, Chuck,” I said finally. “If Max took every one of your latest suggestions, could you support the bill?”
“Well . . .”
“Are there any changes—any at all—that would get us your vote?”
There was an awkward silence before Grassley looked up and met my gaze. “I guess not, Mr. President.”
I guess not.
At the White House, the mood rapidly darkened. Some of my team began asking whether it was time to fold our hand. Rahm was especially dour. Having been to this rodeo before, he understood all too well what my declining poll numbers might mean for the reëlection prospects of swing-district Democrats, many of whom he had personally recruited and helped elect, not to mention my own prospects in 2012. Rahm proposed that we try to cut a deal with Republicans for a significantly scaled-back piece of legislation—perhaps allowing people between sixty and sixty-five to buy into Medicare or widening the reach of the Children’s Health Insurance Program. “It won’t be everything you wanted, Mr. President,” he said. “But it’ll still help a lot of people, and it’ll give us a better chance to make progress on the rest of your agenda.”
Some in the room agreed. Others felt it was too early to give up. Phil Schiliro said he thought there was still a path to passing a comprehensive law with only Democratic votes, but he admitted that it was no sure thing.
“I guess the question for you, Mr. President, is, Do you feel lucky?”
I looked at him. “Where are we, Phil?”
Phil hesitated, wondering if it was a trick question. “The Oval Office?”
“And what’s my name?”
“Barack Obama.”
I smiled. “Barack Hussein Obama. And I’m here with you in the Oval Office. Brother, I always feel lucky.”
I told the team that we were staying the course. But my decision didn’t have much to do with how lucky I felt. Rahm wasn’t wrong about the risks, and perhaps in a different political environment, on a different issue, I might have accepted his advice. On this issue, though, I saw no indication that Republican leaders would throw us a lifeline. We were wounded, their base wanted blood, and, no matter how modest the reform we proposed, they were sure to find a whole new set of reasons for not working with us.
More than that, a scaled-down bill wasn’t going to help millions of people who were desperate. The idea of letting them down—of leaving them to fend for themselves because their President hadn’t been sufficiently brave, skilled, or persuasive to cut through the political noise and get what he knew to be the right thing done—was something I couldn’t stomach.
Knowing we had to try something big to reset the health-care debate, Axe suggested that I deliver a prime-time address before a special joint session of Congress. It was a high-stakes gambit, he explained, used only twice in the past sixteen years, but it would give me a chance to speak directly to millions of viewers. I asked what the other two joint addresses had been about.
“The most recent was when Bush announced the war on terror after 9/11.”
“And the other?”
“Bill Clinton talking about his health-care bill.”
I laughed. “Well, that worked out great, didn’t it?”
Despite the inauspicious precedent, we decided it was worth a shot.
Two days after Labor Day, Michelle and I climbed into the back seat of the Presidential S.U.V., known as the Beast, drove up to the Capitol’s east entrance, and retraced the steps we had taken seven months earlier to the doors of the House chamber, where I’d given my first address to a joint session of Congress, back in February. The mood in the chamber felt different this time—the smiles a little forced, a murmur of tension and doubt in the air. Or maybe it was just that my mood was different. Whatever giddiness or sense of personal triumph I’d felt shortly after taking office had now been burned away, replaced by something sturdier: a determination to see a job through.
For an hour that evening, I explained as straightforwardly as I could what our reform plan would mean for the families who were watching—how it would provide affordable insurance to those who needed it but also give critical protections to those who already had insurance; how it would prevent insurance companies from discriminating against people with preëxisting conditions and eliminate the kind of lifetime limits that burdened families like Laura Klitzka’s. I detailed how the plan would help seniors pay for lifesaving drugs and require insurers to cover routine checkups and preventive care at no extra charge. I explained that the talk about a government takeover and death panels was nonsense, that the legislation wouldn’t add a dime to the deficit, and that the time to make this happen was now. But in the back of my mind was a letter from Ted Kennedy I’d received a few days earlier. He’d written it in May but had instructed Vicki to wait until after his death to pass it along. It was a farewell letter, two pages long, in which he thanked me for taking up the cause of health-care reform, referring to it as “the great unfinished business of our society” and the cause of his life. He added that he would die with some comfort, believing that what he’d spent years working toward would now, under my watch, finally happen.
I ended my speech that night by quoting from Teddy’s letter, hoping that his words would bolster the nation just as they had bolstered me. “What we face,” he’d written, “is above all a moral issue; that at stake are not just the details of policy, but fundamental principles of social justice and the character of our country.”
According to poll data, my address to Congress boosted public support for the health-care bill, at least temporarily. Even more important for our purposes, it seemed to stiffen the spine of wavering congressional Democrats. It did not, however, change the mind of a single Republican in the chamber. This was clear less than thirty minutes into the speech, when—as I debunked the phony claim that the bill would insure undocumented immigrants—a relatively obscure five-term Republican congressman from South Carolina named Joe Wilson leaned forward in his seat, pointed in my direction, and shouted, his face flushed with fury, “You lie!”
For the briefest moment, a stunned silence fell over the chamber. I turned to look for the heckler (as did Speaker Pelosi and Joe Biden, Nancy aghast and Joe shaking his head). I was tempted to exit my perch, make my way down the aisle, and smack the guy in the head. Instead, I simply responded by saying, “It’s not true,” and then carried on with my speech as Democrats hurled boos in Wilson’s direction.
As far as anyone could remember, nothing like that had ever happened before a joint-session address—at least, not in modern times. Congressional criticism was swift and bipartisan, and, by the next morning, Wilson had apologized publicly for the breach of decorum, calling Rahm and asking that his regrets get passed on to me as well. I downplayed the matter, telling a reporter that I appreciated the apology and was a big believer that we all make mistakes.
And yet I couldn’t help noticing the news reports saying that online contributions to Wilson’s reëlection campaign spiked sharply in the week following his outburst. Apparently, for many Republican voters out there, he was a hero, speaking truth to power. It was an indication that the Tea Party and its media allies had accomplished more than just their goal of demonizing the health-care bill. They had demonized me and, in doing so, had delivered a message to all Republican office-holders: when it came to opposing my Administration, the old rules no longer applied.
Despite having grown up in Hawaii, I have never learned to sail a boat; it wasn’t a pastime my family could afford. Still, for the next three and a half months, I felt the way I imagine sailors feel on the open seas after a brutal storm has passed. The work remained arduous and sometimes monotonous, made tougher by the need to patch leaks and bail water. But, for a span of time, we had in us the thankfulness of survivors, propelled in our daily tasks by a renewed belief that we might make it to port after all.
For starters, after months of delay, Baucus finally opened debate on a health-care bill in the Senate Finance Committee. His version, which tracked the Massachusetts model we had all been using, was stingier with its subsidies to the uninsured than we would have preferred, and we insisted that he replace a tax on high-value employer-based insurance plans with increased taxes on the wealthy. But, to everyone’s credit, the deliberations were generally substantive and free of grandstanding. After three weeks of exhaustive work, the bill passed out of committee by a fourteen-to-nine margin. The lone Republican vote we got came from Olympia Snowe.
Speaker Pelosi then engineered the quick passage of a consolidated House bill against overwhelming and boisterous G.O.P. opposition, with a vote held on November 7, 2009. If we could get the full Senate to pass a similarly consolidated version of its bill before the Christmas recess, we figured, we could then use January to negotiate the differences between the Senate and House versions, send a merged bill to both chambers for approval, and, with any luck, have the final legislation on my desk for signing by February.
It was a big if—and one largely dependent on my old friend Harry Reid. True to his generally dim view of human nature, the Senate Majority Leader assumed that Olympia Snowe couldn’t be counted on once a final version of the health-care bill hit the floor. (“When McConnell really puts the screws to her,” he told me matter-of-factly, “she’ll fold like a cheap suit.”) To overcome the possibility of a filibuster, Harry couldn’t afford to lose a single member of his sixty-person caucus. And, as had been true with the Recovery Act, this fact gave each one of those members enormous leverage to demand changes to the bill, regardless of how parochial or ill-considered their requests might be.
This wouldn’t be a situation conducive to high-minded policy considerations, which was just fine with Harry, who could maneuver, cut deals, and apply pressure like nobody else. For the next six weeks, as the consolidated bill was introduced on the Senate floor and lengthy debates commenced on procedural matters, the only action that really mattered took place behind closed doors in Harry’s office, where he met with the holdouts one by one to find out what it would take to get them to yes. Some wanted funding for well-intentioned but marginally useful pet projects. Several of the Senate’s most liberal members, who liked to rail against the outsized profits of Big Pharma and private insurers, suddenly had no problem at all with the outsized profits of medical-device manufacturers with facilities in their home states and were pushing Harry to scale back a proposed tax on the industry. Senators Mary Landrieu and Ben Nelson made their votes contingent on hundreds of millions of additional Medicaid dollars specifically for Louisiana and Nebraska, concessions that the Republicans cleverly labelled “the Louisiana Purchase” and “the Cornhusker Kickback.”
