Obama's healthcare victory

It would be unwise to underestimate the significance of Obama's victory on healthcare last night. However narrow the vote in favour, it marks the beginning of a new phase of his presidency. That he has had to win without Republican support is the result of the absurd extremism of the contemporary Republican party and its media cheerleaders, rather than a sign of the President's having shifted to the left. Had he allowed their wrecking tactics to prevail, he would have destroyed his own Presidency as well as any hope of healthcare reform. Now he needs to set a clear path of other domestic and international policy issues - he is already well advanced on education with little fanfare - including climate change and Middle East policy. But after a rocky start to 2010, the President should be able to regain the confidence of his early months and give the Democrats a stronger chance than they had before today in the November mid-terms.

Creepy political adverts

When Dave has got his elected sheriffs, can elected coroners be far off? We may think the airbrushed posters are creepy, but they can't match this TV ad from Dwight McKenna in the current coroner race in New Orleans. (Hat tip: Time/Swampland blogs)

Obama's Massachusetts failure

Martha Coakley may be winning awards for ineptitude after her spectacular failure to hold onto Ted Kennedy's seat against the Republican insurgent Scott Brown in Massachusetts last night. And it would be hard to dream up a more inept candidate for a by-election (though some of us remember Labour's sterling efforts in the 1980s). But the result was not just a defeat for Coakley, it was a wake-up call to the White House about Obama's singular failure to communicate to middle America.

Looked at in policy terms, Obama has been a reasonably successful President. Viewed through the prism of foreign policy - aside from the Middle East - he has injected new respect for the USA. But with domestic voters, he has simply failed to engage on the issues that matter.

Healthcare is clearly the issue that has mobilised so much anger and suspicion. Of course it is bizarre that Massachusetts, with far more 'socialised' medicine than Obama's latest plans, should be exercised by this. But people are not concerned about the plans, they are concerned at what they think they will do. In part, that is the fault of the crazed right and Fox News. But it is just as much about the inept way that Obama and his team (and Congress) have handled the issue. Instead of giving people simple explanations and clear choices, they have allowed the whole business to look like a threat cooked up in back door negotiations behind closed doors. That is a failure of leadership and a failure of communication by Obama.

As John B Judis of the New Republic puts it:

Obama’s lack of engagement with middle America has come to the surface and has contributed to his decline in popularity. This shortcoming has been evident in his style and choice of venues--he gave his endorsement of Coakley on Sunday at Northeastern University, in Boston, rather than at a union hall or public auditorium in Worcester or Springfield. It is also evident in his choice of advisors and spokespeople and in the way he has framed his programs.

He chose the former head of the New York Fed, Timothy Geithner, to be his chief economic spokesman during a financial crisis that was widely seen as the product of Wall Street. And in developing and presenting his policies on the banks, he didn’t put the kind of conditions on taxpayer assistance that would have assured middle America that they weren’t giving handouts to the wealthy.

In the case of his health care plan, he did not really have a spokesman, but ceded the public face of the policy to the congressional leadership....Where Obama invited a voter backlash was by letting the burden of reducing health care costs appear to fall on senior citizens and those middle-class workers who had acquired good health insurance through decades of union battles with management, and not on the insurance and drug companies. Obama ceded too much to the policy wonks who were devising intricate schemes to show they could cut the deficit. He took his eye of off the political imperative of keeping middle America in his corner.

The fact is that successful politicians need not only to be developing the right policies, they need to know how to communicate them to the voters. Obama showed his weakness reaching many middle class working people during the Democratic primaries. Many of us hoped that he had learned his lessons from that experience. If last night's results are not to be a precursor for a wipeout in the mid-terms, the President must recognise the need to restore clear messages about what he is doing and how.

Edward Kennedy 1932-2009

Ted Kennedy, who has died after a fifteen-month battle with brain cancer, achieved more by not becoming president than either of his two assassinated brothers. Of course, he was a flawed character, as his response at Chappaquiddick and the incident in Florida demonstrated. But he was also a truly great legislator, who despite his liberalism (or perhaps because of it) recognised the importance of reaching across party lines in the US context to achieve change that would make a real difference to his poorer constituents and to African Americans.

No Child Left Behind has its flaws, but it was the first serious attempt to address the great flaws of the American public school system. His work on civil, labour and voting rights was transformative. He paved the way for health care reform, and one must only hope that Barack Obama doesn't blow it.

And as I write this from County Cork, RTE radio reminds its listeners - as if they need reminding - that it was his influence more than most that changed Irish America in its vital role in ensuring that mainstream Irish Republicanism embraced the Northern peace process. Of course, he was also a great lion of Democratic politics, even though his 1980 efforts to wrest the nomination from the hapless Jimmy Carter proved a failure for both men ultimately, and a skilled convention orator. But it for his legislative legacy, rather than his being the last of the Kennedy siblings, that he most deserves to be remembered.

The value of universal healthcare

Janice Turner's column in this morning's Times is one of the sharpest defences of the NHS and best indictments of the shortcomings of American healthcare that I have read:

I happened to read Senator Grassley’s statement that in Britain the 77-year-old Ted Kennedy would not have received treatment for his brain tumour, at the bedside of my 86-year-old father. Mr Grassley’s view that “when you get to be 77, your life is considered less valuable under these [NHS] systems” seemed rather surreal, as my old pa, who collapsed at home, was brain- scanned until it was discovered that he had suffered a minor stroke. As a consultant attended him, physios assessed him and he was found a place in a rehabilitation unit, where he will spend a month recovering, I thought how the life of this elderly man — no high-born statesman but a person of modest means — was treated as immensely precious. Throughout this difficult week, in which I was plunged abruptly into the dark labyrinth that is geriatric care, I gave thanks that the least of my worries — and more importantly my father’s — was money.

Of course, the NHS needs reform, and the Labour government has done - and is doing - much to introduce choice, shorter waiting lists, cleaner and more pleasant wards. Indeed, a danger of the crudity of the debate as it has been framed by the 'eccentric' Daniel Hannan is that the Conservatives retreat further into the dishonest bubble of complacency on health policy that has been effortlessly occupied by BMA spokesman Andrew Lansley since he became shadow health secretary.

An end to entitlements on waiting times, as the Tories propose, will bring back the extreme examples of waits that have so exercised the Republican right. There will be plenty of A&E horror stories again, and an end to the 18 week diagnosis to treatment guarantee.

Nevertheless, the great principle of the NHS, as Turner says, is its underlying principle of universality. Preserving that is what matters.

Obama's impressive 100 days

Today marks the 100th day of Barack Obama's Presidency. And an impressive if challenging 100 days it has been. Leave aside the sillier obsessions of cable news channels and you have a picture of decisiveness and decision-making that would be creditable in a President with far more experience than Obama.

His cabinet picks have been strong - especially Hillary Clinton as Secretary of State - though he had a few early mishaps. Kathleen Sibelius was only sworn in as health secretary yesterday in good time to face up to the flu crisis. But in a few months Obama has pushed through a huge economic stimulus, set a date for closing Guantanamo Bay and stopped CIA torture practices, changed Iran policy and ensured a safe ending to a pirate hostage drama. Importantly, European and Latin American visits changed how the US appears to the outside world (though he should not be afraid to speak up on human rights either - nobody gains if the Chavezes win out over the Lulas in the battle for Latin American minds). With Sibelius in place, he should be able to push forward the crucial healthcare reforms.

That he has been more liberal than pundits expect may owe more to the times than to the man. I finally read Dreams from my Father over the Easter and found it a far more perceptive and revealing book than his rather bland policy tome Audacity of Hope written more recently. It is a good guide to his philosophy, and the influence of Chicago community politics. It also suggests a mix of radicalism and pragmatism that came through in the election, and which many thought would translate into greater bipartisanship. His standing - and his ability to get things done - is certainly boosted by the defection of Arlen Spector, the Pennsylvania senator, from the Republicans, but his failure to reach more widely into the Republicans reflects both the increasing partisanship of the party (and the far reach of its lunatic fringe) as well as the more partisan instincts of an unforgiving Democrat majority in Congress.

It won't be easy for Obama to keep up the momentum, or to maintain his current levels of popularity, though the Republicans and their crackpot media allies are doing their bit to help him. What he needs to show over the next year are solid results in the economy, progress in Afghanistan and Pakistan on security, and the beginnings of healthcare reform. His ability to do so will help determine whether he is to become a great President.