Politics

Universal Coverage? Sure, Whatever. That Sounds Good.

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Whitehouse.gov

Was President Obama's initial promise to pursue a major health care overhaul initially little more than an afterthought? In a lengthy reported piece on Obamacare's backstory, Politico traces Obamacare's inception to a pre-campaign speech in 2007, in which then-Senator Obama declared his intention to pursue universal coverage mainly because he thought it sounded good. 

Soon-to-be-candidate Obama, then an Illinois senator, was thinking about turning down an invitation to speak at a big health care conference sponsored by the progressive group Families USA, when two aides, Robert Gibbs and Jon Favreau, hit on an idea that would make him appear more prepared and committed than he actually was at the moment.

Why not just announce his intention to pass universal health care by the end of his first term?

Thus was born Obamacare, a check-the-box, news-cycle expedient that would ultimately define a president.

"We needed something to say," recalled one of the advisers involved in the discussion. "I can't tell you how little thought was given to that thought other than it sounded good. So they just kind of hatched it on their own. It just happened. It wasn't like a deep strategic conversation."

Even after Obama made the promise, the piece suggests, Obama still didn't put much energy into understanding the issue. 

Even after his pledge, though, it took months for Obama to buy in. In March 2007, he found himself on the same stage with a highly confident Clinton at another health care forum, this one sponsored by the Service Employees International Union in Las Vegas.

Obama staggered through a discussion that left policy wonks convinced that he was out of his league, particularly when compared to Clinton, arguably the nation's premier expert on health care after her unsuccessful attempt to enact reform in the 1990s.

While she dominated, he was confronted by an audience member who asked why he didn't have a health care plan yet. He responded that his campaign was only eight weeks old and promised to come up with one soon.

Another fun detail from the story: Obama's campaign trail opposition to the individual mandate was most political positioning. As a candidate in a tough primary, Obama was "simply looking for any way to differentiate himself from an opponent [Hillary Clinton] whose basic policy positions were indistinguishable from his own." But as soon as Clinton quit the race, Obama privately told advisers he'd likely end up proposing a law with a mandate.