From 1997 to 2004, as a member of the Illinois Senate, Obama advocated several proposals to make medical care more accessible--culminating, three years ago, in a bill designed to force the creation of a universal coverage system for Illinois. And, while none of these efforts come even close in scale to what he's promised to try in Washington, they do provide a window into the governing style he would pursue there.
Time after time, Obama brought adversaries into the process early, heard out their concerns, then fashioned compromises many of them ultimately supported. In other words, he used the very strategy he's been describing on the campaign trail--the one giving people like me such angst. And yet, if you talk to liberals in Springfield, the ones who've spent decades fighting for universal health care, you don't hear a lot of disappointment with him. As far as they are concerned, Obama's signature inclusiveness was always a means to an end--a way to push the limits of reform rather than accept them. And, they say, it worked.
In 2002, when Democrats won back control of the Senate, Obama became chairman of the Health and Human Services Committee. And it was from that perch that he adopted his other noteworthy health care cause, a measure called the Health Care Justice Act. The brainchild of grassroots activists tired of fighting losing battles to create a single-payer system for Illinois, the act, as originally proposed, would have created a task force, empowered it to develop a universal coverage plan, and then forced the legislature to vote on that plan. Predictably, it aroused the ire of insurers and other business interests, who, by all accounts, lobbied to derail the effort. "They--the insurers--pushed [Obama] really hard," says Jim Duffett, executive director of the Campaign for Better Health Care, the group championing the plan. "They also tried to use other people to push him really hard."
Publicly, Obama used hearings to rally voter support for universal coverage. Inside the statehouse, he pursued a two-track strategy. He made common cause with doctors and hospitals, two groups that had become more sympathetic to universal coverage because of the financial burdens charity care placed on them. This gave cover to moderates who wanted to support the bill, while increasing pressure on the insurers to fall in line. At the same time, Obama carried on discussions with the insurance and business lobbyists directly, eventually granting them two key concessions: He altered the makeup of the task force to make it more industryfriendly and dropped the provision requiring a vote from the next year's General Assembly. "We had significant concerns and looked to Senator Obama, who is an extremely bright and accessible individual," Phil Lackman, who represents the Professional Independent Insurance Agents of Illinois, told me. "My experience is that he is willing to listen to anybody willing to talk to him."
It's those kinds of statements that lead to stories, like one that The Boston Globe published in the fall, noting that "Obama's own experience in lawmaking involved dealings with the kinds of lobbyists and special interests he now demonizes on the campaign trail." But, whatever the contrast with Obama's campaign rhetoric, reformers in Springfield say the concessions worked out just fine. As it turned out, binding a future Assembly to vote on a measure was probably unconstitutional anyway. And the presence of insurance representatives on the task force may have actually bestowed it with additional legitimacy. Although those members would end up filing a dissent to the task force's final report--which was issued after Obama had moved on to the U.S. Senate--press attention focused on the majority recommendation. And that recommendation was just what many advocates hoped (and opponents feared) it would be: a comprehensive plan for universal coverage, financed and overseen by the state government. "He didn't back down," says Duffett. "There was no mandate [on the next Assembly to vote], but that was a constitutional issue. ... We got everything else we wanted."
Duffett's quote is important because he is among the state's most prominent and committed advocates on behalf of universal health care. (For the wonks out there, he's the Illinois equivalent of Ron Pollack.) If Obama were in the pocket of health care lobbyists, he'd be the first guy to complain. But Duffett has only good things to say about Obama. Very good things, as a matter of fact.
