BROOKLINE – Barack Obama became president thanks to house parties like the thousands across the county this weekend, and thanks to activists who wrote checks and blogged and made phone calls to neighbors for the campaign. The agenda then was clear: Win the election.
Now Obama is reactivating his grass-roots political machine for a new purpose: Pass major legislation overhauling the nation’s healthcare system.
Together with a growing alliance of independent liberal activist groups that have amassed more money, members, and influence than ever before, the grass-roots base may provide the critical strength Obama needs to accomplish a goal that has eluded his predecessors.
But firing up those activists may pose political risks for Obama: The bill that finally emerges from Congress may not live up to liberals’ expectations. Any compromise with moderate Democrats or Republicans, or with business or health industry interests, could include elements many on the left abhor – a small, limited public insurance plan, for example, or modest insurance subsidies for middle-income people. It may contain weak penalties for employers who refuse to contribute to workers’ health insurance, and it may tax generous employer-sponsored health benefits, which many unions have sacrificed wages to keep.
"You don’t have a plan and you’re having events to rev people up to be for whatever it is – that’s very tricky," said Robert Blendon, a health policy professor at Harvard University. "Many of them may be disappointed in the compromise plan."
This weekend, Organizing for America – the president’s former national campaign organization, now run through the Democratic National Committee to support his policies – kicked off a months-long effort to build ground-level support for a healthcare overhaul. At the house parties, organizers read from talking points, urging those in attendance to get involved, echoing Obama’s contention in his weekly radio and Internet address that lowering costs and improving access to quality healthcare is "a necessity we can’t postpone any longer." Other liberal groups announced last week that they would spend $82 million to pay hundreds of organizers and buy TV ads in pivotal congressional districts.
Addisu Demissie, national political director of Organizing for America, said the goal of the campaign is to build support for the president’s main principles: to lower healthcare costs, improve quality, and offer affordable coverage for all.
"I do think that the lawmaking process is a long and winding one, but as long as we are moving the ball down the field, we are doing our job," he said.
But principles are not specifics. And some observers say the administration should tread carefully.
"Historically it’s the far left and the far right that kill health reform, and they need to be mindful of that going forward," said Phil Blando, a healthcare consultant who represents insurers and employers.
To most activists, a healthcare overhaul means sweeping changes, such as the creation of a Medicare-style public insurance option that would compete directly with private companies – and that many Republicans and business interests adamantly oppose. Some Obama supporters are already dismayed that a national health system, along the lines of Britain or Canada, isn’t being seriously considered.
Alan Frankel, co-coordinator of Obama’s campaign in Framingham last year, was among eight activists who gathered at an apartment complex in Natick yesterday for an Obama healthcare party. He wants to help the president fix the healthcare system, but if Congress comes out with a bill that does not include what he sees as a reasonable alternative to a Canadian-style system – a strong government insurance option – he said, "I would certainly be angry."
"I think it would be my responsibility then to make it clear to my legislators, especially if they didn’t work for a public option, to voice my opinion," he said.
David Kidder, 69, of Watertown, retired head of health policy research at Abt Associates Inc., gathered with nine others in Brookline yesterday over strawberries and iced tea to find out what he could do to make sure a strong public insurance option is included in the final plan.
"I know the insurance companies say this is a stalking horse for single payer," he said. "I say, ‘Yeah, hi-ho Silver!’ . . . I think it’s absolutely crucial that we have that."
Liberals have gained considerable ground recently in pushing their agenda on healthcare.
In late May, Senator Edward M. Kennedy made it known that his bill would embrace most of the left’s wish list, including a Medicare-style public insurance option plan.
A draft that circulated Friday proposed a large public insurance plan, subsidies for families earning up to $110,000 a year, a significant expansion of the Medicaid program, and an employer mandate.
On Wednesday, Obama, who had sounded noncommittal on the issue in March, issued a letter saying he "strongly" supported the public plan concept he had espoused in the campaign, as well as requirements that individuals buy insurance and employers help them pay for it. Advocates for Canadian-style national health insurance – which Obama has said is off the table – even won meetings with key committees last week.
Finance Committee chairman Max Baucus of Montana, a middle-of-the-road Democrat who is drafting legislation he hopes to merge with Kennedy’s, continues to argue that the bill must be bipartisan to succeed. But liberals have sounded uncompromising lately.
At a national conference of activists in Washington last week, liberal leaders drew "a line in the sand" about the kind of public plan they would support.
But it’s not clear whether it will be so easy.
Moderate Republicans who provided critical support in passing the president’s economic stimulus package in February voiced concern over the public insurance plan. "I always worry about government-run programs," Senator Olympia Snowe of Maine, one of the moderates, said in an interview.
Snowe said she told the president she liked the idea of a "trigger" that would call for a public plan if private insurers failed to offer affordable premiums after a certain point.
The 51 "Blue Dogs," a crucial coalition of fiscally conservative House Democrats, also called for restraint. One member, Representative Jim Cooper of Tennessee, downplayed any disagreements within the party; careful reading of the president’s letter, he said, showed it to be an exceedingly moderate document.
"The only way legislation ever gets passed is by making compromises," he said.
At this early stage of the debate, said Drew Altman, president of the Kaiser Family Foundation in Palo Alto, Calif., it is only natural for both the left and the right to sound unyielding. "We’re at a stage where all groups should be expected to fight hard for the positions they want," he said. "That’s how our system works."
Lisa Wangsness can be reached at lwangsness@globe.com.
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