Big Win for Obama, but at What Cost?

The House’s passage of health care legislation late Sunday night assures that whatever the ultimate cost, President Obama will go down in history as one of the handful of presidents who found a way to reshape the nation’s social welfare system.

After the bitterest of debates, Mr. Obama proved that he was willing to fight for something that moved him to his core. Skeptics had begun to wonder. But he showed that when he was finally committed to throwing all his political capital onto the table, he could win, if by the narrowest of margins.

Whether it was a historic achievement or political suicide for his party — perhaps both — he succeeded where President Bill Clinton failed in trying to remake American health care. President George W. Bush also failed to enact a landmark change in a domestic program, his second-term effort to create private accounts in the Social Security system.

At the core of Mr. Obama’s strategy stands a bet that the Republicans, in trying to portray the bill as veering toward socialism, overplayed their hand. Fueled by the antigovernment anger of the Tea Party movement, Republicans have staked much on the idea that they can protect the country by acting as what the Democrats gleefully call the “Party of No.”

Now, armed with a specific piece of legislation that offers concrete benefits to millions of people — and that promises to guarantee insurance for many who found it unaffordable or unattainable — the White House and Democrats believe they may have gained the upper hand.

“This only worked well for the Republican Party if it failed to pass,” David Axelrod, one of the president’s closest political advisers, said at the White House as he watched the vote count for the final bill reach 219 in favor. “They wanted to run against a caricature of it rather than the real bill. Now let them tell a child with a pre-existing condition, ‘We don’t think you should be covered.’”

But there is no doubt that in the course of this debate, Mr. Obama has lost something — and lost it for good. Gone is the promise on which he rode to victory less than a year and a half ago — the promise of a “postpartisan” Washington in which rationality and calm discourse replaced partisan bickering.

Never in modern memory has a major piece of legislation passed without a single Republican vote. Even President Lyndon B. Johnson got just shy of half of Republicans in the House to vote for Medicare in 1965, a piece of legislation that was denounced with many of the same words used to oppose this one. That may be the true measure of how much has changed in Washington in the ensuing 45 years, and how Mr. Obama’s own strategy is changing with the discovery that the approach to governing he had in mind simply will not work.

“Let’s face it, he’s failed in the effort to be the nonpolarizing president, the one who can use rationality and calm debate to bridge our traditional divides,” said Peter Beinart, a liberal essayist who is publishing a history of hubris in politics. “It turns out he’s our third highly polarizing president in a row. But for his liberal base, it confirms that they were right to believe in the guy — and they had their doubts.”

For that lesson in governing, Mr. Obama paid a heavy price. He nearly lost the health care debate, and pulled out victory only after deferring nearly every other priority and stumping with a passion he had not shown since his campaign. His winning argument, in the end, was that while the political result could run against him — and other Democrats — remaking health care was a keystone of his “Change You Can Believe In” credo.

Mr. Obama acknowledged the political uncertainties ahead even as, in typically understated tones, he marked the moment shortly before midnight at the White House.

“There will be predictions of what it means for Democrats and Republicans and for my administration,” he said. But he insisted that after the scorecards were filled out, the system that emerged from a year of debate would prove “a victory for common sense.”

“This isn’t radical reform,” he insisted, “but it is major reform.”

Republicans entered this fight convinced, at least for public consumption, that they know how it will play out: with an end to Mr. Obama’s mandate and a bigger-than-normal loss for the incumbent party in the midterms.

In the soaring deficits that began in the Bush era and accelerated in the heat of the financial crisis, and in the argument that Mr. Obama was taking over wide swaths of the economy, an increasingly conservative Republican Party believes the health care overhaul encapsulates the argument that the president is about big government intruding into the lives of citizens.

“In the short term Obama will get a boost, because the narrative is that he came back from the dead and got done what no president has managed to do in 70 years,” said Peter Wehner, who was a political adviser to President Bush. “But once people discover that their Medicare taxes are going up, that there are deeper cuts in Medicare Advantage, that there are court challenges to many provisions, and that the process of getting it passed created a portrait of corruption, it won’t sit well.”

Perhaps so, but Mr. Obama’s counterargument is that three-quarters of a century of American history is largely on his side. In 1966, celebrating the creation of the first Medicare rolls that covered 20 million Americans, President Johnson recalled the complaints three decades earlier that Social Security “would destroy this country,” and noted “there is not one out of 100 who would think of repealing it.” (He may have been right at the time, but since then many have come to believe that the system must change or go broke, the battle Mr. Bush fought and lost in 2005.)

Today, many would tinker with Medicare; many of the arguments over the last three months have been how to reshape it, but no one on Capitol Hill has dared suggest eliminating it.

Mr. Obama’s gamble is that what worked for Johnson and President Franklin D. Roosevelt will ultimately work for him. Once Americans discover that they can no longer be rejected for insurance for pre-existing conditions, he is betting, or that they can keep their children on their own insurance plans longer, the more they will come to appreciate the effect of the changes on their day-to-day lives.

He is trying to sell the government’s oversight role over doctors and insurance companies the way he is trying to sell financial regulation: as a leveling of the playing field, in favor of consumers. But as the fight over health care shows, the political atmosphere of 2010 resembles neither 1965 nor 1933.

The more the country debated this change to the social contract, the more divided it became. The more Mr. Obama talked, the more his Republican opponents decided that their best strategy was to dig in and defend the status quo. If deficits soar, if the Congressional Budget Office’s estimates prove fanciful, they will be able to argue that Mr. Obama expanded government at a time the country simply could not afford yet another entitlement.

But it will take years to know whether the Republicans’ worst predictions, or Mr. Obama’s vision of affordable near-universal care, will resemble reality. In the meantime, Mr. Obama can lay credible claim, for the first time in his presidency, that he proved willing to risk all to turn his convictions into legislation.