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NOW, BACK TO HEALTH CARE

Despite the turmoil, with players still at the table, reform has a chance of passing.

New York Times

WASHINGTON - The conventional wisdom, here and around the country, is that the centerpiece of President Barack Obama's domestic agenda - remaking the health care system to cut costs and cover the uninsured - is on life support and that only a political miracle could revive it.

Here's why the conventional wisdom might be wrong:

While the month of August clearly knocked the White House back on its heels, as congressional town hall-style meetings exposed Americans' unease with an overhaul, the uproar does not seem to have greatly altered public opinion or substantially weakened Democrats' resolve.

Critical players in the health care industry remain at the negotiating table, meaning they are not out whipping up public or legislative opposition.

Despite tensions between moderate and liberal Democrats, there is broad agreement within the party over most of what a package would look like. Four of the five congressional committees considering health care legislation have already passed bills. Each would require all Americans to have insurance and provide government subsidies for those who cannot afford it. Each would bar insurance companies from refusing coverage for pre-existing conditions; imposing lifetime caps on coverage; or dropping people who get sick.

Getting a bill through the Senate remains a big challenge, but even there, the Obama administration has a reasonable chance of corralling the 60 votes it would need to pass legislation more or less on its terms. One wavering Democratic moderate, Sen. Ben Nelson of Nebraska, signaled over the weekend that he might be able to go along with one of the compromise proposals under discussion. Sen. Olympia J. Snowe, R-Maine, whose vote would be vital to Obama, remains deeply engaged in negotiations, and there are indications that one or two other Republicans, like Sen. George Voinovich of Ohio, might be in play.

Politically, there is an imperative for Democrats to act; they remember well the disastrous political fate that befell them in 1994, when they lost control of the House after failing to pass a health bill under President Bill Clinton. Rahm Emanuel, the former Clinton aide who is now the White House chief of staff, has wasted little time in reminding his fellow Democrats that, as he said in an interview Tuesday, "the inability to act here will have political consequences."

None of this is to understate the magnitude of the task facing Obama as he begins a final drive for the legislation with a nationally televised address to a joint session of Congress tonight. The size and complexity of the legislation, the deep partisan divide, the concern among voters about whether government is getting too big and intrusive, opposition from special interests - all create land mines that could blow up the effort.

But even after weeks in which the daily news cycle seemed filled with ominous portents for Obama's ambitions, there is evidence that public opinion remains basically supportive of him. Despite intense controversy over the "public option," a government-backed insurance plan that would compete with the private sector, a CBS poll at the end of August found that 60 percent of Americans still support the idea, down from 66 percent in July. And half the respondents to the poll said Obama had better ideas on health care than Republicans, down from 55 percent in July.

Obama likes to say, as he did Monday at a Labor Day picnic in Cincinnati, that in the 100 years since President Theodore Roosevelt first began advocating universal health care, "we've never had such broad agreement on what needs to be done." On Capitol Hill, it is possible to see how a compromise could come together; Nelson indicated over the weekend that he could back a provision known as a "trigger" to create a public option if private efforts to cover the uninsured failed.

And despite the fracas of August, the major stakeholders in the health care debate - hospitals, doctors, insurers and the pharmaceutical industry - have not abandoned the negotiations. Ralph Neas, the chief executive of the National Coalition on Health Care and a veteran of years of Washington legislative fights, said this was significant.

"They're saying to themselves, 'We're going to get 30 to 40 or 50 million new customers. This is in our economic self interest,'" Neas said. ''That, as much as anything else, could propel this forward to a law that does provide quality health care for all."

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