The U.S. healthcare reform drama is moving towards a resolution. The House of Representatives narrowly passed a version of the reform bill that scaled down the public option while retaining some landmark elements of the original Obama reform. Most importantly, the bill extends healthcare cover to 36 million uninsured Americans, bringing 96 per cent of the eligible population under the insurance umbrella. With the Senate voting last week to take up the debate in December, the risk of delaying tactics, especially a filibuster by Senate Republicans, has diminished. Now all that stands between President Barack Obama and unprecedented success in reforming a bloated and fundamentally inequitable healthcare system is a Senate vote on and for the bill and, after that, a final vote on a House-reconciled version of it.

The real threat to the U.S. President’s Senate support comes not from three vacillating Democratic Senators but from a potentially ruinous failure to convince the American public that his reform proposals will create a system that is more equitable in its delivery and deficit-neutral in its cost. The recent fall in Mr. Obama’s approval ratings to below 50 per cent for the first time reflects a failure to come with a bold political initiative to engage with, and enthuse, the American public. To put this in perspective, one needs only to recall how his brilliant campaign for the presidency was powered by broad-based and innovative grassroots appeal — among other things, through the use of the social media, rousing speeches that somehow managed to strike the right social balances, and genuinely democratic internet-based fundraising. Candidate Obama had charisma but, more importantly, demonstrated a gift for inspiring ordinary people with his inclusive promise of leadership. This left the Republican campaign floundering amidst confused and bitter sound bytes. But given the highly polarised nature of American politics and with the White House team performing below par, the Republicans, and especially their right wing, have recovered some ground. Specifically on healthcare reform, until the recent upturn in its fortunes, the administration seemed to be retreating into a cocoon of policy analytics. President Obama may well be banking on regaining his touch, and the political advantage, on the strength of his adroit technical manoeuvres and Congressional victories. Paradoxically, the prospects of his most ambitious reform project hinge on whether he has the capability to persuade millions of ordinary Americans — many of whom suffer from poor healthcare by developed country standards and debilitating unemployment — of its vital necessity.

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