We've been here before- Will Obama be more like Truman and Clinton or more like Johnson?

From the New York Times-
Changing Health Care by Steps
By DAVID LEONHARDT

Sept 1, 2009

After Harry Truman repeatedly failed to persuade Congress to pass universal health insurance, some Truman administration officials came up with a less ambitious idea. They suggested covering only 8 percent of the population, and an especially sympathetic 8 percent at that: everybody 65 and older.

Truman never really pushed the plan, however. John F. Kennedy later did, yet was stymied by Congress and the American Medical Association, which equated it with Soviet-like socialism. So it fell to Lyndon Johnson. Even after he won a 23-point landslide in 1964, he had to agree to some unseemly deal-making, as Jonathan Cohn of The New Republic has noted, that handed a big payday to hospitals and doctors.

Only then, in the summer of 1965, was Medicare born.

Next week, Congress will return to session, and health care, of course, will be at the top of its agenda. Passing a bill, it’s clear, will be no easier than in previous decades. President Obama’s poll numbers have fallen, while untruths about death panels have made the rounds and members of Congress have been subjected to town hall harangues.

But the job facing Mr. Obama hasn’t really changed: he will have to figure out how to end up more like Johnson than like Truman or, more recently, Bill Clinton. He and Congress will have to figure out how to make some progress toward fixing the country’s troubled health care system.

Any bill they pass will inevitably be flawed. It will not do enough to reduce wasteful spending. It probably will not result in universal coverage. Special interests — like drug companies and, once again, hospitals — will get off too lightly.

----------------------
So is this what our politics have become? Has everything gotten so political that we are doomed to implement poor policy and half-baked reforms?

In today's climate bold politicians run the risk of being removed from office before we find out how effective their policies are.

Hypothetical: Let's say the House (240-195) and Senate (51-48) (through Reconciliation) both pass a bold health care initiative with the controversial public plan as a cornerstone but also includes massive payment reform such as "episodes of care" based payment, mandates for individual and small business coverage, tort reform, elimination of individual underwriting and mandates LEAN health care practices by hospitals and doc's by 2015. Let's say all businesses under 10 employees are pooled in the Health Insurance Exchange where the public option is available to them in addition to private plans. Let's further say that most of the reforms including the individual and employer mandates for businesses above 10 employees are effective Jan 1, 2013. That's a realistic timeframe but its after 67% of the Senate has gone through a re-election and 2 x for the House of Reps.

It will be well into 2014 before we have a good sense of how those changes are working. If you were a member of Congress would you vote yes given our current political climate?