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Editor's note: This week's column is a special reprint from BioWorld Today columnist Karl Thiel. To make sure you receive all of his columns, subscribe to BioWorld Today or sign up for a free trial for 30 days. With a free trial, you'll also get access to our archives and the BioWorld Industry Snapshots database.

What did President Obama, backed by one of the largest Democratic majorities in history, accomplish in his first year in the Oval Office? A recent parody on Saturday Night Live summed it up: "When you look at my record, it's very clear what I've done so far. And that is . . . nothing. Nada."

At the time, it seemed a little unfair. After all, the president was on the verge of passing sweeping health care reform, and whatever you thought of the bill, after decades of failed attempts, that certainly constituted something. But by last week's State of the Union address, it looked like SNL had it right after all. A lot of effort had led to "two big accomplishments," as they put it: "'jack' and 'squat.'"

Certainly, the immediate source of President Obama's woes when it comes to health care, appeared seemingly out of nowhere: Anti-reform Republican Scott Brown swept in and took what Democrats had assumed was the safest of seats, Sen. Ted Kennedy's bully pulpit in Massachusetts. That Kennedy's seat should become the weak link that broke the chain of reform is, of course, rich in irony. But it also points out a lot of problems with President Obama's methods.

Think about it: Poll after poll shows widespread support for most core elements of the health care reform packages. Yet poll after poll shows that health care reform, taken as a whole, is extremely unpopular. In that dichotomy is a failure of leadership.

After all, how do you reconcile these seemingly contradictory opinions? It mostly comes down to the technocratic process by which the legislation was publicly sliced and diced. For one thing, President Obama failed to communicate any kind of broad vision that got more Americans on board – something he acknowledged in his State of the Union speech, saying, "I know that with all the lobbying and horse-trading, the process left most Americans wondering what's in it for them."

Indeed, by focusing on that horse-trading, he not only drew attention to some ugly compromises – really, why should we support the "Cornhusker Kickback" (Nebraska's permanent, single-state exemption to picking up its share of Medicaid expansion, apparently negotiated to get Sen. Ben Nelson on board) or dozens of other backroom deals? – but he also left Republicans free to make well-crafted, largely unhindered attacks on the plans. Ridiculous distortions about "death panels" and "government takeovers" largely stuck because Democrats didn't effectively counter them.

Even the Biotechnology Industry Organization (BIO) got in on the action. According to Politico.com, BIO's Massachusetts affiliate drafted a press release calling for support of Scott Brown in the Massachusetts Senate race. The reason? The Obama administration was still fiddling with the details of the portion of the bill dealing with follow-on biologics, talking about his desire to shorten the exclusivity period.

That was the danger of this tactic. By having a plan that counted on zero Republican support, that relied on having a Democratic supermajority, the administration's plan was subject to any threat to that majority.

What, in the scheme of sweeping health care reform, was a pretty trivial issue – whether manufacturers get 10 or 12 years of exclusivity – suddenly threatened to become a deal-breaker. In a state with as large a biotechnology industry as Massachusetts, BIO's threat meant something. In fact, the Pharmaceutical Research and Manufacturers of America (PhRMA) – a much larger and more powerful lobby courted by the administration – was also reportedly threatening to withdraw support for the final reform bill if exclusivity periods were changed. (BIO never put out its press release, awaiting confirmation that the Obama administration would really push for these changes, but the point remains.)

Well, they can't count on a supermajority anymore, and that will mean a shift in strategy. But as President Obama himself said in his speech, "I would remind you that we still have the largest majority in decades, and the people expect us to solve some problems, not run for the hills."

When he took office, there were only 58 Democrats in the Senate. He made health care reform the top of his agenda then. And he still has the chance to make something happen, perhaps by incorporating the negotiated parts of the bill into a budget bill that can pass by simple majority.

But if we have to wind back the clock further – and if anyone in Congress still has the stomach to do it – the administration should revert to thinking about bipartisanship and put elements into the bill – say, a hint of cost control, a consideration of malpractice tort reform – that might entice some Republicans.

Admittedly, it won't be easy working with Senate Republicans, but that kind of effort is going to make it a lot harder for the GOP to simply stand in lockstep against everything the Obama administration proposes. More importantly, they need to make this issue resonate with the American public.

BIO and PhRMA can threaten to scuttle broad reform over the exclusivity issue because that's how the game is being played.

If the public were clamoring for reform – and all indications are that the potential for that clamor is out there – lobbying groups wouldn't have that kind of power. And we might actually get a better bill out of it.

Karl Thiel, an analyst for the Motley Fool, can be reached at kthiel@qwest.net. His opinions do not necessarily reflect those of BioWorld Today.

Published: February 1, 2010