• Election Reactions from Beast writersIn 2008, Barack Obama campaigned against the Bush administration’s executive over-reach on issues such as torture (practicing it), stem cell research (limiting it), and the environment (making it easier for corporations to pollute). The irony is that now—when facing down a Republican House of Representatives and an ever-more recalcitrant clique of Democratic moderates, like West Virginia’s new senator, Joe Manchin—Obama might have to embrace the aggressive, agency-level activism that Dubya perfected.

Take health-care reform, Obama’s signature legislative achievement. His conciliatory stance toward corporate interests and Blue Dog Democrats saved the bill, but it also vastly weakened the resulting law, which lacks many of the cost containment and equity measures that health policy experts recommend.

The success of health reform now depends on how faithfully this imperfect, yet crucial, bill is implemented. To realize the new law’s promise, Obama will need to ignore the inevitable complaints from Congress and the spurious investigations Republicans are sure to launch.

A crucial first test of the president’s fortitude will be the Department of Health and Human Services’ effort to define a coverage “floor”—the list of medical services insurers must cover in plans sold through the new health insurance exchanges. Will controversial but cost-effective treatments such as birth control, voluntary sterilization, and drug addiction therapy be included?

So far, the administration hasn’t been very tough. In July, it told states not to offer abortion coverage in a new insurance program for individuals with pre-existing conditions, even if consumers paid for such coverage with their own money. And last month, the White House granted 30 large corporations and unions exemptions from the employer responsibility aspects of health reform, allowing companies like McDonalds and Jack n’ the Box to continue to offer their workers sub-par “health insurance” that would be useless to any family suffering from a real medical emergency or chronic health condition.

A president as committed to his progressive base as George W. Bush was to his conservative one would have made different regulatory choices. Whether Obama will become such a president remains to be seen.

Dana Goldstein is a Spencer Education Journalism Fellow at Columbia University, and a former associate editor at The Daily Beast. Her writing on politics, women's issues, and education has also appeared in The American Prospect, The Nation, The New Republic, BusinessWeek, and Slate. You can follow her work at www.danagoldstein.net.