Barack Obama missed a golden opportunity to overhaul the US healthcare system, says Phil Bredesen, the Democratic governor of Tennessee. Instead, the US president simply loaded the existing system with new costs that will escalate over time.

Mr Bredesen, who is seen as one of America’s most effective governors, also said the “corrupted integrity” of the healthcare bill, which was passed in March, helped fuel the popular backlash that could lead to a loss of Democratic control of the House of Representatives in the midterm elections on November 2.

However, the final product fell short of justifying the high price Democrats are expected to pay. “All the difficult policy stuff was left undone – what appeared in the final bill was very plain vanilla,” Mr Bredesen told the Financial Times.

“Instead of showing vision, President Obama quietly handed the bill over to staffers in Congress. They are much better editors than authors.”

Mr Bredesen said that he and three other leaders from the National Governor’s Association – Jim Douglas of Vermont, Mike Rounds of South Dakota and Joe Manchin of West Virginia – repeatedly tried to inject themselves into the debate during 2009, but were largely ignored by the White House and Capitol Hill.

“We had a lot of experience between us and we were a bipartisan group,” he said. “It is the states that have to implement this bill. But they made it pretty clear they didn’t care about our views.” Mr Obama made the same error, he said, in drafting the $787bn stimulus in his first few days in office by outsourcing its preparation to people on Capitol Hill.

The outgoing governor said that Mr Obama would need to “reset” the way the White House did business after the midterm elections. He said that Bill Clinton’s best two years as president were in 1995 and 1996 after his party suffered defeat in the midterms.

“The Obama White House is very intolerant of people who haven’t drunk the Kool-Aid,” he said. “After November they need to reach out to a much broader range of people if the president is going to make his first term a success. If, on the other hand, he puts his head down and focuses on re-election in 2012, then things will continue to go wrong.”

Mr Bredesen’s new book, Fresh Medicine, outlines the kind of healthcare reforms he believes Mr Obama should have undertaken. “I wrote this book because of the frustration of not being listened to when the process was happening,” he said.

Among the “missed opportunities” was the chance to break the link between healthcare coverage and employers – a system that dates back to the 1940s.

The bill also failed to drive costs down by enabling the federal government to negotiate lower drugs prices with the pharmaceutical companies – “a feature of most other healthcare systems”, he said. A better funding model would be based on the Social Security system for pensions, which had long been the “third rail” of American politics.

He predicted Mr Obama could face setbacks from the courts over the provision requiring people to get healthcare insurance or pay a penalty. Several Republican state attorney-generals have contested it, saying it exceeds the federal government’s powers under the commerce clause of the constitution. “It is quite a stretch to say the commerce clause allows Washington to mandate everyone gets health insurance,” said Mr Bredesen. “This bill is by no means a done deal.”

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