美国总统巴拉克•奥巴马(Barack Obama)跳下了政治病床，拔掉了喂食管，准备在椭圆办公室跳上一支舞。美国国会批准医改方案，使奥巴马的总统任期重焕生机，这对美国人乃至整个世界都将产生影响。
从西奥多•罗斯福(Teddy Roosevelt)到比尔•克林顿(Bill Clinton)，历代总统都未能实现这一社会改革。如今，奥巴马有了一项可以记在自己名下的真正的历史成就。他扭转了自己身为总统却无法落实事情的软弱形象，这种形象本来就要成为一个自我应验的预言。
过去一年，奥巴马宣誓就职时围绕着他的乐观情绪逐渐消失了。取而代之的是一些不那么光鲜的新形象：奥巴马是空谈家，而非实干家；奥巴马是一位幼稚的总统，任凭世界上那些强悍的人物摆布；奥巴马失去了民主党最安全的马萨诸塞州参议院席位，是美国右翼的憎恨对象。
奥巴马貌似没有能力让医改方案通过的形象，损害了他在全球（而非仅在美国）的可信度。外国人对参议院程序的规定不感兴趣：他们看到的只是一位人气颇高的总统，在国会拥有绝对多数席位，却似乎无法让自己最主要的国内政策获得通过。
医改问题上的僵局形成了一种令人担忧的模式，这种模式随后再现于奥巴马政府与世界其它地区的来往。奥巴马在执政第一年养成了一种习惯：宣布一些宏伟的目标，然后拿不出实际成果。
奥巴马宣布，他将重启中东和平进程，并要求以色列停止在巴勒斯坦地区修建新的移民点。但和平会谈从未成为现实，而在移民问题上，以色列总理本杰明•内塔尼亚胡(Benjamin Netanyahu)基本上不理会他的要求。在当选之夜的胜选演讲中，奥巴马将“危机四伏的星球”列为自己的工作重点之一，但哥本哈根气候变化谈判以失败告终，中国的外交动作让美国陷入被动。
奥巴马政府表示，不会容许伊朗发展核武器，但伊朗核计划仍在加速发展，而美国政府迄今无法团结各国，支持对伊朗实施新的制裁。在阿富汗战争问题上，奥巴马政府公开挣扎了几个月，才宣布似乎连他本人都没有信心的新的增兵计划。
渐渐地，奥巴马在海外被描绘成了软弱、优柔寡断和无能的形象。随着医改方案的通过，这种情况现在可能发生改变，至少在短期会如此。因此，奥巴马目前有机会重新塑造其总统形象，无论是在国外还是在国内。
当然，奥巴马在国内政界重新振作、与他能否取得外交政策成功之间没有直接联系。但间接联系还是有的。生硬地说，医改方案得以通过，让奥巴马看上去像是一个赢家，而非输家。这还展示出他的执著，以及他的顽强能得到回报。
医改曾经看上去是场败仗，但结果证明不过是旷日持久的一仗。曾以为奥巴马不可能成功解决那些重大国际问题——阿富汗、中东、气候变化及伊朗等等——的外国领导人，如今都不得不考虑这样一种可能性：即奥巴马的坚持不懈也许最终会取得成功。这就增加了那些犹豫不决的领导人聆听奥巴马的意见、并设法与之合作的可能性。
这也会让那些喜欢对奥巴马嗤之以鼻的外国领导人三思。现在不是内塔尼亚胡访美的好时机——他定于本周在美国以色列公共事务委员会(Aipac)年会上发表演讲。如果医改方案在国会折戟，内塔尼亚胡或许会放胆号召美国内部的反对势力，共同抵制奥巴马政府的中东政策。但现在，由于奥巴马气势正旺，对抗他的风险看上去增大了不少。
在医改问题上取得成功，还可能促使那些善变的预言家们（我也算一个）对奥巴马的第一年任期有更均衡的看法。毕竟，奥巴马政府避免了银行业彻底崩盘的威胁。美国经济目前以将近6%的年率增长，远远快于其它可比的西方经济体。
美国保守人士说得没错：医改让美国朝欧洲人的社会团结理念迈近了一步，而离美国自己的刚毅个人主义传统远了一些。此举在社会和经济上的成本与效益有待商榷，但有可能间接地对美国外交政策产生有利影响。
通过承诺为几乎全民提供医保，奥巴马将让迈克尔•摩尔(Michael Moore)对美国的描述站不住脚：即大企业无情地剥削受压迫的穷人。在欧洲乃至全世界，这种对美国的漫画式描绘十分流行。但随着奥巴马医改方案的通过，其传播会更加困难。
译者/陈云飞
http://www.ftchinese.com/story/001031896
President Barack Obama has leapt out of his political sick-bed, ripped out his feeding tubes and is ready to dance a jig around the Oval office. The Congressional approval of healthcare reform has reinvigorated the Obama presidency in a way that has implications not just for Americans, but for the world.
By pushing through a social reform that eluded generations of presidents from Teddy Roosevelt to Bill Clinton, Mr Obama can now point to a genuinely historic achievement. He has turned around his image as a weak president who cannot get things done – just when it was getting dangerously close to becoming a self-fulfilling prophecy.
Over the past year, the optimistic glow that surrounded Mr Obama when he took the oath of office has faded away. In its place came new and less flattering images: Obama the talker, not the doer; Obama the naive president, who was getting pushed around by the world's tough guys; Obama, the hate figure for the American right, who lost one of the safest Democratic seats in the Senate in Massachusetts.
The president's apparent inability to get healthcare reform passed sapped his credibility, not just in America but around the world. Foreigners were uninterested by the rules of Senate procedure: all they saw was a popular president, with a massive majority, who seemed unable to get his major domestic policy through.
Deadlock over healthcare set a disturbing pattern, which then replicated itself in the Obama administration's dealings with the rest of the world. In his first year in office, Mr Obama fell into the habit of declaring grand goals and then failing to deliver.
The president announced that he would reinvigorate the Middle East peace process and demanded a halt to new Israeli settlements on Palestinian land. But there were no peace talks and Benjamin Netanyahu, the Israeli prime minister, basically ignored him on settlements. On the night that he was elected, Mr Obama made a “planet in peril” one of his top priorities – but the Copenhagen talks on climate-change ended in fiasco, with the US diplomatically out-manoeuvred by China.
The Obama administration said that it would not tolerate the development of an Iranian bomb – yet the Iranian nuclear programme continued apace and the Americans have so far proved unable to rally the world behind fresh sanctions. When it came to the war in Afghanistan, the Obama administration agonised in public for months – and then announced a new troop surge that even the president seemed unconvinced by.
Increasingly Mr Obama was portrayed overseas as weak, indecisive and ineffective. That is now likely to change – at least for a while – in the wake of the passage of healthcare reform. As a result, Mr Obama now has a chance to re-launch his presidency, abroad as well as at home.
Of course, there is no direct connection between the renewal of Mr Obama's domestic political momentum and his chances of success in foreign policy. But there is an indirect connection. Put crudely, the passage of healthcare reform makes Mr Obama look like a winner rather than a loser. It also shows that he is tenacious and that his stubbornness can pay dividends.
Healthcare looked like a lost battle – but it turned out just to be a long battle. Foreign leaders who have written off Mr Obama's chances of succeeding on the big international issues – Afghanistan, the Middle East, climate change, Iran – will now have to consider the possibility that the president's persistence might ultimately deliver success. That increases the likelihood that leaders who are wavering will listen and try to work with him.
It may also make foreign leaders who are inclined to thumb their nose at the president think twice. This is not a great week for Mr Netanyahu to arrive in Washington – where he is scheduled to speak to the annual conference of the American Israel Public Affairs Committee (Aipac). If healthcare reform had collapsed in Congress, the Israeli prime minister might have been emboldened to try to rally US opposition to the Obama administration's Middle East policies. But now that the president has a following wind, confronting him looks riskier.
Success over healthcare may also encourage fickle pundits (I include myself amongst them) to take a more balanced view of Mr Obama's first year in office. The administration did, after all, avert the threat of a complete meltdown of the banking industry. The US economy is now growing at an annualised rate of almost 6 per cent a year – much faster than any comparable western economy.
American conservatives are right that healthcare reform has nudged the US a bit closer towards European ideas of social solidarity – and a bit further away from America's own tradition of rugged individualism. The social and economic costs and benefits of such a move can be debated. But there is likely to be an indirect foreign-policy pay-off for the US.
By committing his nation to providing healthcare for nearly everyone, Mr Obama will undermine the Michael Moore vision of America as a country where big business ruthlessly exploits the downtrodden poor. This is a cartoon version of the US that is wildly popular in Europe and around the world. It will be harder to propagate in the wake of the passage of Mr Obama's healthcare reforms.
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