Yesterday, I was one of the two million or so people who gathered in downtown Washington to witness the inauguration of President Barack Obama. Or, more accurately, I tried to.
On television, the inauguration was a grand spectacle, worthy of the occasion. On the streets of Washington it was a different story. Would-be viewers of the swearing in were required to enter the National Mall through one of about a half dozen security check points, which quickly became overwhelmed. One DC cop told me that "absolute chaos" ensued as the Secret Service closed checkpoints, with thousands still waiting in line, without informing local authorities. By the time President Obama was sworn a little after noon, many of those waiting found themselves on the outside looking in. I was one of them - after hours of trying and failing to access the Mall I ended up rushing to catch it on my office TV.
I relate my experience not in the spirit of whining about what was a truly moving and historic occasion. I was still glad I was there. That things didn't go smoothly is not at all surprising, given that Washington had never before handled an event of this size and the circumstances demanded extraordinary security.
I offer it instead, as a metaphorical and cautionary tale for the new President. President Obama takes office at a time when the demand for help from the government could outstrip its capacity to deliver, just as the demand from millions to watch the swearing in exceeded the government's ability to accommodate them.
This may especially be true of health care. The demand is overwhelming. The recession will cause millions of Americans to join the already bloated ranks of the uninsured. State governments are pleading for help from Washington for funds to keep their Medicaid programs afloat. Employers want help paying their employees' premiums. Will the Obama administration have the capacity to organize a federal response sufficient to meet the demand? And with a trillion dollar deficit, will it have the wallet needed to deliver on its will to reform health care?
Obama isn't dissuaded. In yesterday's inaugural address, he had this to say:
"The question we ask today is not whether our government is too big or too small, but whether it works, whether it helps families find jobs at a decent wage, care they can afford, a retirement that is dignified ...
We will restore science to its rightful place and wield technology's wonders to raise health care's quality and lower its costs ... All this we can do. And all this we will do."
I was struck by the words he chose - helping families get the care they can afford, using technology to raise health care and lower costs. And by the words he did not say. No mention of universal coverage or health care for all.
Now, I still believe that President Obama is committed to covering everyone. After all, people without health insurance coverage are the least likely to have "care they can afford." But his choice of words also says to me that controlling health care costs will be a focus of his administration.
As hard it is may be to get agreement on how to extend health insurance coverage to everyone, controlling the cost of care will be an even bigger challenge. Experts tell us that as much as $700 billion is wasted each year on unnecessary or inefficient care. But that "waste" and "inefficiency" represents someone else's income, hospital bed, MRI, or profit from sales of drugs and medical devices. Getting control over that will test the capacity of our new President to bring about the change we need.
Today's questions: Do you think President Obama will be able to deliver on his promise to control health care costs and provide everyone with care they can afford? How will you help?