The ACP Advocate Blog
by Bob Doherty
Thursday, September 10, 2009
Obama tells the public what "ObamaCare" really means
Even before President Obama uttered the closing words in his health care reform speech to Congress, pundits and politicians alike were tweeting their instant reaction. I am skeptical that hasty opinions can provide an accurate assessment of the impact of the speech on the course of health care reform. This is not to say that the speech didn't have an impact, it is just that we really won't know what the impact is until we see how the public responds over the next days and weeks, and what the politicians do as they figure out how to translate the vision of reform articulated by the president into legislation that can actually pass. Legislation is a slog, and a presidential address - even one as important as this one, delivered at a critical time by a president who demonstrated again his mastery of rhetorical tools of his office - cannot substitute for the nitty-gritting work of finding the legislative "sweet spot" that will unite a fractious Democratic party and deeply divided electorate.
Having just cautioned you about the instant analysis, I am now going to disregard my own advice and provide you my own analysis and what the president's speech might accomplish. Borrowing a phrase from Winston Churchill, though, I also reserve the right to explain afterwards why it didn't happen! (Churchill reportedly once said that, "A politician needs the ability to foretell what is going to happen tomorrow, next week, next month, and next year. And to have the ability afterwards to explain why it didn't happen.")
I think the president's speech potentially accomplished several important things.
First, the president finally answered the call to put his own stamp on health care reform, in much greater specificity than in the past. For all of the talk about "Obamacare" (the catch-all label for critics of the president's efforts), we have not, until now, had a clear idea about what the president really wants. Last night, he made it clear that health care reform, at its most basic level, must regulate the practices of health insurers so that no one can be turned down, have their coverage cancelled, or charged excessive rates because they have a pre-existing condition or health problem. He also said he does not want to put health insurers out of business. He laid out a strong argument for a public plan option as one important piece of comprehensive health reform, but also made it clear that he does not share the views of those on the left or the right who have assigned the public plan with more importance than he thinks it merits. He will fight for a public plan, but only to a point - if he can get what he wants in terms of regulating health insurers and subsidizing coverage, he will not insist that a public plan be included.
Second, he spoke to the need for responsibility for funding health care to be a shared responsibility. The government must provide help to those who can't afford coverage. Employers must provide coverage or pay into a fund to subsidize coverage for their employees. Individuals must buy coverage, with hardship exemptions who still find the cost out of reach.
Third, he forcefully went after critics who have used distortions - he called them lies - to stoke opposition to his proposal. I don't believe that this will stop his critics from doing so, or cause the people who really believe that the president wants to allow government bureaucrats to pull the plug on grandma to change their minds. But his words suggest that there may now be a bigger political cost for doing so. (ACP, for its part, is trying to set the record straight.)
Fourth, he insisted that the legislation will be fully paid for, not adding a "dime" to the deficit. This will create enormous pressure on Congress to either find more savings or scale back the subsidies, but any substantial reduction in the subsidies would go in the face of the president's promise to make coverage affordable to all. I believe that the president missed an opportunity to really be direct with the American people on the sacrifices that real cost control will involve. Instead, he fell on the old argument that most of reform can be paid for by eliminating fraud and waste.
Fifth, he addressed the need for malpractice reform to reduce the costs of defensive medicine. He didn't provide any specifics, other than that he's instructed HHS Secretary Kathleen Sebelius to "immediately" develop a program to provide funding to states to launch demonstration projects to medical liability reform. I don't expect the reforms will include caps on damages. Still, it is an opening on an issue that previously had been ignored by the president and his Democratic allies in Congress.
All of these details were important, but I think the biggest impact of the president's speech may have been in his closing remarks, when he defined health care reform as an issue that will test the moral character of the American people. Referring to the life work of the late Ted Kennedy, Obama said this: "That large-heartedness -- that concern and regard for the plight of others -- is not a partisan feeling. It's not a Republican or a Democratic feeling. It, too, is part of the American character -- our ability to stand in other people's shoes; a recognition that we are all in this together, and when fortune turns against one of us, others are there to lend a helping hand; a belief that in this country, hard work and responsibility should be rewarded by some measure of security and fair play; and an acknowledgment that sometimes government has to step in to help deliver on that promise."
The next few weeks will tell us if he is right in his assessment of the character of the American people.
Today's question: What did you think of the president's speech?
About the Author
Bob Doherty is Senior Vice President, American College of Physicians Government Affairs and Public Policy; Author of the ACP Advocate Blog
Email Bob Doherty: TheACPAdvocateblog@acponline.org.Follow @BobDohertyACP
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