Some Notes Before Obama’s Health Care Speech
The presidential speech before a joint session of Congress tonight is probably one of the more highly anticipated speeches in Obama’s young presidency. Some say it is a “make or break” speech, alluding to the fact that if it doesn’t hit the mark, it could doom health care legislation and his presidency.
We’ve heard from Robert Gibbs that Obama will draw some “lines in the sand”. We’ve been led to believe that Obama will get specific and essentially lay out the minimums he’ll accept for health care legislation. There’s debate as to whether the public option will be a demand or optional.
To this point, no one really knows. So I thought I’d throw a few thoughts out here for you to ponder.
One thing I hope to hear is the “purpose” of any reform. It began as a cry to insure the uninsured. It morphed into “health care reform”. And now, it is often called “health insurance reform”. If people seem confused about the purpose of the legislation, it’s because Democrats and the president have been unclear.
If it is about insuring the uninsured, that ought to be about a 50 page bill – the size of the Medicare bill when it was submitted to Congress years ago. Of course that’s not what this reform is about and the extent of what is being considered needs to be made crystal clear.
Another aspect of this is cost. Both the president and Congress have claimed that the reason this reform is necessary is the level of spending is rising such that it will bankrupt us in the future. They believe we must control costs.
Ezra Klein has a piece about the public option which makes a very important point cost control. There are only three ways to do that:
Cost control happens when we use less treatment, need less treatment, or pay less for treatment …
Anyone sharp enough to turn on a light switch should be able to understand what those three things promise. They should also understand that, used in combination, they mean more than “health insurance reform”. They mean a completely different way of treatment in which less costly treatments are encouraged, preventive medicine is encouraged and, regardless of the treatment given, less reimbursement for the care.
So when the president talks about cost controls tonight, that’s what he is talking about. The reality is, someone will have to be making those decisions about cost and treatment, and there’s no question the person doing so will not be you or your doctor. It should also be clear that the third leg of the cost control stool – less reimbursement for the care – does indeed require cuts in Medicare spending. Pretending otherwise is just an odious lie.
On a cultural level, Obama has to be convincing enough to sell the idea that government can handle this sort of change. That is a very tall order.
Paul Krugman, in a post about the public option said this about the politics of reform:
Let me add a sort of larger point: aside from the essentially circular political arguments — centrist Democrats insisting that the public option must be dropped to get the votes of centrist Democrats — the argument against the public option boils down to the fact that it’s bad because it is, horrors, a government program. And sooner or later Democrats have to take a stand against Reaganism — against the presumption that if the government does it, it’s bad.
The problem, of course, is there is nothing the Democrats have done to this point that makes any other case. Krugman needs only to think back to TARP, “stimulus”, GM takeover, financial institution bailout, even “cash for clunkers” have all been mostly ineffective or too intrusive or badly handled. While government certainly has some functions in which it can be effective, for the most part and for most of its history, when it goes outside those basic functions, it fails miserably.
This promises to be one of those failures and the public understands that. As many have pointed out, Medicare – a government health care insurance system run by government as a single-payer – has 58 trillion in future unfunded liabilities. If government can’t control costs in a program that is only part of the whole of the health care system, why should anyone believe it can competently run the whole thing?
Obviously, as polls show, they don’t. And a glib speech is not likely to convince them otherwise.
What Obama has to do tonight is reestablish what he’s been hemorrhaging for months – trust. The majority of people do not trust he or the Democrats on this particular issue. There are a number of reasons why that trust has slipped so badly. The primary reason, however, is neither he nor the Democrats have been able to substantiate the claims they’ve made about health care reform. In fact it has been a debacle for them. Few people who’ve looked into their claims have come away satisfied they can deliver.
So his major problem and his major task tonight is to rebuild that trust that has eroded so quickly. That’s a onerous task because usually, once trust is lost, it is very hard to regain. While what Mr. Obama presents tonight is important, nothing is more important than how he presents it.
If he can produce a clear vision with claims backed by reputable cites, studies and numbers, he might make a difference. But if he has simply repackaged the Democrat ideas to date and is counting on his rhetorical skills to make the case no one else has successfully made, he’s setting himself up for failure.
Additionally, the first time he uses one of the old and tired talking points he loves to throw out at town halls, such as keeping your doctor and your plan, those with whom he is trying to reestablish that critical link of trust will turn him off.
He also needs to avoid partisanship. If he goes after Republicans and claims they have brought nothing to the table, he’ll hurt his cause. Sarah Palin, of all people, laid out what Republicans have been saying for a while in a WSJ editorial today. Most people understand that it isn’t that Republicans haven’t put forward ideas, it is that Democrats have refused to consider them and basically shut them out of this process.
I’m looking forward to this speech for any number of reasons. But, given August, I’m not sure there are that many minds that are going to be swayed by his speech. Speaking of lines in the sand, I think among both the pubic and among legislators, they’re fairly well drawn.
Do I think something called “health care reform” will emerge at some point within the next few months? Yes, I do. Will it be what Obama talks about tonight and the Democrats want? Not necessarily. Not necessarily at all.
So let’s give a listen tonight and see how he does. I expect emotional appeals, moral appeals and financial appeals in the speech. But the question is will the speech have enough appeal to change the direction of the debate? Given the atmosphere in which he must make his appeal, my guess is “no”.