Free Markets, Free People


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”.

~McQ

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17 Responses to Some Notes Before Obama’s Health Care Speech

  • I have a feeling that the viewing numbers will be very poor for this speech.

    You can only go to the well so many times.

  • The Democrats have the votes, and now Obama is likely to gain momentum. There has been a shift in the tone of the debate in the last week, which makes me think Obama is going to get pretty much what he wants — in fact, his advisors are smart enough to make sure that what he asks for can be delivered.

    Reality check: every industrialized state has a health care system that guarantees coverage and has government involvement. We’re the outlier. That doesn’t mean we should change, but it does mean that change isn’t going to dramatically alter the country. Even conservatives throughout the rest of the industrialized world support such health care systems. You’d think if it really were so scary and disastrous there would be more opposition in places that have such plans!

    • The Democrats have the votes, and now Obama is likely to gain momentum. I can assure you these things are true because we wise leftists have received our talking points from the New York Times, and that’s what their brilliant analysts say.

      There has been a shift in the tone of the debate in the last week, which makes me think Obama is going to get pretty much what he wants. Thank goodness those politicians are back in Washington where they can get the straight dope instead of listening to whackjobs in their own districts. That really changes the tone.

      Right here in the faculty lounge, the tone shifted from confusion over those silly teabaggers into outright derision. And Sarah Palin doing editorials in the Wall Street Journal? That right there tells you how desperate the neanderthals who oppose Obama really are. So it’s clear that the opposition has mostly fallen away — in fact, his advisors are smart enough to make sure that what he asks for can be delivered.

      Reality check: every industrialized state has a health care system run by wise leftists that guarantees coverage and has government involvement, and they’re not either bankrupting their societies, so stop saying that! And for goodness sake, stop with all the horror stories from them! Just a little bit of allocation of resources by wise leftists, and all you dense righties can do is shout about rationing! Their intentions are good, and that’s what counts!

      We’re the outlier. That doesn’t mean we should change, but it does mean that change isn’t going to dramatically alter the country. Nope, effectively nationalizing a sixth of the economy is no big deal, no matter how much you thick righties wail about “loss of freedom” and high taxes and other silly stuff. Even conservatives throughout the rest of the industrialized world support such health care systems – yes, their dense righties have fallen into line, and you ex-military basket cases around here should do so too.

      You’d think if it really were so scary and disastrous there would be more opposition in places that have such plans! After all, don’t you think sick people who are not getting the proper treatment would be energized to get out of their hospital beds and organize some protest marches or something? And those people who just give up on the Canadian system and come down to the US don’t count, so stop bringing them up.

      But I think this should all be handled by states. And I simultaneously support Obama’s plan. I go back and forth depending on what I need to say to lure in some more people like Zozo to go round and round in discussion without ever getting anywhere, of course. But I don’t do that because I’m obsessed with coming here to lecture to people for my own self-image, so stop saying that!

    • Hey dummy-

      1) Obama has ALWAYS had the votes. He has the votes to get anything he wants. He doesn’t need the GOP

      2)There’s never been any doubt that Obama would have SOMETHING passed that he could wave around as a “victory”. The only question left is will passing it hurt in the midterms? TBD, but trends show yes.

    • Reality Check: A change to a government system will dramatically alter the country for most Americans with medical coverage. Anyone who’s heard of the British or Canadian systems knows there is opposition to such plans. As pointed out by this blog, once you remove deaths by guns and car accident, the U.S. has the highest life expectancy of any nation.

      Reality Check 2: Right now, the entire planet benefits from U.S. R&D in the medical field. More than one-third of the worldwide spending for research comes from the U.S (Most of it from private companies making ‘excess profit’). If the U.S. cut our research spending per capita down to the level of an average “high income” country, the world loses more than 10% of its medical research.

  • [QUOTE]Reality check: every industrialized state has a health care system that guarantees coverage and has government involvement. We’re the outlier. That doesn’t mean we should change, but it does mean that change isn’t going to dramatically alter the country.[/QUOTE]
    REALITY CHECK: no other country in the developed world has the benefits we have: our military is second to none, our technology far outpaces our closest competitors and our medical treatment is leaps and bounds ahead of every one of those industrial nations with universal coverage.

    Changing to a bad idea because everybody does it does NOT make it a good one, Erb.

    And the reason people don’t protest it is the same reason people don’t protest Medicare: it’s ‘free’ and people want ‘free’. yet you and and I and anyone with two braincells to rub together knows that medicare is going bankrupt in the not too distant future. It’s insolvent.

    So why on Earth would you go to a system that’s proven not to work anywhere and that you know, going into it, that it’s unaffordable?

  • One thing I don’t want to hear is Baracky appealing to the GOP for ideas, etc.

    Coming from “I won. I will trump you on that” would sicken me

  • Ezra’s “important point” misses half of economics, since he looks only at the demand side of the cost function. Why? Besides which, Obamacare isn’t about controlling costs — the costs remain the same. Compensation, access, and prices are controlled. Not costs.

    There are many more than three ways to lower costs, however. For instance, a natural decline in costliness — occurs when *supply* expands, when supply becomes cheaper, or when supply becomes more effective, efficient, and/or productive. Maybe we need a thousand more medical schools, more transparent pricing, etc. etc. instead of restricting the response to demand.

  • I suspect that we’ll get mostly the rote talking points and perhaps some anecdotes to try and shame enough blue dogs to fall in line.

    There’s really nothing else, IMO. The math behind it is bad. I recall an article that complained that the “$58 trillion in unfunded liabilities” line was misguided because it was referring to costs over the life of the program. The thing is, even if we stretch the life of the program, it’s a frightening amount of money. Go ahead, try it. Assume those liabilities will be spread out over 50 years, and that there will not (by some miracle) be any additional burden added.

    You’re still on the hook for $1.16 trillion dollars a year.

    Put that in your prime-time speech and smoke it.

  • “the argument against the public option boils down to the fact that it’s bad because it is, horrors, a government program. ”

    I can only conclude from this passage that the Nobel Prizes have been devalued to the point of being meaningless. (Of course, the Peace prize reached that state long ago, but that’s a different story.)

    No, Mr. Krugman, the problem is NOT simply that it’s a government program, it’s that we have long experience of how those programs work. How long did it take for Medicare to balloon to 10+ times the original estimate? And that’s only 1 aspect – a complete analysis would have to include the mission creep that always occurs, usually coupled with a failure of the original mission.

    The Dept. of Energy is a perfect example: Its original mission was to reduce our dependence on foreign oil. That has not been accomplished, but the department grows rather than shinks. And we should just trust Washington when it metaphorically pats us on the head and says “don’t you worry your pretty little head about it”? I don’t think so.

    • Insanity is often defined as doing the same thing over and over and expecting different results.

      Funny, but the same definition can be applied to liberalism!

  • But I think this should all be handled by states. And I simultaneously support Obama’s plan. I go back and forth depending on what I need to say to lure in some more people like Zozo to go round and round in discussion without ever getting anywhere, of course.

    Ha! Busted. And I only needed one more healthcare post.

    Scott, as a proponent of smaller government units, and of states deciding healthcare for themselves, how can you defend the increased federal control being proposed? Surely a liberty-minded person sees that it’s better to defeat this current nonsense completely and move on to state-oriented discussions. Don’t you agree?

  • Despite hefty Democratic majorities in both the House and the Senate, centrists in Obama’s party have balked at the president’s proposal to create a public health care plan to compete with private insurers.

  • MediaCurves.com just conducted a national study with 951 viewers of President Barack Obama’s speech to Congress in which he focused on his plan for healthcare reform. Results showed that more than half of all political parties reported that the speech was “somewhat or extremely effective. The study also found that the majority of Democrats reported that they have a better perception of healthcare reform after viewing Obama’s speech, while Republicans’ perceptions are relatively unchanged and Independents were split on their reactions to the speech. More in-depth results can be viewed at http://www.mediacurves.com/Politics/J7550-HealthcareSpeech/Index.cfm
    Thanks,
    Ben

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