President Obama continued to seek middle ground in his speech tonight to a joint session of congress. In trying to incorporate ideas from figures all the way from John McCain to Ted Kennedy and in talking of allowing four years to phase in his health Exchange, Obama marked himself as a conciliator still eager either to win Republican votes or at least give the appearance he tried. On the other hand, he seemed full of fight when it comes to getting something done, dispelling the distortions that opponents of reform have been spreading and making the case that humane action on health coverage is a moral imperative.
This administration drew some fateful conclusions from the failed Clinton-era effort at health reform. The most important seems to have been that by delivering a fully-formed bill to congress in 1993 Bill and Hillary stepped on too many Capitol Hill toes and that is what led to defeat. As a result the Obama team has up to now sketched merely the broad outlines of what he wants and left most of the bill-drafting heavy lifting to Congress. On the positive side, this has resulted in three bills passing from committee in the House and one in the Senate. By contrast, none made it out of committee sixteen years ago. But on the negative side, the President's reticence has allowed his political enemies to command the initiative and control the debate for the past month. The result has been a slide in support for the health bill and for Obama's popularity too.
Obama walked a fine line. He made clear he wants any final product to accomplish three things: reform and regulate insurance practices, cover just about all the American people and rein in costs. He made a good case for a "public option" to be part of the mix. He sounded quite committed to it. But he also said his "door is always open" to discuss constructive ideas for accomplishing the three principal components of the reform he wants.
He spoke angrily about the distortions that have been spread, such as "death panels," funding for abortions, cutting medicare coverage, or funding services for illegal aliens. He said if people continued to spread untruths about his plan he would, "call them out."
And there also seemed to be a catch in his voice near the end as he spoke about his feelings about why this is all necessary. He gave examples of people who had been cut off from their coverage and died. He spoke of not wanting anyone to have to say to a loved one, "There is something that could make you better but I just can't afford it." He summed up with a quote from Ted Kennedy that, "What we face is a moral principle of social justice and the character of our country."
The president made an effort to present many more specifics than he had in recent speeches up to now. There are too many for a short blog, but you can go to his website for an outline here. Some are that everyone would have to get coverage or pay fees, and large companies would have to cover their workers or pay fees. 95% of small businesses could be exempt. There would be "tax credits" for those of limited income to afford something. An "Exchange" would provide a menu of choices to select from. A not for profit public option would be one of them. It would not receive subsidies from the government. Insurers would be required to insure all comers, could not decline for pre-existing conditions, could not discontinue someone if they got sick, and would have to cover preventive care and routine checkups. Out of pocket expenses would be limited by law.
Although the Republican response delivered by Rep. Charles Boustany (R-La), an MD, called for delay, there is every chance that something will pass this year. Democrats are not all on the same page, but they are aware that failure to get anything passed would destroy their claim to effective governance and likely position the GOP for big gains in the 2010 congressional election. So the Democrats will pass something this fall. Exactly what that is will depend on the compromises necessary to get the more conservative Democrats on board in the Senate. But at a minimum, expect it to include the requirements and regulations mentioned in the preceding paragraph. On those matters the Republicans stood and joined the Democrats in their applause this evening. There will be improvement in health care in America in the near future. It may not be as much as fervent progressives want, but it will nevertheless be at the very least the most extensive overhaul since Medicare in 1964. Given the wealth and power of the insurance, pharmaceutical, medical and HMO interest groups, that will be an accomplishment for Barack Obama and his party to be proud of.
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