Thursday, September 10, 2009

Obama's health care speech: nothing new, strongly partisan and a missed opportunity

As usual, President Obama delivered an impressive speech to Congress and the nation Wednesday night. But the speech contained nothing of consequence different from what he had to say in mid-July, despite the many signs of deep and growing public anxiety about and opposition to Democratic health care reform proposals.

The major questions surrounding these proposals remain unanswered, including these in particular:

How will programs that will cost $1 trillion, give or take, be paid for?

The President offered no support to any specific financing scheme but seemed to say that much of the cost would be covered by cutting "waste, fraud and abuse" in the Medicare and Medicaid programs. No one believes this. The President did say he would reject any plan that "adds one dime to the deficit." Fine words but the deficit will be added to a great deal without a major, new revenue stream -- very likely taxes -- to pay for a comprehensive plan and the President provided no guidance on that all-important matter.

How can Medicare and Medicaid be cut by as much as $500 billion without any reduction in benefits or increased out-of-pocket costs for beneficiaries?

The President said again that seniors would lose nothing, but no one believes this either.

Amidst sweeping changes of the roles of private insurers and payment methods, new efforts to extract savings from the current system, and a plethora of new federal rules and requirements, how is it possible that people who like the plan or doctors they have will be able to keep them?

If there is a government-run "public option," or a government-subsidized "co-op" option at the same time as private insurers are required to provide a certain specified benefits package and to insure everyone, while being barred from imposing lifetime benefit caps, isn't it obvious that private insurers won't be able to compete successfully with the government-linked plan over time so that large numbers of people will wind up having no choice

Obama had the opportunity to confront these questions head on and answer them laying out a new reform program that moderate Democrats and some Republicans could get behind. Unfortunately, he chose instead to give a basically partisan speech -- notwithstanding a few compliments to some GOPers and acknowledgement of a couple of GOP ideas. His aim seemed to be to mollify the left of his party, which had started to turn on him, while laying down a number of markers around which he can hope to rally Congressional Democrats and pressure those who are reluctant to back a sweeping, expensive plan.

I think he's missed a huge opportunity to bring about some really important health care reforms. He won't be able to rally or pressure enough moderate Democrats in the Senate to pass a bill that House progressives also support. He needs every single Senate Democrat to get the necessary 60 votes ("reconciliation" with only 51 votes simply won't work). The Senate's centrist Democrats are keenly aware of their states' and constituents' interests and are not easily pushed around, even by a President.

So we are still where we were in July. Nothing has changed -- except the President has put himself and his Presidency on the line without having provided Congress or the nation the clear leadership needed. My guess is that there will not be a bill passed and signed by the President anytime soon.

What are your thoughts about the speech and the issue? Post a comment.

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