9 New Surprises in President Obama's Speech

A week ago, before tonight’s presidential address before Congress was even confirmed, I asked if President Obama had anything new to say about health care reform. I asked it even knowing that in many ways, it was the wrong question. The reality was he didn’t need to say anything new -- all it needed to be was new for most of the country. All he needed to do was say it better.

Not that the content of the speech being mostly rehash is at all a bad thing. If you read this blog regularly, or even every-so-often, you’re far more deeply enmeshed in the contours of this debate than, I believe, most Americans are. Although Obama’s town halls have been televised, although there was the press conference dedicated to health care, and the night of Q&A on ABC, although there have been op-eds, and blog posts, and Web casts and radio interviews a-plenty, most people just haven’t had the time to follow it. As a result, not everyone knows that the uninsured aren’t just sad unfortunate folks completely unconnected to us, but that our skin is in that game as well, with at least $1,000 hidden cost for uncompensated care for those of us with insurance.

People may know about pre-existing conditions, but they haven’t heard the story of Robin Beaton, the Texas nurse whose acne years prior was used an excuse to drop her health insurance precisely when she needed it the most to fight breast cancer. People know costs are going up but don’t realize, as the president said, “Our health care problem is our deficit problem -- nothing else even comes close.”

And they don’t hear nearly enough, nowhere nearly enough about the moral deficit of not fixing health care reform: “That is heart-breaking, it is wrong, and no one should be treated that way in the United States of America.”

Health care reform doesn’t exist in a vacuum. It’s not a good idea because it’s ideological or because the Obama plan is how anyone would build a system from scratch. It’s a good idea only to the extent that it solves an immediate problem. The structure of Obama’s speech was therefore elementary: you need to know the problem first, then you need to know how the solution relates to it, and then you need to be shown how all the stuff the media fixates on -- bipartisanship, “death panels,” illegal aliens, you name it -- how that doesn’t even relate to either the solution or the problem. Did Obama get a big enough audience or make a big enough impression to sway public opinion? Time will tell.

But since novelty is the spice of life, I have to share the nine things that I had legitimately not heard before, either from a policy or political perspective. Not all of them were positive, mind you, but I have to confess that the answer to the question of my earlier post -- does Obama have anything new to say about health care -- is yes.

1. We’ve been talking about giving “subsidies” to those who cannot afford the full cost of premiums for a plan in the Exchange. The best re-branding of the day goes to calling them “tax credits” instead. Functionally, there’s really no difference. Politically, it helps play up a notion Obama sold well -- that the uninsured aren’t the poor, or those on “welfare.” As we know, 80% of the uninsured come from full-time working households. A “tax credit” sounds solidly middle-class for a feature that will actually only help the middle-class.
2. The House bill and, to an unclear extent, the likely Senate Finance Committee bill would not open the Exchanges for the uninsured and small businesses to buy coverage in a one-stop shopping marketplace until 2013. Obama now proposes -- with a public nod to John McCain -- temporarily covering those with pre-existing conditions in “high risk pools.” By the way, this was a terrible idea in McCain’s plan, but there it was meant to be permanent. I’ll need to look through the actual proposal and re-assess whether it’s a better idea on a strictly temporary basis -- just until the Exchange is up and running. It’s certainly new!
3. The president’s entire section on the public option made a lot of sense. Finally, after muddling through analogies of public and private competing against each other, he’s abandoned the FedEx vs. Post Office metaphor (which unintentionally suggested the public option would be an inferior product) and instead came up with private vs. public colleges. Much better!
4. I’ll have to go back over Baucus’ proposal, but I think this is totally new as well: “And to prove that I'm serious, there will be a provision in this plan that requires us to come forward with more spending cuts if the savings we promised don't materialize.” That is a favorite recommendation from the Congressional Budget Office -- that if health care costs continue to rise, a provision will cut overall spending by a fraction of a percentage point automatically. It proves some deficit-fighting bona fides, but the over under until your Sarah Palin or your Betsy McCaughey writes an editorial equating this with rationing and killing seniors has to be 2 days or less.
5. “And that is why not a dollar of the Medicare trust fund will be used to pay for this plan.” Absolutely true in the plans on the table, and about time someone said it.
6. “So don't pay attention to those scary stories about how your benefits will be cut, especially since some of the same folks who are spreading these tall tales have fought against Medicare in the past and just this year supported a budget that would essentially have turned Medicare into a privatized voucher program.” This is the part that Democrats never do. It’s not enough for Democrats to stir up the ghost of LBJ. Rep. Paul Ryan, co-author of the Patients Choice Act, proposed an alternative budget that would have disbanded Medicare and funneled its beneficiaries into private insurance by a voucher system into private insurance. Most Republicans in Congress voted against postponing a draconian 20% cut to physician fees in Medicare across the board -- the filibuster was only broken by a sick Ted Kennedy dramatically walking onto the Senate floor. This isn’t ancient history. This is this year! If we’re going to have a debate, let’s debate our actual positions.
7. Obama clearly embraced Baucus’ notion of putting a fee or tax on insurance plans. That’s new. It’s also lame.
8. “I think [President Bush’s malpractice reform pilot program is] a good idea, and I'm directing my Secretary of Health and Human Services to move forward on this initiative today.” Well, that’s one way to take action even if the chances of getting substantial tort reform into the bill remain miniscule!
9. The entire last section on “the character of our country.” If Obama succeeds in this legislative adventure, doubtlessly those paragraphs, and the inspiration of Ted Kennedy’s last letter on health care will be studied for years to come.

So yes, there was plenty new. Some specifics, some vague notions, some good ideas, some bad, and some downright inspiring. The only question is whether the efforts to finally reform health care and reaffirm the social justice character of our country will take new energy from this night. In this, as in most things, words can inspire, but ‘tis deeds that must win the prize.

(Photo credit:  The Official White House Photostream on Flickr.)