Obama in the Lion's Den

Tonight was President Obama’s ABC News special on health care, and those (*cough* Fox News *cough*) who thought Charlie Gibson and Diane Sawyer would be media lap dogs could not have been more wrong.  As noted in Jon Cohn’s Twitter feed, it took nearly an hour and a half before we even mentioned the rising number of uninsured or cost control.  It took almost no time to wade into questions of government involvement, so-called “rationing,” controversial end of life decisions, whether we’d still have access to unproven but very expensive cutting edge treatments, and everyone’s favorite no-win question, where do you find the money to pay for it all.  And that’s before they trotted out representatives from Aetna and the favorite-of-conservatives Lewin Group to talk to the president directly.  This wasn’t a cushy couch interview – it was walking into the lion’s den.

You have to ask yourself, when’s the last time you saw a public form quite like this in the White House?  When was the last time Charlie Gibson controlled the questions in his idiosyncratic, obsessed with the upper class manner, for a sitting president, not just as a gauntlet that a candidate for president must run through? When was the last time those who have been outwardly critical of a president’s particular policy priorities got a crack at him on live TV?  I suppose if you wanted a full debate on the public health insurance option, then yes, you would want Ron Williams, CEO of Aetna, who made a gazillion dollars of our current system of private insurance, to be the one asking the question about the effectiveness of the public plan.  You would want my old buddy John Shiels of the Lewin Group in the audience to bring up statistical modeling for the “crowd out” notion that a public option would cause employers to drop their benefits in droves.  By the same token, you would want someone as clearly versed in the topic as President Obama refuting strongly by pointing out, “I don't think you're going to get a lot of complaints from people if the deal is a better deal. If it's not a better deal, then people aren't going to choose it.”

Yes, Obama walked out with only a few scratches.  But the night was still weird.

Think of it, for a second, in the context of the push to privatize Social Security in 2005.  Would George W. Bush have put himself in the hot seat while Charlie Gibson controlled the flow of the show, and forced him to answer questions from Paul Krugman, the AARP, and respond to written statements by the Democratic Leadership about how his plan would fundamentally ruin Social Security?

Sadly, neither that back and forth with Obama, Williams and Shiels, nor my personal favorite moment of the night with the small business owner in Massachusetts who is himself uninsured, are not yet available on ABC News video.  But they do have my third favorite moment.  The president spells out – in a way that I wish his counterparts in Congress would do more often – that we actually aren’t facing a choice between change or staying pat.

Our health care system has and will continue to change whether we reform health care or not.  The question isn’t can I keep the insurance I have exactly as I have it now.  The answer to that is clearly no – employers are shifting more cost-share to employees, the insurance plans are scaling back coverage in unpredictable ways (when they don’t cut you out with a rescission or a lifetime maximum benefit), your coverage is tied to your job and your employer being satisfied with your plan (whether you are or not), etc.  These trends have not only been continuous, they were accelerating even before the economic downturn accelerated them even more.

So the real question is will we allow the current set of economic forces to continue kicking more and more of us out of coverage, cause us to spend more and more on care that has less and less quality?  Or will we start making the tough decisions that will allow us to give every American quality, affordable health care and putting our country’s economic house in order?