Obama's Press Conference: There Are Two Health Care Plans on the Table

Jon Cohn titles his review of the president’s latest press conference, which was nearly entirely about health care reform, “Obama Has a Grown-up Talk with America (Gulp!)”  He praises Obama’s forthrightness on giving the tough answer instead of the expedient answer, particularly on the question as to whether he would guarantee that no doctor’s decision would ever be interfered with (kind of a stupid question, if you think about it – Michael Jackson’s personal doctors could probably have benefited from some interference.)  Reacting to the self-same press conference, Mark Halperin said the only novel part of the night was, “Obama’s failure to address head on some of the most difficult issues.”

That’s the story with presidential press conferences.  Whether it was a winner or a loser is largely in the eye of the beholder.

So let me instead focus on the message that came through clearer than anything else:  if we fix health care, it won’t bust the deficit; if we don’t, it will.  Cost has been the overwhelming theme of the past week, but cost is at best a nebulous term.  There’s the cost of the bill itself – how much will the federal government have to raise to pay for all of these reforms?  There’s the cost to the deficit – if we don’t have enough on hand, will we have to borrow and, if so, how do we pay for that?  There’s the cost of health care spending in total in this country – are we doing enough to spend less in aggregate but keep the same quality? There’s the cost of Medicare and Medicaid – two programs that are taking up an increasingly large share of the federal budget because health care costs over all have gone up so dramatically.  There’s the cost of insurance – will it keep going up for those who have it, and being out of reach for those who don’t?  Because we keep talking about cost, cost, cost, I get the distinct impression that each of these very distinct items get jumbled up and confused – hence Doug Elmendorf of the CBO mentions one (federal health care spending) and people think he means all of the above.

So it’s encouraging to see the ledes from the major news outlets seem to have gotten Obama’s central message:  there is a cost to doing nothing.  I thought the most striking moment, and the one I haven’t heard before, was Obama’s explanation that there were really two plans under consideration.  No, I’m not talking about the Patient’s Choice Act, or even single-payer (Anthony Weiner’s proposed amendment notwithstanding.)  There’s the plan Congress is currently working on to reform health care, expand coverage, make meaningful improvements to primary care, health IT, prevention and wellness, and insurance market reform.  And there’s this plan:

If somebody told you that there is a plan out there that is guaranteed to double your health-care costs over the next 10 years, that’s guaranteed to result in more Americans losing their health care, and that is by far the biggest contributor to our federal deficit, I think most people would be opposed to that.  That’s what we have right now.  So if we don’t change, we can’t expect a different result.

We talk a lot about how the forces of the status quo focus on scaring people and changing the calculus so the risk seems much greater than the reward.  Fair enough – people seem to have a block on imagining what “better” health care is.  But the reality is our health care system and our nation’s financial footing are actually getting worse, year by year.  We may not know what “better” is, but we should be able to understand “worse.”

There are two plans on the table.  One has some pretty broad flaws, but makes a serious attempt to address a problem that hurts families, hospitals, health care workers, small businesses, large businesses, state budgets, the federal budget, and our national competitiveness.  The other is worse.

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