Should the President’s Language on Health Care Trouble Us?

We're on day three of "The road to fiscal responsibility goes through health care" week, and although the President is not pushing anything specific on health care today, the release of his first budget tomorrow and the reactions to his speech last night guarantee that health care reform is still in the air.  Although many think the president's speech was a home run, some were concerned about the lack of details for his vision of health care reform.  Others found the fact that he did not precisely say the specific words "universal health care" to be troubling.  But I'm not too concerned.

On the specifics, I will readily admit that people in my generation were spoiled by Bill Clinton.  You left his addresses to Congress feeling like your brain was on policy information overload.  But the Clinton way is atypical.  When you're trying to cram the economy, energy, health care and education, warn bankers the day of reckoning is here, and also talk about your legislative accomplishments and the tone of our politics, there's no way you can fit in detail on anything.  Well, there's one exception - when you're only talking about one topic.  Bill Clinton's 1993 health care speech was only about health care, and he unveiled the principles and mechanisms of his plan.  However, the fact that he also delivered Congress a 1,000 page plan that they'd had no prior input or ownership in is one of the reasons why his plan failed to pass.  Obama has signaled from the beginning that Congress - particularly the Senate - will take the lead in drafting, with his public and private input along the way.

So Obama went with visions and principles:  health care reform must be "comprehensive," it must tackle "efficiencies," the process must include "many different opinions and ideas," it must tackle costs, and it "cannot wait, it must not wait, and it will not wait another year."

Many, including the Politico, noted he's promising "a down-payment on the principle that we must have quality, affordable health care for every American."  He's not promising we'll be finished in 2009, not is he using the phrase "Universal health care."  I'm not bothered by the lack of a concrete end date because, hey, health care is really complicated.  (If it wasn't, I'd be out of a job) and even a system that passes Congress will take a while to set up and begin working - look how long it took just to implement Medicare Part D. I'm also not bothered by him not using the U word, because "quality, affordable health care for every American" is pretty dang specific.  I also prefer it - "universal" doesn't tell the whole story.  Universal access to health care that's not affordable (see the objections to Massachusetts) either for individuals or the federal government, or access to the same old "37th in the world" levels of quality is not sufficient.  We ain't done until we have all three.  In my mind, it's no lack of commitment to use the longer version, and shows a better understanding of what we need.

Some are also concerned about the focus on cost, not coverage.  This is doubtlessly more politics than policy - cost is the common denominator.  I do not know why so many Americans may have sympathy but no action in the face of 47 million + without insurance, but history tells us they do.  Costs are a different matter.  The runaway cost of health care unites large business, small business, families with coverage, families who are underinsured, families without coverage, health care providers, and deficit hawks.  Moreover, talking about costs in health care at a time when so many are worried about the economy and linking the two in the public mind is essential to building support for those who would otherwise be indifferent.  Kaiser Family Foundation has a fascinating tracking poll on health care out today, and one of the many good nuggets in it is that the respondents ranked "reforming health care" fourth (39%).  But number one was the economy (71%) and number two were the entitlements, including Medicare (49%).  What has the president done all week?  Make the case that you can't fix #1 and #2 without fixing #4 first.  Another nugget - of those who think health care reform is a priority, only 39% think that means extending coverage.  An equal amount - 40% -- associate it with making care more affordable.

Put another way, Gov. Bobby Jindal in his response said, "We stand for universal access to affordable health care coverage."  That's the right language.  But, as Igor Wolsky on Wonk Room says, "Jindal is shrouding deeply unpopular conservative health principles in progressive rhetoric (and that's no accident)."

So I'm not concerned by Obama's language because I recognize I'm not really his audience on health care.  I would rather have a president use a big speech to make the case to my fellow citizens who have doubts.  I would rather have him prove himself to me in writing and with prose.

And he can start with the budget.